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Text_Files/Campylobacteriosis.txt

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+CAMPYLOBACTER  (cont.)  
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+CAMPYLOBACTER 
+ 
+Campylobacteriosis is an intestinal illness caused by 
+the bacterium Campylobacter of which there are 
+many types. 
+ 
+Who gets this disease? 
+Anyone can.  The illness occurs in all age groups. 
+ 
+How is it spread? 
+Campylobacter is spread by the f ecal-oral route.  
+Water, milk or food (especially poorly cooked 
+poultry products) contaminated with 
+Campylobacter, or contact with infected animals 
+may also be a source of infection to people.  
+ 
+What are the symptoms? 
+Diarrhea (which may be severe and bloo dy), 
+stomach cramps,  abdominal pain, vomiting and 
+fever are the usual symptoms. 
+ 
+How soon do symptoms appear? 
+The symptoms generally appear between one and 
+seven days, but can take longer. 
+ 
+Can a person have this disease without 
+knowing it? 
+Yes.  Although symptoms usually go away after one 
+to 10 days on their own, there may still be germs in 
+the stools for several weeks if treatment is not 
+given. 
+ 
+What is the treatment? 
+Although antibiotic therapy may not shorten the 
+illness, it does shorten the amount of t ime the germ 
+is passed in the stools.  Therefore, in the childcare 
+setting, treatment is recommended for adults and 
+children with Campylobacter in their stools.  This 
+will reduce the chance of spread to others. 
+How can the spread of this disease be 
+prevented? 
+1. Wash hands thoroughly after using the toilet 
+and diapering children. 
+2. Wash hands thoroughly before preparing 
+food. 
+3. Keep children who have diarrhea at home. 
+4. Wash children’s toys frequently, especially 
+if they have diarrhea.  
+5. Make sure children wash thei r hands after 
+handling pets  or have contact with animal 
+feces. 
+6. Symptomatic staff with positive stool 
+cultures for Campylobacter should be 
+excluded from work. 
+7. Always treat raw poultry, beef and pork as if 
+they are contaminated and handle 
+accordingly. 
+8. Wrap f resh meats in plastic bags at the 
+market to prevent blood from dripping onto 
+other foods. 
+9. Refrigerate foods promptly; minimize 
+holding at room temperature. 
+10. Avoid ingesting unpasteurized milk.  
+11. Use separate cutting boards for raw poultry 
+and beef to prevent cross contamination with 
+other foods. 
+12. Cutting boards and counters used for 
+preparation should be washed immediately 
+after use to prevent cross contamination with 
+other foods. 
+13. Be certain all foods (especially beef and 
+poultry products) are thoroughly cooked. 
+
+
+CAMPYLOBACTER  (cont.)  
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+Who should be excluded? 
+Any person with diarrhea shall be excluded from 
+foodhandling, from childcare agencies and from 
+direct care of hospitalized or institutionalized 
+patients until 48 hours after resolution of symptoms.  
+Children can return to childcare once they are no 
+longer having diarrhea. 
+ 
+Reportable? 
+Yes.  Campylobacteriosis is reportable by New 
+Hampshire law to the Division of Public Health 
+Services, Bureau of Infectious Disease Control  at 
+(603) 271-4496.  
+

Text_Files/Chickenpox_and_Shingles.txt

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+CHICKENPOX (VARICELLA) AND SHINGLE 
+(cont.)  
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+CHICKENPOX (VARICELLA) AND 
+SHINGLES 
+ 
+Chickenpox is a very contagious disease caused by 
+the varicella -zoster virus.  It usually begins with a 
+mild fever and an itchy rash.  The rash starts with 
+crops of small red bumps on the stomach or back 
+and spreads t o the face and limbs.  The red bumps 
+rapidly become blistered, oozy and then crust over.  
+People may have only a few bumps or may be 
+totally covered. 
+ 
+Once a person has had chickenpox, the varicella-
+zoster virus stays without symptoms in the body’s 
+nerve cells.  In some people (for unknown reasons), 
+the virus can become active again at some later time 
+as “shingles” or zoster.  This problem includes a 
+red, painful, itchy, blistery rash, usually in the line 
+along one side of the body.  There is no fever.  The  
+virus is shed in the blister fluid of the rash and can 
+cause chickenpox in a person who has not had it, if 
+that person has direct contact with the infected 
+shingles blisters. 
+ 
+Who gets this disease? 
+Anyone who is exposed to chickenpox and has not 
+had it before has a very good chance of developing 
+chickenpox.  It is most common in school -aged 
+children.  If you have had chickenpox once, second 
+attacks are very rare.  Shingles is most common in 
+adults, as a person must have already had 
+chickenpox to develop shingles. 
+ 
+When a pregnant woman or a person with a weak 
+immune system who has not had chickenpox is 
+exposed he/she should contact a physician. 
+ 
+Chickenpox does not cause serious illness in 
+healthy children.  Adults may, occasionally, be 
+seriously ill with chickenpox. 
+ 
+How is it spread? 
+Chickenpox is contagious from 1- 2 days before the 
+rash appears to  until the blisters have become 
+crusted over .  It is spread by close contact (i.e., 
+sharing breathing space or direct touching contact) 
+with infected secretion s from the nose, throat or 
+rash. 
+ 
+How soon do symptoms appear? 
+The symptoms generally appear from 14- 16 days 
+after exposure but in some cases can occur as early 
+as 10 days or as late as 21 days after contact.  
+Chickenpox and shingles are usually diagnosed by 
+the typical appearance of the rashes. 
+ 
+What is the treatment? 
+The chickenpox symptoms may be treated with 
+anti-itching medicine and lotions, fever control, 
+fluids and rest.  Because of a possible association 
+with Reye’s Syndrome (i.e., vomiting, liver 
+problems and coma), salicylate- containing products 
+(i.e., aspirin) should not be used for fever control.  
+Acetaminophen may be used for fever control.  
+Scratching should be avoided because it can cause 
+infection and scarring.  A medication to decrease 
+the severity of symptoms is available for high -risk 
+children.  This must be given within 24 hours of the 
+onset of rash.  Please consult the Division of Public 
+Health Services, Bureau of Infectious Disease 
+Control or the child’s physician for more 
+information. 
+
+
+CHICKENPOX (VARICELLA) AND SHINGLE 
+(cont.)  
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+How can the spread of this disease be 
+prevented? 
+The ACIP recommends that children attending 
+daycare facilities and schools be vaccinated for 
+chickenpox.  New Hampshire currently requires 
+varicella vaccination for school or daycare 
+attendance. The two dos e series should be 
+completed at 12-15 months and again at 4-6 years. 
+ 
+The ACIP also recommends that daycare workers, 
+who have no history of chickenpox disease, be 
+tested for immunity.  If testing shows susceptibility, 
+2 doses of varicella vaccine should be  administered 
+separated by one month. 
+ 
+Each childcare facility should have a system so that 
+it is notified if a child or staff member develops 
+chickenpox or shingles.  This is so the facility may 
+take appropriate measures if there is a pregnant or 
+immunocompromised member in the facility.  
+(Recently the Advisory Committee on 
+Immunization Practice has recommended the use of 
+varicella vaccine for susceptible persons who have 
+been exposed to varicella). 
+ 
+The childcare facility should watch closely for early 
+signs of chickenpox in other children for three 
+weeks following the most recent case.  If a child or 
+staff member develops a suspicious rash, he/she 
+should be sent to his/her healthcare provider so that 
+the rash can be diagnosed.  However, chickenpox is 
+highly contagious and in spite of your best efforts, 
+you will probably have several more cases if 
+children have not already had the disease. 
+ 
+Who should be excluded? 
+Children should be excluded from daycare after the 
+rash eruption first appears and until the v esicles 
+become dry and crusted over .  In certain situations 
+exposed unvaccinated children without symptoms 
+do need to stay at home.  Generally exposed 
+children, who have been vaccinated, do not need to 
+stay at home.  Adults with shingles should be 
+excluded if vesicles/blisters cannot be covered. 
+ 
+Reportable? 
+Yes, chickenpox is reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease Control  at (603) 271-
+4496  
+

Text_Files/Common_Cold_and_Influenza.txt

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+COMMON COLD & INFLUENZA (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+COMMON COLD & INFLUENZA 
+ 
+Common colds are mild infections of the nose and 
+throat, which are very common in young children 
+(and in adults who are around them), and are caused 
+by many different viruses.  Usually the viral illness 
+causes some combination of  stuffy nose, runny 
+nose, sore throat, cough, runny eyes, ear fluid and 
+fever. 
+ 
+Influenza (the flu) is also caused by a virus (e.g., 
+influenza-A, influenza -B) and causes symptoms of 
+fever, headache, sore throat, cough, muscle ache 
+and fatigue.  Most people  with influenza feel too ill 
+to attend childcare. 
+ 
+Occasionally, the common cold or influenza can be 
+complicated by a bacterial infection such as an ear 
+infection, sinus infections, or pneumonia.  These 
+complications can be treated with appropriate 
+antibiotics after evaluation by their health care 
+provider. 
+ 
+Who gets these diseases? 
+Anyone can.  Young children may be sick with 
+these illnesses several times per year.  As the 
+number of persons in contact with a child increases, 
+so does the likelihood of expos ure to the common 
+viruses that cause the cold and flu. 
+ 
+How are they spread? 
+The viruses can be transmitted from one person to 
+another in respiratory secretions (i.e., saliva, nasal 
+discharge, and phlegm).  Infected droplets may be 
+scattered through sneezing or coughing or they may 
+land on surfaces touched by other persons, who then 
+touch their eyes, nose or mouth. 
+ 
+How soon do symptoms appear? 
+The symptoms of a common cold appear as soon as 
+12-72 hours after exposure.  The symptoms of 
+influenza appear in 1- 4 days after exposure , and 
+typically last 2-3 days. 
+ 
+What is the treatment? 
+While there is medication available , most health 
+care providers suggest rest and plenty of fluids.  To 
+see if there is bacterial infection in addition to the 
+viral infection, a healthcare provider should 
+evaluate a child who has a high fever, persistent 
+cough, or earache.  Because of a possible 
+association with Reye’s Syndrome (i.e., vomiting, 
+liver problems and coma), salicylate -containing 
+products (i.e., aspirin) are not recomme nded for 
+control of fever. 
+ 
+How can the spread of these diseases be 
+prevented? 
+Influenza vaccine is the primary method of 
+preventing influenza and its severe complications.  
+The vaccine should be given annually beginning  at 
+6 months of age. Two doses should be given the 
+first year the child receives the influenza vaccine.  
+ 
+Annual influenza vaccination is recommended  for 
+all children aged 6 months through age 18 with 
+priority given to the following persons for influenza 
+vaccine if influenza vaccine supplies are limited: 
+• Children 6 months to 18 years 
+• Pregnant women 
+• Persons aged 50 years old and older 
+• Persons of any age with certain chronic 
+medical conditions 
+• Persons who live with or care for persons at 
+high risk 
+ 
+Additional ways to prevent the spread of 
+these diseases: 
+• Get adequate rest, good nutrition, plenty of 
+fluids 
+• Avoid people who are sick 
+• Observe children for symptoms of coughing, 
+sneezing, headache, fatigue, fever.  Notify 
+parent to pick child up 
+• Remind children if they sneeze or cough 
+into their hand or tissue, they must properly 
+dispose of the tissue and wash their hands 
+
+
+COMMON COLD & INFLUENZA (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+• Runny noses and eyes should be promptly 
+wiped, then wash their hands 
+• Disposable tissues should be used.  Keep 
+tissues available 
+• Toys that children put in their mouths and 
+frequently used surfaces (e.g., tables) should 
+be washed and disinfected at least once each 
+day 
+• The childcare facility should have fresh air 
+and be aired out completely once a day, 
+even in the winter months 
+ 
+Who should be excluded? 
+Children should be excluded if they have a fever or 
+are unable to participate in general activities.  
+Exclusion is of little benefit since viruses are likely 
+to spread. 
+ 
+Reportable? 
+No.  Influenza is not reportable, but please notify 
+the Division of Public Health Services, Bureau of 
+Infectious Disease Control  at (603) 271- 4496 of 
+influenza outbreaks.  The common cold is not 
+reportable. 
+

Text_Files/Conjunctivitis.txt

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+CONJUNCTIVITIS (Pink Eye) cont. 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+CONJUNCTIVITIS (Pink Eye) 
+ 
+Conjunctivitis is an infection of the eyes commonly 
+known as “pink eye”.  Conjunctivitis can be 
+purulent or nonpurulent.  It is most often caused by 
+a virus (like those which cause the common cold), 
+but can also be caused by bacteria, allergies or 
+chemicals.  The conjunctiva – the clear layer over 
+the whites of the eyes – becomes pink and there 
+may be tearing and discharge from the eyes.  Eyes 
+may be itchy or even painful.  In the morning, the 
+discharge may make the eyelids stick together.  
+Conjunctivitis is a mild illness.  Viral conjunctivitis 
+will go away by itself in one to three weeks. 
+ 
+Who gets this disease? 
+Anyone can get it.  Conjunctivitis is caused by a 
+virus or bacterium and is highly contagious.  
+Preschoolers and school -age children have it most 
+often and can spread it to people taking care of them 
+or to each other. 
+ 
+How is it spread? 
+Both viral and bacterial conjunctivitis spread by 
+contact with discharge from the eye.  Children often 
+pass it along by rubbing their ey es and getting 
+discharge on their hands and then: 
+a) Touches another child’s eye. 
+b) Touches another child’s hands.  The second 
+child then touches his/her eyes. 
+c) Touches an object.  Another child touches the 
+object and then puts his/her hands into his/her 
+eyes. 
+ 
+Staff washing, drying or wiping a child’s face and 
+then using the same washcloth/towel/paper 
+towel/tissue on another child’s face can also pass it 
+along.  Staff could also get eye discharge on their 
+hands when wiping a child’s eyes and then pass it 
+along as outlined above. 
+The incubation period varies depending upon the 
+cause whether it is viral or bacterial; symptoms may 
+develop in 5 –12 days depending on the cause.  
+(Bacterial 24-72 hours, viral 12 hours to 12 days). 
+ 
+How is it diagnosed and treated? 
+Signs and symptoms of purulent conjunctivitis are 
+white or colored discharge from the eye, eye 
+redness, eyelid swelling, eye pain, and sometime 
+fever.  It is often difficult to tell if the cause is 
+bacterial or viral.  Occasionally the doctor will 
+examine the discharge under the microscope or 
+culture it.  Often an antibiotic eye medicine will be 
+given because treatment of bacterial conjunctivitis 
+shortens the length of symptoms and decreases 
+infectiousness.  There is not treatment for viral 
+conjunctivitis; it will go away by itself but may last 
+a week or more. 
+ 
+Signs and symptoms of nonpurulent conjunctivitis 
+are clear watery discharge from the eye, without eye 
+redness or pain or fever.   
+ 
+How can the spread of this disease be 
+prevented? 
+1. Follow hand washing and center cleanliness 
+guidelines. 
+2. Teach children to avoid rubbing their eyes 
+3. Keep children’s eyes wiped free of 
+discharge. 
+4. Always use disposable tissues/towels for 
+wiping and washing.  Never
+ use the same 
+tissue/towel for more than one child. 
+5. Always wash your  hands after wiping a 
+child’s eyes. 
+6. Teach children to wash their hands after 
+wiping their eyes. 
+7. Dispose of tissues/towels in lined, covered 
+container kept away from food and childcare 
+materials.
+
+
+CONJUNCTIVITIS (Pink Eye) cont. 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+8. Be sure articles that may touch children’s 
+eyes (e.g., pillo wcases, sheets, towels 
+binoculars, prisms, toy cameras) are washed 
+well with soap and hot water at least once 
+daily. 
+ 
+Who should be excluded? 
+It is recommended that children and staff with 
+purulent conjunctivitis be excluded from childcare 
+until examined b y a healthcare provider  and 
+approved for re -admission, with or without 
+treatment. Children with nonpurulent conjunctivitis 
+do not need to be excluded from childcare. 
+ 
+ 
+Reportable? 
+No. Conjunctivitis is not reportable by New 
+Hampshire state law to the Divis ion of Public 
+Health Services, Bureau of Infectious Disease 
+Control.  However, Public Health Professionals are 
+available for consultation at (603) 271-4496. 
+

Text_Files/Diarrhea.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+DIARRHEA (Infectious Diarrhea) 
+ 
+Diarrhea is defined as: 1) an increase in the 
+number of stools over what is normal for that 
+person, and 2) stools which are not formed (i.e., 
+loose and watery and take the shape of the 
+container they are in).  (NOTE: Breas t-fed babies 
+may have stools that are normally
+ not formed). 
+ 
+There are two (2) general types of diarrhea:  
+infectious and non-infectious. 
+ 
+Infectious Diarrhea  is caused by a virus, 
+parasite, or bacterium.  It can spread quickly from 
+person-to-person, espec ially in daycare centers.  
+Some of the causes of infectious diarrhea, such as 
+Campylobacteriosis, shiga -toxin producing E. 
+coli, giardiasis, salmonellosis and shigellosis, are 
+discussed in their own fact sheets found in this 
+document.  There are other agents that can also 
+cause infectious diarrhea in children.  These 
+include parasites (e.g., cryptosporidiosis, amoeba) 
+other bacterial (e.g., yersinia) and other viruses 
+(e.g., Rotavirus).  Although these other disease -
+causing organisms are not discussed in de tail, the 
+general principles outlined in this section are 
+applicable to prevent the spread of any of these 
+germs. 
+ 
+Non-infectious Diarrhea can be caused by toxins 
+(e.g., certain types of food poisoning), chronic 
+diseases (e.g., cystic fibrosis) or antibiot ics (e.g., 
+ampicillin).  Non -infectious diarrhea DOES NOT
+ 
+spread from person-to-person. 
+ 
+Who gets it? 
+Anyone can catch infectious diarrhea.  It can 
+spread especially quickly among babies and 
+young children who are not toilet -trained or who 
+may not wash the ir hands well after going to the 
+bathroom.  It can also easily spread to the adults 
+taking care of them and helping them with 
+diapering and toileting. 
+How is it spread? 
+The germs that can cause infectious diarrhea are 
+spread by fecal-oral route. 
+ 
+How is it diagnosed and treated? 
+The germs can be diagnosed by stool cultures or 
+by looking at stool under a microscope for eggs or 
+parasites.  (The healthcare provider will ask for a 
+stool sample and send it to a laboratory for 
+analysis).  The physician will deci de on 
+appropriate treatment. 
+ 
+How can the spread of diarrhea be 
+prevented? 
+Hand washing is the most important way to stop 
+the spread.  Specific methods for preventing the 
+spread of infectious diarrhea are discussed in each 
+fact sheet. 
+ 
+Who should be excluded? 
+Any person with diarrhea shall be excluded from 
+food handling, from childcare agencies and from 
+direct care of hospitalized or institutionalized 
+patients until 48 hours after resolution of 
+symptoms.. Children who have 2 or more stools 
+above their normal amount should be excluded as 
+it impedes the caregiver’s  ability to care for the 
+children and maintain sanitary conditions.  For 
+diarrhea caused by a specific agent, see the related 
+fact sheet to learn if exclusion is necessary. 
+ 
+Reportable? 
+Non-specific diarrhea is not reportable.  Clusters 
+of diarrhea illness in a facility should be reported 
+to the Division of Public Health Services, Bureau 
+of Infectious Disease and Control  at (603) 271-
+4496.  
+
+

Text_Files/Diphtheria.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+DIPHTHERIA 
+ 
+Diphtheria is a potentially serious bacterial 
+infection of the nose and throat. 
+ 
+Who gets this disease? 
+Diphtheria occurs primarily among unimmunized 
+or inadequately immunized people. 
+ 
+How is it spread? 
+The bacteria are spread by direct contact with 
+discharge from the nose, throat, skin, eyes, or 
+from sores of infected persons.  Articles or food 
+contaminated with discharge can also spread 
+infection. 
+ 
+What are the symptoms? 
+Diphtheria causes a sore throat and swollen 
+tonsils, with a grayish cov ering and swollen 
+glands in the neck.  It can lead to severe throat 
+swelling that can block breathing.  The bacteria 
+also produce a toxin (a type of poisonous 
+substance) that can cause severe and permanent 
+damage to the nervous system and heart.   
+ 
+What is the Treatment? 
+Diphtheria is treated primarily with an antitoxin, 
+along with antibiotics.  Antibiotics are also given 
+to the carriers of the diphtheria (e.g., people who 
+test positive for diphtheria but who are not sick). 
+Individuals who have been in cont act with an 
+infected person and are not adequately vaccinated 
+should receive a booster.  
+ 
+How can the spread of this disease be 
+prevented? 
+The combination vaccine Diphtheria, Tetanus and 
+acellular Pertussis (DTap), is required  for both 
+childcare and school  attendance.  The Advisory 
+Committee on Immunization Practices (ACIP) 
+recommends immunizing children against 
+diphtheria, along with pertussis and tetanus, 
+beginning as early as six weeks of age.  The five 
+dose series should be completed at 2 months, 4 
+months, 6 months, and 15- 18 months, and 4- 6 
+years of age.  
+Patients and carriers of diphtheria should receive 
+appropriate treatment and not return to childcare 
+until two (2) cultures from both the nose and 
+throat (and from skin sores in cutaneous 
+diptheria), a re negative for the bacteria.  These 
+cultures should be taken at least 24 hours apart 
+and no sooner than 24 hours after finishing 
+antibiotic treatment.  Where culture is impractical, 
+isolation may be ended after 14 days of 
+appropriate treatment. 
+ 
+Who should be excluded? 
+Children and staff should be excluded until 
+bacteriological examination proves them not to be 
+carriers. 
+ 
+Reportable? 
+Yes, Diphtheria is reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease C ontrol at (603) 
+271-4496.  
+
+

Text_Files/E_Coli_O157_H7.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+E. COLI 0157:H7 
+ 
+E. coli 0157:H7 is an intestinal illness caused by a 
+bacterium that can cause severe bloody diarrhea, 
+anemia, and –in some cases- kidney failure. 
+ 
+Who gets this disease? 
+Anyone is susceptible to this particular category of 
+E. coli 0157:H7, but it most seriously affects young 
+children and the elderly. 
+ 
+How is it spread? 
+This bacterium lives in a small number of healthy 
+cattle.  When the infected animal is slaughtered, the 
+meat can become contaminated.  The bacteria may 
+also contaminate raw  milk by being present on the 
+cow’s udder. 
+ 
+E. coli 0157:H7 is spread by eating contaminated 
+food – most often undercooked beef, especially 
+undercooked ground beef.  Contaminated meat 
+looks and smells normal.  Drinking unpasteurized 
+milk and swimming in or  drinking sewage -
+contaminated water can also cause infection. 
+ 
+An infected person having diarrhea can pass the 
+bacteria from one person to another if hand-washing 
+habits are not adequate.  This is more likely to 
+happen among toddlers who are not toilet trained. 
+ 
+Young children usually continue to shed the 
+bacteria in their stool a week or two following their 
+illness. 
+ 
+What are the symptoms? 
+They vary from mild diarrhea to a bloody diarrhea 
+with severe abdominal cramps and little or no fever.  
+Vomiting may o ccur late in the illness.  A small 
+percent may develop hemolytic uremic syndrome  
+(HUS), a condition that destroys the red blood cells 
+and causes kidney failure.  This is more likely to 
+occur in children under five years of age and the 
+elderly, and may lead to death. 
+ 
+How soon do symptoms appear? 
+Symptoms appear 12 -72 hours after exposure with 
+the average being 48 hours. 
+ 
+Can a person have this disease without 
+knowing it? 
+Yes.  The organism is identified through stool 
+culture testing.  Usually symptoms disa ppear in a 
+few days but the bacteria can remain in the 
+intestinal tract for several weeks. 
+ 
+What is the treatment? 
+Seek medical help for identification of the 
+organism.  Usually the person is treated for diarrhea 
+dehydration with fluid replacement. 
+ 
+How ca n the spread of this disease be 
+prevented? 
+1. Wash hands thoroughly after diapering and 
+using the bathroom. 
+2. Avoid eating undercooked beef, especially 
+hamburger.   
+3. Avoid drinking from unknown water sources ,, 
+raw milk, and unpasteurized apple juice. 
+4. Teach children good hand washing techniques 
+ 
+Who should be excluded? 
+Children who are infected with this bacterium will 
+be excluded from childcare while they are 
+symptomatic.  Infected adults should be excluded 
+from childcare centers, food handling, and direct 
+care healthcare, until their stool cultures are free of 
+E. coli 0157:H7 on two (2) consecutive specimens 
+collected not less than 24 -hours apart.  If antibiotics 
+have been given, the initial cultures should be 
+obtained at least 48-hours after the last dose. 
+ 
+Reportable? 
+Yes.  E. coli 0157:H7 is reportable by New 
+Hampshire law to the Division of Public Health 
+Services, Bureau of Infectious Disease Control  at 
+(603) 271-4496.  
+
+

Text_Files/Eastern_Equine_Encephalitis.txt

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+EASTERN EQUINE ENCEPHALITIS (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+EASTERN EQUINE ENCEPHALITIS 
+ 
+What is eastern equine encephalitis? 
+Eastern equine encephalitis (EEE) is an uncommon 
+but serious disease caused by EEE virus.  EEE is an 
+arbovirus (short for ar thropod-borne, meaning 
+spread by insects).  The virus can be transmitted to 
+horses, other animals, and in rare cases, people. 
+ 
+How do people get eastern equine 
+encephalitis? 
+The EEE virus grows in birds that live in freshwater 
+swamps.  The virus has a complex life cycle 
+involving birds and a specific type of mosquito, 
+called Culiseta melanura.  This particular mosquito 
+does not bite people.  Sometimes though, the virus 
+can escape from its marsh habitat by means of other 
+mosquitoes that feed on both birds and mammals.  
+These mosquitoes can transmit the virus to animals 
+and people. 
+ 
+What are the symptoms of EEE? 
+Infection can cause a range of illnesses.  Most 
+people have no symptoms; others get only a mild 
+flu-like illness with fever, headache, and sore throat.  
+For people with infection of the central nervous 
+system, a su dden high fever (103 to  106 ), severe 
+headache, and stiff neck can be followed quickly by 
+seizures and coma.  About one third of these 
+patients die from the disease.  Of those that survive, 
+many suffer permanent brain damage and require 
+lifetime institutional care. 
+ 
+How soon after exposure do symptoms 
+appear? 
+Symptoms of EEE usually appear 4 to 10 days after 
+the bite of an infected mosquito. 
+ 
+How is eastern equine encephalitis 
+diagnosed? 
+Diagnosis is based on tests of blood or spinal fluid. 
+Who is at risk for eastern equine 
+encephalitis? 
+Anyone can get EEE, but some people are at 
+increased risk, such as people living in or visiting 
+areas where the disease is common and people who 
+work outside or participate in outdoor recreational 
+activities in areas where the disease is common. 
+Children and those over age 50 are more susceptible 
+to the disease.  The risk of getting EEE is highest 
+from late July through September. 
+ 
+What is the treatment for eastern equine 
+encephalitis? 
+There is no specific treatment for east ern equine 
+encephalitis.  Antibiotics are not effective against 
+viruses, and no effective anti -viral drugs have yet 
+been discovered.  Care of the patient centers around 
+treatment of symptoms and complications. 
+ 
+How common is eastern equine 
+encephalitis? 
+EEE is a rare disease.  An average of 6 cases are 
+reported in the United States in most years.  There 
+is concern, however, that EEE is re -emerging.  In 
+NH, EEE has been found in horses, mosquitoes and 
+several species of birds.  In 2014, 3 cases of EEE 
+were reported in humans in NH.   
+ 
+How can eastern equine encephalitis be 
+prevented? 
+A vaccine is available for horses, but not for 
+humans.  Prevention of the disease centers around 
+controlling mosquitoes and on individual action to 
+avoid mosquito bites.  To avoi d being bitten by the 
+mosquitoes that transmits EEE: 
+• If possible, stay inside between dusk and dawn, 
+when mosquitoes are most active 
+• When outside between dusk and dawn, wear 
+long pants and long-sleeved shirts 
+
+
+EASTERN EQUINE ENCEPHALITIS (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+• Use an insect repellent with DEET or Picaridi n 
+according to the manufacturer’s directions 
+when outside.  Oil of lemon eucalyptus and 
+IR3535 have been found to provide protection 
+similar to repellents with low concentrations of 
+DEET 
+• Clothing can be treated with permethrin 
+according to the manufacturer’s directions 
+• When possible wearing long sleeves and pants 
+while outside 
+• Put screens on windows and make sure they do 
+not have holes 
+• Eliminate standing water and other mosquito 
+breeding locations from your property.  Do not 
+alter natural water bodies.  The  management of 
+ponds and wetlands is regulated by the 
+Department of Environmental Services and any 
+alterations require a permit before work may 
+begin 
+ 
+For more information about eastern equine 
+encephalitis, call the New Hampshire Department 
+of Health & Hum an Services, Bureau of Infectious 
+Disease Control  at (603) 271- 4496 or visit our 
+website at www.dhhs.nh.gov
+ or the Centers for 
+Disease Control and Prevention at www.cdc.gov.  
+

Text_Files/Fifth_Disease.txt

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+FIFTH DISEASE (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+FIFTH DISEASE 
+ 
+Fifth disease is an illness caused by a virus called 
+human parvovirus B19.  Although people may be 
+asymptomatic with the illness, most children with it 
+develop a facial rash (i.e., “slapped check” 
+appearance) and a lace- like rash on the tr unk and 
+extremities.  The rash may reappear for several 
+weeks following exposure to non- specific stimuli 
+such as sunlight, change in temperature or 
+emotional stress. 
+ 
+Except for the rash, the patient is typically 
+otherwise well:  but some give a history of  mild 
+general symptoms one to four days before rash 
+onset.  Fever, sore throat or pain and swelling in the 
+joints may also occur. 
+ 
+Who gets this disease? 
+Although most commonly recognized in children, 
+anyone is susceptible.  Studies indicate previous 
+infection with Fifth disease correlates with a lower 
+risk of a second infection.  Outbreaks in schools 
+often begin in late winter or early spring and may 
+continue until the school year is over. 
+ 
+In the U.S. about 50% of the adult population are 
+already immune t o the disease.  Some studies 
+indicate the pregnant women who are exposed to 
+Fifth disease and subsequently develop infection 
+may have an increased risk for fetal death.  
+However, this risk is felt to be extremely low.  
+There is no evidence that the infecti on during 
+pregnancy causes fetal malformations (i.e., birth 
+defects).  Pregnant childcare workers should contact 
+their obstetricians. 
+ 
+How is it spread? 
+The virus that causes Fifth disease has been found 
+in the respiratory secretions of patients and is, 
+therefore, most likely spread by direct person-to-
+person contact through the respiratory route. 
+How soon do symptoms appear? 
+It takes from 4 -21 days after exposure to develop 
+the characteristic rash illness of Fifth disease.   
+People with the rash are past the period of 
+infectiousness to others.  The highest risk of 
+transmitting the Fifth disease virus to others is felt 
+to occur before the rash develops. 
+ 
+How is it diagnosed and treated? 
+A healthcare provider based on the characteristic 
+rash and any other ac companying symptoms may 
+diagnose Fifth disease.  There is no specific 
+treatment for Fifth disease. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Because transmission of the Fifth disease 
+virus usually occurs before the rash develops 
+– when a child may seem well or has a non -
+specific illness – excluding children with the 
+Fifth disease rash is of no proven value.  
+However, it is very important  for a 
+healthcare provider to rule out other rash-
+causing illnesses (e.g., measles, chickenpox) 
+that may require exclusion from childcare. 
+2. Transmission of infection can be lessened by 
+routine hygienic practices for control of 
+respiratory infections, which include hand 
+washing and disposal of facial tissues 
+containing respiratory secretions. 
+3. People with particular conc erns about 
+contracting Fifth disease (e.g., pregnant 
+women) should consult their healthcare 
+providers. 
+
+
+FIFTH DISEASE (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+Who should be excluded? 
+Children with Fifth disease MAY attend daycare or 
+school, as they are not contagious after onset of 
+rash.  Routine exclusion of pregnant women from 
+the workplace where Fifth disease is occurring is 
+not recommended. 
+ 
+Reportable? 
+No, Fifth disease is not reportable by New 
+Hampshire law to the Division of Public Health 
+Services, Bureau of Infectious Disease Control .  
+However, Public H ealth Professionals are available 
+for consultation at (603) 271-4496. 
+

Text_Files/Giardiasis.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+GIARDIASIS 
+ 
+Giardiasis is an intestinal illness caused by 
+Giardia lamblia, a microscopic parasite.  The 
+infectious form of the parasite is passed in the 
+stool of an infected individual. 
+ 
+Who gets this disease? 
+Anyone can get Giardiasis.  It is very commo n in 
+childcare centers; especially those that have 
+children under age three.  It spreads easily among 
+these children to their caretakers and families. 
+ 
+How is it spread? 
+The most common way a person becomes 
+infected with giardia in the childcare setting is  by 
+the fecal -oral route.  Eating food contaminated 
+with the parasite may also infect a person.  Food 
+may become contaminated when the person 
+preparing the food has giardiasis and has some 
+infected stool on his/her hands because of poor 
+hand washing habits. 
+ 
+Additionally, a person may become infected by 
+drinking water that is contaminated with the 
+parasite.  Streams, ponds and springs in New 
+Hampshire are frequently contaminated with 
+giardiasis parasites.  Water can also be 
+contaminated with giardia when sewage enters the 
+drinking water supply. 
+ 
+What are the symptoms? 
+The most common symptoms of a giardia 
+infection are diarrhea, abdominal pain, cramping, 
+decreased appetite and excess gas.  There is 
+usually no fever or vomiting.  The diarrhea may 
+last up to several months and can cause significant 
+weight loss. 
+ 
+How soon do the symptoms appear? 
+The symptoms appear within 5- 25 days or longer.  
+The average incubation period is 1-3 weeks. 
+Can a person have this disease without 
+knowing it? 
+Yes.  Some people may ha ve very mild infections 
+that are not serious enough to cause them to go to 
+a doctor.  They may not feel sick at all.  In some 
+cases of giardia infection, parasites can be found 
+in the stool from several days to several months 
+after the symptoms have stopped. 
+ 
+What is the treatment? 
+Several drugs are effective in killing the giardia 
+parasite.  Treatment is usually necessary for 
+persons with diarrhea. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Wash hands thoroughly after using the 
+toilet and diapering a child. 
+2. Wash hands thoroughly before preparing 
+food. 
+3. Keep children who have diarrhea at home. 
+4. Staff with stool positive for giardia should 
+not prepare food or feed children. 
+ 
+Who should be excluded? 
+Any person with diarrhea shall be excluded from 
+food handling, from childcare agencies and from 
+direct care of hospitalized or institutionalized 
+patients until 48 hours after resolution of 
+symptoms  
+Reportable? 
+Yes, giardiasis is reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease Control  at (603) 
+271-4496.  
+
+

Text_Files/HIV_AIDS.txt

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+HIV/AIDS CONT. 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+HIV/AIDS 
+ 
+The human immunodeficiency virus – or HIV for 
+short – is the name of the virus that causes the 
+condition known as AIDS (Acquired 
+Immunodeficiency Syndrome).  HIV attacks the 
+body’s immune system and makes it unable to 
+fight-off certain infections and cancers. 
+ 
+How do children get HIV? 
+The primary method that children become 
+infected with HIV is through maternal 
+transmission (i.e., the transfer of HIV) from 
+mother-to-child during pregnancy, childbirth or 
+breastfeeding.  If medical treatment is us ed in 
+combination with obstetric care and an elective 
+caesarian section, transmission is reduced to an 
+only 2% chance of infant transmission. 
+ 
+Can HIV be spread in childcare 
+settings? 
+No documented cases of HIV infection have been 
+traced to kissing, biting , playing with an infected 
+child, or sharing food, eating utensils, toys or 
+bathroom facilities. 
+ 
+Sexual transmission of HIV 
+With individuals that are positive, HIV is found in 
+blood, mother’s milk, semen and vaginal 
+secretions.  HIV transmission as a resu lt of anal, 
+oral, or vaginal intercourse has been well 
+documented.  HIV infection can also occur as a 
+result of sexual abuse in children. 
+ 
+How is HIV diagnosed? 
+For adults rapid HIV tests are available and are 
+used in NH.  To confirm a rapid test, people 
+should still receive a blood test.  A blood test 
+involves testing for the HIV antibody.  However, 
+use of HIV -antibody testing in children less than 
+18 months old may be confounded by the 
+presence of maternally acquired HIV antibodies.  
+Other laboratory tests such as viral culture, 
+nucleic acid detection or antigen test are useful in 
+determining HIV infection in these children. 
+ 
+What are the symptoms? 
+There are a wide range of signs and symptoms 
+seen in HIV -infected children.  Symptoms may 
+include failure to  thrive, weight loss, fever, mild 
+or severe developmental delay, neurologic 
+deterioration and severe, prolonged or recurrent 
+infections.  In general, the interval from HIV 
+infection to the onset of symptoms is shorter in 
+children than adults due to the developing and 
+immature immune system.  For this reason, HIV 
+infected women should seek medical care and 
+treatment early on in a pregnancy. 
+ 
+Should children with HIV be enrolled in 
+childcare? 
+Yes.  Studies continue to show no evidence of 
+transmission of HIV within the childcare setting.  
+HIV infected children should therefore be 
+enrolled in daycare if their health, neurologic 
+development, behavior and immune status are 
+appropriate.  The decision as to whether or not a 
+child with known HIV infection may be enrolled 
+in childcare should be made on a case -by-case 
+basis.  The decision is best made by the child’s 
+healthcare provider. 
+ 
+Reportable? 
+Yes, both HIV infection and AIDS are reportable 
+by New Hampshire law to the Division of Public 
+Health Services, Bureau of Infectious Disease 
+Control at (603) 271-4496.  
+
+

Text_Files/Haemophilus_Influenza_Type_B.txt

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+HAEMOPHILUS INFLUENZA TYPE-B (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+HAEMOPHILUS INFLUENZAE 
+TYPE-B (aka Hib Disease) 
+ 
+Haemophilus influenzae  type-b (Hib) is a 
+bacterium that causes serious, sometimes fatal 
+illnesses, most often in young children.  Some of 
+the diseases it can cause include: meningitis (an 
+infection of the coverings of the brain), epiglottitis 
+(an infection of the upper throat and entrance of 
+the windpipe), cellulitis (an infection of the deep 
+tissues, especially of the face and neck), septic 
+arthritis (an infection and swelling of the joints), 
+pneumonia (an infection of the lung), and 
+bacteremia (blood stream) infections. 
+ 
+Who gets this disease? 
+This illness is primarily seen in unimmunized 
+children under four years of age.  Children under 
+age two are most susceptible because their 
+immune systems are not yet  able to fight the 
+bacteria.  Rarely, older children and adults may 
+develop infection. 
+ 
+It appears that in a setting such as the household 
+or childcare facility –  where there are young 
+children and everyone is in close contact – there is 
+an increased risk of one of these contacts 
+developing Hib infection following a first case. 
+ 
+How is it spread? 
+The bacterium is passed from person-to-person by 
+breathing in infected droplets of nose or throat 
+fluids scattered in the air or by direct contact with 
+these infected secretions.  The bacteria cannot live 
+on environmental surfaces – they quickly shrivel 
+and die. 
+ 
+Like meningococcus, some people can “carry” 
+this bacterium for a period of time without it 
+causing illness.  However, a carrier may spread 
+the bacteria to another person who may then 
+become ill.  In a household or childcare center in 
+which Hib infection has occurred, the number of 
+persons with nose or throat carriage is greatly 
+increased; thus, risk of serious disease is also 
+increased. 
+How is it diagnosed and treated? 
+Illnesses caused by Haemophilus influenzae  type-
+b are diagnosed by signs and symptoms and by 
+examining the blood and/or spinal fluid for white 
+blood cells and bacteria.  Spinal fluid is obtained 
+by a physician performing a lumbar puncture (i.e., 
+spinal tap). 
+ 
+How can the spread of this disease be 
+prevented? 
+1. If a person develops an illness caused by 
+Hib, close contacts of this patient 
+(including family members and persons 
+having intimate contact such as sleeping 
+together, hugging and kissing) are  at 
+increased risk of developing the illness.  In 
+this situation a physician may recommend: 
+1) carefully watching for early symptoms 
+of illness caused by Haemophilus 
+influenzae and/or 2) taking a preventive 
+antibiotic to eliminate the bacteria from 
+the body before disease begins. 
+2. Any child or adult contact that  develops 
+symptoms consistent with Hib infection 
+requires evaluation by a heath care 
+provider regardless of whether or not this 
+person has taken preventive antibiotics. 
+3. A vaccination against Hib infec tion is 
+available and the Advisory Committee on 
+Immunization Practices (ACIP) 
+recommends that all children begin the 
+vaccine series against  Hib infection at two 
+months of age. The four dose series should 
+be completed at  2 months, 4 months, 6 
+months, and 12- 15 months.  
+
+
+HAEMOPHILUS INFLUENZA TYPE-B (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+4. For unvaccinated children age 15 months 
+or older only 1 dose of the Hib vaccine is 
+required.  
+5. The Hib vaccine is not required for 
+children over age 5.  
+6. Children in childcare aged 3 -60 months 
+are required to have age appropriate Hib 
+vaccination in order to attend.  Parents 
+with specific questions about the Hib 
+vaccine and their child should contact their 
+child’s physician.  The vaccination is not 
+required for school entry. 
+7. Notify parents or guardians about the 
+occurrence of this illness and urge them to 
+contact their physicians for specific 
+medical care advice. 
+8. Contact the Bureau of Infectious Disease 
+Control for recommendations about 
+preventing the spread of this illness and 
+assistance in implementing them. 
+ 
+Who should be excluded? 
+Children and staff who are ill with Hib infection 
+should be excluded while they are ill and until 24 
+hours of antibiotic therapy has been completed. 
+ 
+Reportable? 
+Yes, Haemophilus influenzae  infections are 
+reportable by New Hampshire law to the Bureau 
+of Infectious Disease Control at (603) 271-4496.  
+

Text_Files/Hand_Foot_and_Mouth_Disease.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+HAND, FOOT & MOUTH DISEASE 
+ 
+Hand, foot and mouth disease is a self -limited 
+infection caused by the Coxsackie A16 virus and 
+enterovirus 71.  Vesicular lesions (i.e., blisters) 
+may appear in the mouth, on the sides of the 
+tongue, inside the cheek and on the gums.  
+Lesions may also occur on the palms, fingers, 
+soles and buttocks.  Most lesions persist for 7- 10 
+days.  A low -grade fever may accompany the 
+illness for one to two days.  The infection usually 
+goes away without any serious complications. 
+ 
+Who gets this disease? 
+The infection is seen primarily in children under 
+10 years old but may also occur in adults.  
+Outbreaks of hand, foot and mouth disease among 
+groups of children in nursery schools and 
+childcare centers during the summer and early fall 
+are common. 
+ 
+How is it spread? 
+Having direct contact with nose and throat 
+secretions of an infected person may spread the 
+infection.  It may also be spread by the aerosol 
+droplet route (e.g., sneezing, coughing). 
+ 
+Additionally, the virus may also be spread by 
+having contact with infected persons who may not 
+seem sick (aka carriers) but are able to spread the 
+infection since the virus may persist in the stool 
+for several weeks after the acute illness is over. 
+ 
+What are the symptoms? 
+Vesicular lesions may occur in t he mouth, on the 
+sides of the tongue, inside the cheek and on the 
+gums.  Lesions also occur on the palms, fingers, 
+soles and buttocks.  Most lesions persist for 7- 10 
+days.  A low -grade fever may accompany the 
+illness for one to two days. 
+ 
+How soon do symptoms appear? 
+People who are going to contract the infection 
+usually do so three to six days after exposure. 
+ 
+Can a person have this disease without 
+knowing it? 
+Yes.  Infected persons who may not seem sick are 
+able to spread infection.  The virus may persist  in 
+the stool for several weeks after the acute illness 
+is over. 
+ 
+How is it diagnosed and treated? 
+A healthcare provider may diagnose hand, foot 
+and mouth disease based on clinical signs and 
+symptoms.  There is no specific treatment. 
+ 
+How can the spread of  this disease be 
+prevented? 
+1. Wash your hands thoroughly after using 
+the toilet and diapering a child. 
+2. Wash hands thoroughly after handling 
+respiratory discharges, stool and soiled 
+articles of infected persons. 
+3. Discourage children from putting toys and 
+other objects in their mouths. 
+4. Clean and disinfect toys and contaminated 
+areas (e.g., diapering area, potty chairs, 
+toilets) daily and when soiled. 
+5. Do not allow children to share drinking 
+cups or eating utensils. 
+6. Teach children to sneeze and cough into a 
+tissue, or into their elbow and away from 
+other people. 
+7. Dispose of tissues and diapers properly; 
+wash hands after sneezing, coughing, 
+changing diapers and using the toilets. 
+8. Children may attend childcare if they feel 
+well enough even if lesions are still 
+present.  In this situation, childcare staff 
+should be especially careful to adhere to 
+steps 1-7 above. 
+9. Grouping of symptomatic individuals, 
+where practical, might be considered. 
+
+
+HAND, FOOT & MOUTH DISEASE (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+Who should be excluded? 
+Exclusion from a childcare facility or school is 
+not recomm ended.  Special attention to hand 
+washing after toileting is required. 
+ 
+Reportable? 
+No.  Hand, foot and mouth disease are not 
+reportable by New Hampshire law to the Division 
+of Public Health Services, Bureau of Infectious 
+Disease Control .  However, Public Health 
+Professionals are available for consultation at 
+(603) 271-4496.  
+

Text_Files/Hepatitis_A.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+HEPATITIS A 
+ 
+Hepatitis A is an infection of the liver caused by 
+the hepatitis A virus. 
+ 
+Who gets this disease? 
+Anyone can.  It can spread quickly in groups of 
+small children who are not yet toilet- trained and 
+who cannot wash their own hands well. 
+ 
+How is it spread? 
+Hepatitis A virus is passed out of the body in the 
+stool and is spread by the fecal-oral route, just like 
+infectious diarrhea.  Contact with stool -
+contaminated food, drink or environment surfaces 
+(e.g., toilet seat, changing table) can spread t he 
+infection.  
+ 
+What are the symptoms? 
+The symptoms vary greatly, ranging from none at 
+all to severe illness.  Early symptoms can include 
+loss of appetite, nausea, aching, fever, and 
+stomachache.  Later signs can include dark 
+colored urine, light colored s tools and jaundice 
+(i.e., yellowing of white of eyes, eyes or skin).  
+(Note: jaundice occurs more often among adults 
+than children).  These symptoms usually last from 
+one to two weeks, although some adults may be 
+sick for several months. 
+ 
+How soon do symptoms appear? 
+After the hepatitis A virus is ingested, it is 
+between 15 -50 days before illness begins.  Most 
+commonly, it begins within 25-30 days. 
+ 
+Can a person have this disease without 
+knowing it? 
+Yes.  This is especially important in the childcare 
+setting because most young children with hepatitis 
+A do not become ill.  Children with hepatitis A 
+without symptoms who are in diapers could easily 
+pass the virus to unsuspecting childcare facility 
+staff and family members. 
+ 
+In addition, people with hepatitis A are most 
+likely to spread the disease to others during a 
+period extending from 14 days before developing 
+symptoms to one week after symptoms develop.  
+This means that a person may be infectious to 
+others before even realizing he or she is ill. 
+ 
+What is the treatment? 
+There is no treatment that cures hepatitis A.  
+However, there are two shots available to help 
+prevent illness in people exposed to patients with 
+hepatitis A.  These protective shots – either 
+hepatitis A vaccine or Hepatitis A immune 
+globulin (IG) – must be given within two weeks 
+of a person’s exposure to hepatitis A in order for 
+it to be helpful.  A person’s healthcare provider 
+and the New Hampshire Division of Public Health 
+Services, Bureau of Infectious Disease Control  
+will assist in making re commendations about 
+administering hepatitis A vaccine or IG to 
+contacts. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Hepatitis A vaccine is recommended for 
+children 12- 23 months.  The Advisory 
+Committee on Immunization Practices 
+(ACIP), recommends immunizing children 
+against Hepatitis A. 
+2. The two dose series should be given at 12 
+and 18 months of age  Children who are 
+not vaccinated by age 2 years can be 
+vaccinated at subsequent visits. 
+3. Wash hands thoroughly after using the 
+toilet.   
+4. Wash hands thoroughly after diapering 
+children. 
+5. Wash hands thoroughly before preparing 
+food. 
+
+
+HEPATITIS A (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+6. Clean toilet facilities thoroughly and wash 
+hands afterward. 
+7. Discourage children from putting non-
+food items into their mouths since these 
+items may be a source of the virus. 
+ 
+Who should be excluded? 
+Persons with hepatitis A (or suspected 
+hepatitis A) should be excluded from daycare 
+centers, food-handling occupations, and direct 
+care of hospitalized and institutionalized 
+patients for one week after the onset of 
+symptoms (jaundice) or hepatitis A has been 
+ruled out.  A Public Health Professional will 
+advise individuals  regarding specific 
+recommendations. 
+ 
+Reportable? 
+Yes, hepatitis A is reportable by New 
+Hampshire law to the Division of Public 
+Health Services, Bureau of Infectious Disease 
+Control at (603) 271-4496. 
+It is important that cases associated with a 
+childcare center be reported as soon as 
+possible.  A Public Health Professional will 
+give specific recommendations for 
+immunization of the people exposed. 
+

Text_Files/Hepatitis_B.txt

@@ -0,0 +1,90 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+HEPATITIS B 
+ 
+Hepatitis B is a disease primarily of the liver caused 
+by the hepatitis B virus. 
+ 
+Who gets this disease? 
+In the United States, hepatitis B is primarily a 
+disease of young adults.  Children can be infected 
+during childbirth if the mother has the virus in her 
+blood. 
+ 
+How is it spread? 
+Only blood, semen, vaginal fluids and saliva have 
+been shown to be infectious.  Most cases are 
+transmitted by blood (i.e., getting blood from an 
+infected person into the open skin or the eye, nose 
+or mouth of anot her person), or through sexual 
+contact. Note:  salivary transmission has rarely 
+occurred and generally through bites . The Hepatitis 
+virus can live on the surface of objects for 7 days or 
+more.  
+ 
+What are the signs and symptoms? 
+Hepatitis B signs and sympto ms include loss of 
+appetite, tiredness, abdominal pain, nausea, 
+vomiting, and sometimes rash or joint pain.  
+Jaundice (yellowing of eyes or skin), may be 
+present in adults but it is often absent in children.  
+Symptoms vary from none at all to severe illness. 
+ 
+Can a person have this disease without 
+knowing it? 
+Yes.  Some people may not have the illness serious 
+enough to seek medical attention.  People who 
+contract hepatitis B may become chronic carriers of 
+the virus and continue to be infectious for life 
+especially if they are infected as young children. 
+ 
+What is the treatment? 
+No medical treatment is effective for acute hepatitis 
+B.  Most adults recover from hepatitis B without 
+intervention. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Hepatitis B vacci ne is required  for all 
+children in childcare  and school attendance 
+for all children born after January 1, 1993.    
+The Advisory Committee on Immunization 
+Practices (ACIP), recommends immunizing 
+children against hepatitis B. The three dose 
+series should be completed at birth, 1- 2 
+months of age, and 6- 18 months of age. 
+(Please see Immunization requirements page 
+for adult immunization recommendations). 
+2. Standard precautions should be in effect at 
+all times.  Disposable gloves should be used 
+when dealing with an y bodily fluids 
+(blood/body fluid- soiled items, surfaces or 
+clothing), when administering first aid (nose 
+bleeds, cuts, scrapes, etc). 
+3. Disinfect surfaces and objects that are 
+contaminated with blood or other body 
+fluids containing visible blood.  One -part 
+bleach to 10 parts of water can be used as a 
+disinfectant for cleaning contaminated 
+surfaces.  The bleach mixture must be 
+changed daily. 
+4. Wash hands immediately after contact with 
+blood or other body fluids containing visible 
+blood, even if gloves have been worn. 
+ 
+Who should be excluded? 
+Children and staff who have the hepatitis B virus in 
+their blood may attend and/or work in childcare and 
+schools.  Hepatitis B carrier children with risk 
+factors (e.g., biting, frequent scratching, generalized 
+dermatitis) sh ould be assessed for exclusion on an 
+individual basis. 
+ 
+ 
+Reportable? 
+Yes.  Hepatitis B is reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease Control  at (603) 271-
+4496.  
+
+

Text_Files/Impetigo.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+IMPETIGO 
+ 
+Impetigo is a very common skin infection caused 
+by streptococcal or staphylococcal bacteria.  It 
+may start at an injured spot on the skin, such as an 
+insect bite, cut or burn.  Bacteria can easily be 
+spread by the person’s hands to other areas of the 
+body.  In children, the face is often involved.  The 
+rash appears red, is elevated and may secrete fluid.  
+The rash may have a flat honey-colored crust.  The 
+area may be itchy.  The staph bacteria can cause 
+blisters that break easily and leave raw r ed skin 
+exposed.  Impetigo caused by strep bacteria can be 
+associated in very rare circumstances with the 
+development of a kidney disease.  Impetigo is 
+most commonly seen in the warm summer 
+months. 
+ 
+Who gets this disease? 
+Ordinarily the skin protects the body from 
+bacteria.  When the skin is broken (i.e., cut, 
+scraped, bitten, scratched), bacteria can get under 
+the surface, multiply and cause an infection. 
+ 
+Children – who typically touch everything and 
+wash only under duress – are likely to have 
+multiple cu ts and scrapes on their bodies at all 
+times, which make them more vulnerable to 
+impetigo than adults.  Most children have 
+impetigo at least a few times during their growing 
+up years; adults can get it as well. 
+ 
+How is it spread? 
+The bacteria are under, on and in the infected skin, 
+and they are shed into the secretions and crusts.  
+They can be spread to another person who directly 
+touches the infected skin or a surface 
+contaminated by the secretions or crusts.  If the 
+bacteria then gets under the top protect ive skin 
+layer of the second person, they multiply and 
+cause infection. 
+ 
+The incubation period for this disease is variable:  
+Staph infections 4- 10 days, Strep infections 1- 3 
+days. 
+ 
+How is it diagnosed and treated? 
+Most of the time, impetigo can be diagnos ed by 
+the way it looks.  Bacterial cultures are not usually 
+needed.  Strep and staph impetigo may look the 
+same, although staph tends to cause blisters more 
+often. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. If children hurt themselves and cause 
+breaks in the skin, wash the area 
+thoroughly with soap and water and dry 
+carefully. 
+2. If you think a child may have impetigo: 
+a. Wash the rash with soap and water 
+and cover it loosely with gauze, a 
+bandage, or clothing. 
+b. Be sure anyone who touches the 
+rash wears dis posable gloves 
+carefully. 
+c. Dispose of any soiled tissues, 
+bandages and gloves carefully.  
+Keep any dirty clothing in a plastic 
+bag and give to the parent for 
+laundering at home. 
+3. Ask the parents to have the child seen by 
+his/her healthcare provider. Keep 
+children’s finger nails short as to prevent 
+damage from scratching.  
+ 
+Who should be excluded? 
+It is recommended that untreated children and 
+staff be excluded from the childcare facility until 
+24-hours after they have begun treatment. 
+ 
+Reportable? 
+No.  Impetigo is not reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease Control .  However, 
+Public Health Professionals are available for 
+consultation at (603) 271-4496. 
+
+

Text_Files/Lyme_Disease.txt

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+LYME DISEASE (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+LYME DISEASE 
+ 
+Lyme disease is caused by a bacterium, Borrelia 
+burgdorferi.  In New England it is transmitted by 
+a certain type of tick, commonly called the deer 
+tick or black -legged tick (scientific name: 
+Ixodes 
+scapularis).  Lyme disease may cause sympt oms 
+affecting the skin, nervous system, heart and/or 
+joints of an individual.  The NH Department of 
+Health & Health Services made Lyme disease 
+reportable in October 1990.  During recent years, 
+the incidence of Lyme disease has increased in 
+New Hampshire. 
+ 
+Who gets this disease? 
+The bacterium that causes Lyme disease is 
+transmitted within the natural cycle of the deer 
+tick, which feed on animals such as mice, 
+opossums, dogs and deer.  Certain stages of the 
+tick – especially the nymph and adult – can feed 
+on a human; if the tick is infected with the 
+bacteria it can cause infection in people.  Cases of 
+Lyme disease have also been reported in domestic 
+animals.  There is no evidence that Lyme disease 
+is transmitted from person to person.  For 
+example, a person ca nnot get infected from 
+touching, kissing, or having sex with a person 
+who has Lyme disease.  Lyme disease acquired 
+during pregnancy may lead to infection of the 
+placenta and possible stillbirth.  However, no 
+negative effects on the fetus have been found 
+when the mother receives appropriate antibiotic 
+treatment.  There are no reports of Lyme disease 
+transmission from breast milk.   
+ 
+People who spend time in wooded or grassy areas, 
+including areas around the home, are at greater 
+risk of Lyme disease.  Althoug h persons of all 
+ages and gender are susceptible to Lyme disease, 
+it is most common among children aged 5- 9 and 
+adults aged 55-59.  Most cases of Lyme disease 
+occur between April and October. Current data 
+indicates that it is possible for someone to get 
+Lyme disease more than once. 
+ 
+What are the symptoms? 
+The illness usually occurs during the summer 
+months and generally starts as a large circular 
+reddish expanding rash around or near the site of 
+the tick bite.  (NOTE: In some cases, a rash may 
+not occur).  Multiple rash sites may occur.  
+During the rash stage, or occasionally prior to the 
+rash, other symptoms such as fever, headache, 
+fatigue, stiff neck and muscle and/or joint pain 
+may be present.  These may last for several 
+weeks.  If left untreated – within a few weeks to 
+months after the rash onset – complications such 
+as meningitis and heart abnormalities may occur 
+and other body systems may be affected.  
+Swelling and pain in the large joints may recur 
+over many months or years. 
+ 
+How soon do symptoms appear? 
+Symptoms usually begin within a month of a tick 
+bite, generally 3-32 days. 
+ 
+What is the treatment? 
+Current therapy includes the use of antibiotics.  
+Early diagnosis improves the outcome of 
+treatment. 
+ 
+How can the spread of this disease be 
+prevented? 
+Special precautions to prevent exposure to ticks 
+should be used.  Apply insect repellent containing 
+greater than 20% DEET, on clothes and exposed 
+skin.  Clothes (especially pants, socks, and shoes) 
+may be treated with permethrin, which kills ticks 
+on contact.  Permethrin can also be used on tents 
+and some camping gear.  Do not use permethrin 
+directly on skin .  Always follow the 
+manufacturer’s instructions when applying any 
+repellents.  Long pants and long sleeves help keep 
+ticks off skin.  Pant legs may be tucked into socks 
+or boots and shirt into pants to keep ticks on the 
+outside of clothing.  After being outdoors, wash 
+and dry clothing at a high temperature to kill any 
+
+
+LYME DISEASE (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ticks that may remain on clothing.  Perform tick 
+checks after being outdoors.  Early removal of 
+ticks can reduce the risk of infection. If a tick is 
+attached to the skin for less than 24 hours, the 
+chance of getting Lyme disease is extremely 
+small.  Landscaping to reduce tick habitats and 
+prevent deer and rodents around the home may be 
+helpful. 
+ 
+How should a tick be removed? 
+To remove an attached tick, grasp it with one of 
+the tick -removal tools found in stores or fine -
+tipped tweezers as close as possible to the 
+attachment site (i.e., skin) and pull upward and 
+out with a firm and steady pressure. 
+ 
+Do not handle the tick with bare hands , if using 
+your fingers to remove a tick be sure to use a 
+disposable towel when removing the tick.  Be 
+careful not to squeeze, crush, or puncture the body 
+of the tick, which may contain infectious fluids.  
+After re moving the tick, thoroughly cleanse the 
+area with an antiseptic.  Seek medical attention if 
+there is a concern about incomplete tick removal. 
+ 
+Do not attempt to remove ticks by using Vaseline, 
+lit cigarettes, or other home remedies; doing so 
+may actually increase the chances of contracting a 
+tick-borne disease. 
+ 
+Who should be excluded? 
+Exclusion is not necessary since the disease is not 
+spread from person-to-person. 
+ 
+Reportable? 
+Yes.  Lyme disease is reportable by New 
+Hampshire law to the Division of Public  Health 
+Services, Bureau of Infectious Disease Control  at 
+(603) 271-4496. 
+

Text_Files/MRSA.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+MRSA SKIN INFECTIONS 
+ 
+A frequent cause of skin infections is a bacteria 
+called Staphylococcus aureus (Staph).  Most of 
+these skin infections are minor.  However, staph 
+bacteria can also cause more serious infections 
+such as pneumonia and bloodstream infe ctions.  
+Some staph bacteria are resistant to certain 
+antibiotics and are known as MRSA (methicillin -
+resistant Staphylococcus aureus). 
+ 
+What is a MRSA skin infection? 
+A MRSA skin infection can be a pimple, rash, 
+boil, or an open wound.  MRSA is often 
+misdiagnosed as spider bites.  MRSA bacteria are 
+commonly found on the skin of healthy persons.  
+MRSA infections often begin with an injury to the 
+skin.  Symptoms of MRSA infection include 
+redness, warmth, swelling, tenderness of the skin, 
+and boils or blisters.  Sometimes it does not cause 
+any problems; sometimes it causes minor 
+infections, such as pimples or boils.  If left 
+untreated, it can cause serious infections. 
+ 
+How do MRSA skin infections spread? 
+MRSA lives on skin and survives on objects for 
+24 hours or more.  MRSA can rub off on the skin 
+of an infected person onto the skin of another 
+person during rigorous skin- to-skin contact.  Or, 
+the MRSA bacteria can come off of the infected 
+skin of a person onto a shared object, and get onto 
+the skin of the next person who uses it.  Examples 
+of commonly shared objects include towels, soap, 
+razors and athletic equipment. 
+ 
+How can I prevent myself or my family 
+members from getting infected? 
+Wash your hands with soap and warm water.  
+Keep cuts and scrapes clean with s oap and water.  
+Avoid skin contact and sharing personal items 
+with anyone you suspect could have a MRSA skin 
+infection.  When using protective gloves to treat  
+the infected area, remove and dispose of them 
+properly; wash your hands with soap and water.  
+Do not share personal items with other persons. 
+ 
+What should I do if I think I have a skin 
+infection?
+ 
+Consult your healthcare provider as soon as 
+possible if you think you have a skin infection.  
+Early treatment can help you prevent the infection 
+from getting worse.  Be sure to follow directions 
+from your doctor or healthcare provider closely, 
+even when you start to feel better.  Not taking all 
+of your antibiotics leads to stronger, antibiotic -
+resistant bacteria. 
+ 
+If my healthcare provider told me that I 
+have a MRSA skin infection, how do I 
+keep others from getting infected? 
+• Keep the infected area covered with clean, 
+dry bandages.  Pus from infected wounds 
+is very infectious. 
+• Wash your hands frequently with soap and 
+warm water, especially after changing 
+your b andages or touching the infected 
+skin. 
+• Regularly clean your bathroom, kitchen, 
+and all other rooms, as well as your 
+personal items.  Wash clothes and other 
+items that become soiled with hot water or 
+bleach, when possible. 
+• Drying clothes in a hot dryer, rat her than 
+air-drying them also helps to kill bacteria 
+in clothes. 
+• Tell any healthcare provider that treats you 
+during the infection that you have an 
+MRSA skin infection. 
+ 
+Reportable? 
+No.  MRSA is not reportable by New Hampshire 
+law to the Division of Public  Health Services, 
+Bureau of Infectious Disease Control .  However, 
+Public Health Professionals are available for 
+consultation at 603-271-4496.   
+
+
+MRSA SKIN INFECTION (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+For further information, refer to the Centers for 
+Disease Control & Prevention website at 
+www.cdc.gov
+  or the NH Department of Health & 
+Human Services website at www.dhhs.nh.gov . 
+ 
+

Text_Files/Measles.txt

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+MEASLES (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+MEASLES 
+ 
+ 
+Measles (aka, rubeola, red measles or hard 
+measles) is a very communicable viral illness that 
+can be prevented by immunization.  Usually it 
+causes a rash, high fever, cough, runny nose and 
+watery eyes.  The disease lasts one to two weeks.  
+Measles may be complicated by an ear infection 
+or pneumonia.  One out of every 1,000 children 
+who gets measles develops an inflammation of the 
+brain (i.e., encephalitis).  Encephalitis can lead to 
+convulsions, deafness or mental retardation.  
+Approximately one  child in every 10,000 who 
+gets measles dies from it. 
+ 
+Who gets this disease? 
+Measles cases are generally limited to three 
+groups: 1) children less than 15 months of age 
+(who are too young to have been immunized), 2) 
+those over 15 months of age but remain 
+unvaccinated and 3) adolescents and young adults 
+who may have received an earlier ineffective 
+measles vaccine prior to 1968 OR graduated from 
+school prior to the mandatory measles vaccination 
+law OR who have received only one dose of live 
+virus measles vaccine.  Adults born prior to 1957 
+are generally considered to be immune against 
+measles. 
+ 
+How is it spread? 
+Susceptible individuals spread measles by large 
+infectious droplets or direct contact with the nasal 
+or throat secretions of infected persons.  Inhal ing 
+air that has tiny infectious droplets from sneezes 
+and coughs also can spread it.  
+Measles is one of 
+the most readily transmissible communicable 
+diseases.  The communicable period is greatest 
+prior to or just after rash onset. 
+What are the symptoms? 
+The first signs and symptoms of measles – which 
+appear approximately 10 -days after exposure –  
+are similar to the common cold: cough, runny 
+nose, fever greater that can reach as high as  103-
+105 degrees Fahrenheit, and red and watery eyes.  
+After these cold -like symptoms a rash develops, 
+typically beginning on the face and then spreading 
+downward over the entire body.  This rash lasts 4 -
+10 days. Infected persons may also experience 
+loss of appetite or diarrhea.  
+ 
+Infected persons are contagious from the 
+appearance of the first cold symptom to four days 
+after the appearance of the rash.  A small 
+percentage of immunized children may become 
+infected if their bodies fail to respond adequately 
+to the vaccine. 
+ 
+How can the spread of this disease be 
+prevented? 
+The Advisory Committee on Immunization 
+Practices (ACIP) recommends that children be 
+immunized against measles between 12 to 15 
+months of age.  Children who are immunized 
+before 12 months of age need to be re-immunized. 
+ 
+Children 15 months and older are required  to 
+have one dose of measles vaccine for daycare and 
+school admittance.  A second dose of measles 
+vaccine is required between 4-6 years of age. 
+ 
+Who should be excluded? 
+Children and staff with measles shall be excluded 
+from the school or work for at least four days after 
+the appearance of the rash.  If children are 
+unimmunized for medical, religious or other 
+reasons they should be excluded for at least 2 
+weeks after the onset of the rash in the last case of 
+measles reported in the child care setting. 
+
+
+MEASLES (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+Reportable? 
+Yes.  Measles is reportable immediately  by New 
+Hampshire law to the Division of Public Health 
+Services, Bureau of Infectious Disease and 
+Control at (603) 271-4496.  
+

Text_Files/Meningococcal_Illness.txt

@@ -0,0 +1,134 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+MENINGOCOCCAL ILLNESS 
+ 
+Meningococcal Illnesses are caused by a 
+bacterium called Neisseria meningitidis (N. 
+meningitidis) and are serious, sometimes fatal 
+illnesses.  The most common illness is meningitis, 
+an infection of the coverings of the brain.  
+Meningitis caused by N. meningitidis  must be 
+treated immediately with hospitalization and IV 
+(intravenous) antibiotics.  The disease usually 
+starts suddenly with fever, chills, and lethargy 
+(i.e., a feeling of tiredness) and a rash with fine 
+red “freckles” or purple splotches.  With 
+meningitis, older children and adults may 
+complain of severe headache, neck pain and neck 
+stiffness.  In younger children, unusual irritability, 
+poor appetite, excessive and high- pitched crying, 
+vomiting and fever may be seen. 
+ 
+Who gets this disease? 
+Meningococcal illnesses affect children less than 
+5 years primarily affecting infants less than 24 
+months.  It peaks again in adolescents 16-21 years 
+of age.  There is a high incidence N. meningitidis  
+with people living in crowded living conditions 
+such as barracks and institutions.  Freshman 
+college students living in dormitories have a 
+higher incidence than other college students not 
+living in dorms.  This illness can affect any age 
+group. 
+ 
+How is it spread? 
+The bacterium is passed from  person to person 
+when they are in very close contact.  It is spread 
+through infectious droplets of respiratory tract 
+secretions (e.g., sneezing, coughing, nasal 
+discharge, saliva).  It can also be passed if people 
+touch infected secretions then put their hands in 
+their noses, eyes or mouths.  However, the 
+bacteria cannot live on environmental surfaces – 
+they quickly shrivel and die. 
+People can carry the germs, without knowing it, in 
+their noses, mouths or throats without ever getting 
+sick themselves.  Thi s is called “carrying” the 
+germ or being a “carrier”.  The germs can be 
+spread from carriers to other people who may then 
+develop a meningococcal illness.  Obviously, sick 
+people can also pass the germs on. 
+ 
+The time from exposure to illness can be from 2-
+10 days, but it is usually one to four days.  After 
+one infection has occurred in a facility, there will 
+be more than the usual number of people carrying 
+the germ, so the risk of spread and serious disease 
+becomes greater. 
+ 
+How is it diagnosed and treated? 
+Meningococcal infections are diagnosed by signs 
+and symptoms and by examining a sample of 
+blood and/or spinal fluid for white blood cells and 
+bacteria.  Spinal fluid is obtained by a physician, 
+who performs a lumbar puncture (i.e., spinal tap). 
+ 
+People wi th these infections almost always 
+require hospitalization and are treated with 
+antibiotics for 5-7 days. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Meningititis Conjugate Vaccine is 
+recommended for all children 11 -12 years 
+of age.  It is also recomm ended for all 
+children 13-18 years of age who have not 
+been previously vaccinated.  Unvaccinated 
+college freshmen living in a dormitory 
+should be vaccinated. 
+2. Meningitis Quadrivalent vaccine is 
+available for children 2 years old and 
+older. 
+3. If a person devel ops a meningococcal 
+illness in a childcare center, all parents and 
+staff must be notified immediately. 
+
+
+MENINGOCOCCAL ILLNESS (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+4. If a person develops a meningococcal 
+illness, close contacts of this patient 
+(including family members and person 
+having intimate contact such as sleepin g 
+together, hugging and kissing) are at 
+increased risk of developing the illness.  In 
+this situation, a physician or public health 
+professional may recommend: 1) watching 
+for early symptoms of meningococcal 
+illness, and/or 2) taking a preventive 
+antibiotic to eliminate the bacteria from 
+the body before disease begins. 
+5. Any child or adult who is a close contact 
+and who develops symptoms such as fever 
+or headache require prompt evaluation by 
+a healthcare provider regardless  of 
+whether or not this person has ta ken the 
+preventive antibiotic. 
+6. Monitor the situation closely for two to 
+three weeks.  Make sure all ill children are 
+seen by their doctors and that you are 
+notified if another person develops 
+meningococcal disease. 
+7. Notify parents or guardians about the 
+occurrence of this illness and urge them to 
+contact their healthcare provider  for 
+specific medical advice. 
+8. Childcare centers should contact the NH 
+Department of Health & Human Services, 
+Bureau of Infectious Disease and Control  
+for recommendations about preventing 
+spread of this illness and for assistance in 
+implementing them. 
+ 
+Who should be excluded? 
+Children with meningococcal disease are too ill to 
+attend childcare.   
+ 
+Reportable? 
+Yes.  Meningococcal illnesses are reportable by 
+New Hampshire law to the NH De partment of 
+Health & Human Services, Bureau of Infectious 
+Disease and Control at (603) 271-4496.  
+

Text_Files/Mumps.txt

@@ -0,0 +1,70 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+MUMPS 
+ 
+Mumps is a viral illness that usually causes 
+swelling and tenderness of the salivary glands, 
+particularly the gland at the angle of the jaw.  
+Headache, slight fever and earache are common.  
+Possible complications includ e Meningitis (an 
+inflammation of the coverings of the brain and 
+spinal cord), Encephalitis (an inflammation of the 
+brain), deafness and, particularly in adolescent or 
+adult males, inflammation of the testicles.  Mumps 
+during pregnancy can result is loss of the fetus. 
+ 
+Who gets this disease? 
+Mumps may be seen in unimmunized children, or 
+adolescents and young adults who graduated from 
+school prior to laws requiring mumps 
+immunization.  Most adults born before 1957 
+have been infected by exposure to the disease and 
+are probably immune. 
+ 
+How is it spread? 
+The mumps virus is found most often in saliva.  It 
+is transmitted by direct contact or by droplet 
+spread of the virus in the air through sneezes and 
+coughs.  Mumps is most infectious 48 hours prior 
+to the onset of symptoms. 
+ 
+What are the symptoms? 
+The most common symptoms are: 1) fever with 
+headache and earache,  loss of appetite  and 2) 
+swollen glands in front of and below the ear. 
+ 
+Symptoms appear 12 -25 days after exposure.  
+Infected persons are contagious from 1- 2 days 
+before to 5 days after swelling begins.  A small 
+percentage of immunized children may be 
+infected with mumps if their bodies fail to 
+respond adequately to the vaccine. 
+How can the spread of this disease be 
+prevented? 
+The national Advisory Committee on 
+Immunization Practices ( ACIP) recommends that 
+children be immunized against mumps.  This is 
+frequently combined with measles and rubella 
+vaccine, which is required for childcare and 
+school attendance. Children should receive this 
+vaccine between 12 -15 months of age and again 
+between 4-6 years of age.  
+ 
+Who should be excluded? 
+A child or staff member with mumps should not 
+return until five  days after the onset of swelling.  
+Any susceptible , unvaccinated child or staff 
+member at a childcare center shall not return to 
+the center unti l 26 days after onset of parotid 
+gland inflammation in the last person with mumps 
+in the center.  Any person so excluded may return 
+to the center immediately if he/she receives 
+mumps vaccine. 
+ 
+Reportable? 
+Yes.  Mumps is reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease Control  at (603) 
+271-4496. 
+
+

Text_Files/Norovirus.txt

@@ -0,0 +1,105 @@
+NOROVIRUS (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+NOROVIRUS 
+ 
+What is Norovirus? 
+Noroviruses are a group of viruses that cause the 
+“stomach flu”, or gastrointestinal (stomach or 
+digestive) illness.  Norovirus infection occurs 
+occasionally in only one or a few people or it can 
+be responsible for large out breaks, such as in 
+long-term care facilities. 
+ 
+Who gets Norovirus? 
+Norovirus infects people of all ages worldwide 
+and anyone can become infected.  There are many 
+different strains of norovirus, which makes it 
+difficult for a person’s body to develop long 
+lasting immunity.  Therefore, Norovirus illness 
+can reoccur through a person’s lifetime.  In 
+addition, because of differences in genetic factors, 
+some people are more likely to become infected 
+and develop more severe illness than others. 
+ 
+How does someone get Norovirus? 
+Norovirus is spread from person to person via 
+fecal-oral route, but can also be spread through 
+the air during vomiting.  Good hand washing is 
+the most important way to prevent the 
+transmission of Norovirus.  Outbreaks have been 
+linked to sick food handlers, ill healthcare 
+workers, cases in facilities such as nursing homes 
+spreading to other residents, contaminated 
+shellfish, raw or unpasteurized milk, and water 
+contaminated with sewage. 
+ 
+What are the symptoms of Norovirus? 
+The most common symptoms include nausea, 
+vomiting, watery diarrhea, and stomach cramps.  
+Fever is usually low grade or absent.  Infected 
+people generally recover in 24- 60 hours  and 
+serious illness rarely occurs.   
+ 
+ 
+ 
+ 
+How soon after exposure do symptoms 
+appear? 
+Symptoms of Norovirus illness usually begin 
+about 24 –48 hours after ingestion of the virus. 
+ 
+How is Norovirus infection diagnosed? 
+Laboratory diagnosis can be performed in the 
+New Hampshire Public Health Laboratories when 
+there are multiple cases.  Diagnosis is often b ased 
+on the combination of symptoms and the short 
+time of the illness. 
+ 
+What is the treatment for Norovirus 
+infection? 
+No specific treatment is available.  People who 
+become dehydrated might need to be rehydrated 
+by taking liquids by mouth.  Occasionally, a 
+patient may need to be hospitalized to receive 
+intravenous fluids. 
+ 
+How can Norovirus be prevented? 
+While there is no vaccine for Norovirus, there are 
+precautions people should take: 
+ Wash hands with soap and warm water 
+after using the bathroom and changi ng 
+diapers 
+ Wash hands with soap and warm water 
+before preparing or eating any food 
+ Cook all shellfish thoroughly before eating 
+ Wash raw vegetables before eating 
+ Dispose of sewage in a sanitary manner 
+ 
+Who should be excluded? 
+Food handlers, healthcare worke rs and childcare 
+workers should be excluded for 48 hours after 
+resolution of symptoms.  Children with non -
+specific diarrhea should be excluded until 
+symptoms resolve. 
+
+
+NOROVIRUS (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+Reportable? 
+No. Norovirus is not reportable by New 
+Hampshire state law to the Division o f Public 
+Health Services, Bureau of Infectious Disease 
+Control.  However, Public Health Professionals 
+are available for consultation at (603) 271-4496. 
+For further information, refer to the Centers for 
+Disease Control and Prevention website at: 
+ https://www.cdc.gov/
+  
+Or the NH Department of Health & Human 
+Services website at: 
+ https://www.dhhs.nh.gov/
+  
+ 
+

Text_Files/Oral_Herpes.txt

@@ -0,0 +1,69 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ORAL HERPES (aka, Cold Sores) 
+ 
+Oral herpes – which is also referred to as cold 
+sores – is caused by a virus call herpes simplex 
+type 1.  This infection is commonly acquired for 
+the first time in early childhood and may reappear 
+throughout a person’s lifetime. 
+ 
+Who gets this disease? 
+Anyone can get oral herpes. 
+ 
+How is it spread? 
+Oral herpes is spread through close person- to-
+person contact such as direct contact with saliva 
+or the sores (e.g., kissing). 
+ 
+What are the symptoms? 
+There are initial infections and in some people 
+recurrent sores (fluid -like blisters).  In young 
+children the initial infections may not cause any 
+symptoms or can involve many sores within the 
+mouth, on the cheeks, lips and/or gums.  The 
+sores will crust and heal within a few days.  I f the 
+sores within the mouth are extensive, children can 
+run a fever and refuse to drink or eat. 
+ 
+How soon do the symptoms appear? 
+In initial infections, it takes from 2 to 14 days 
+from the time a person is exposed until the sores 
+become apparent.  Recurrent sores occur in 
+individuals when the virus becomes active after 
+being dormant. 
+ 
+What is the treatment? 
+Most cold sores heal in 3- 4 days without 
+treatment.  There are ointments and medications 
+available that may shorten the healing time but 
+there is no cure for oral herpes.  It is best to check 
+with your physician to see if treatment is 
+indicated. 
+How can the spread of this disease be 
+prevented? 
+1. Frequent hand washing. 
+2. Caregivers should wear gloves when 
+contact with sores is necessary (e.g., when 
+applying medication). 
+3. Clean and disinfect mouthed toys daily or 
+when soiled. 
+4. Do not kiss an infected person when 
+lesions are present. 
+ 
+Who should be excluded? 
+No exclusion is necessary for mild oral herpes 
+in children who are in control of their mouth 
+secretions.  Exclude children who do not have 
+control of oral secretions when active sores 
+are present inside the mouth. 
+ 
+Reportable? 
+No.  Oral herpes is not reportable by New 
+Hampshire law to the Division of Public 
+Health Services, Bureau of Infectious Disease 
+and Control .  However, Public Health 
+Professionals are available for consultation at 
+(603) 271-4496. 
+
+

Text_Files/Pediculosis_Head_Lice.txt

@@ -0,0 +1,205 @@
+PEDICULOSIS CAPITIS (Head Lice) CONT. 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+PEDICULOSIS CAPITIS (Head Lice) 
+ 
+Head lice are tiny insects that live only on 
+people’s scalps and hair.  The adults hatch from 
+small eggs, called nits, which are attached to the 
+individual hairs near the scalp.  Nits may be found 
+throughout the hair, but  are most often located at 
+the back of the scalp, behind the ears and the top 
+of the head.  The eggs hatch in 10- 14 days, with 
+new lice reaching adulthood in about 10 days.  
+The female louse can live for 21-30 days, and lays 
+about six to eight eggs a day.  The lice live by 
+biting and sucking blood from the scalp. 
+ 
+The major symptom of head lice is itching caused 
+by the bite of the louse.  Persistent scratching of 
+the head and back of the neck should be viewed 
+with suspicion.  Often red bite marks and scratc h 
+marks can be seen on the scalp and neck and a 
+secondary bacterial infection causes discharge and 
+crusting.  Swollen neck glands can also occur  
+related to an infection from scratching. 
+ 
+Who gets this disease? 
+Contrary to popular belief, head lice are not a sign 
+of unclean people or homes.  They can occur at 
+any age and to either sex.  Anyone who has close 
+contact with an infected person or shares personal 
+items can become infested. 
+ 
+How is it spread? 
+Lice do not jump or fly.  They cannot be caught 
+from gra ss, trees, or animals.  They are spread 
+only by crawling from person- to-person directly 
+or onto shared personal items, such as combs, 
+brushes, head coverings, clothing, bedding and 
+towels.  Frequent bathing or shampooing will not 
+prevent lice or eliminate them once they are 
+established. 
+ 
+How is it diagnosed and treated? 
+Lice are less than 1/8 -inch long and are usually 
+light brown in color.  They avoid light, which 
+makes it difficult to see them.  The diagnosis is 
+most often made by finding nits within a ¼ -inch 
+of the scalp.  Nits are tiny, plump, pearl gray 
+colored; oval -shaped specks attached to the hair 
+and cannot be easily moved up or down the hair 
+(as could specks of dandruff).  It helps to use a 
+magnifying glass and natural light when searching 
+for them.  The best places to look are the hair on 
+the back of the neck, behind the ears and the top 
+of the head.  Hatched eggs can be found further 
+out on the hair shaft and are snow -white and 
+conspicuous. 
+ 
+Treatment is directed at getting rid of the lice 
+from bo th the infested person and his/her 
+surrounding and personal items.  All household 
+members and persons with close physical contact 
+with the infested person should be examined for 
+lice and treated if infested (live lice are seen).  
+Some healthcare providers may simultaneously 
+treat all members of a household. 
+ 
+Treating the infested person. 
+Consult a physician before treating:  (1) infants, 
+(2) pregnant or nursing women, or (3) anyone 
+with extensive cuts or scratches on the head or 
+neck.  For others, there are  several medicines 
+available to kill head lice.  They are used like 
+shampoo.  Many head lice medications are 
+available at your local drug store without 
+prescription and some products are available by 
+prescription.  All of these products must be used 
+carefully and according to direction. 
+ 
+There are several over -the-counter (OTC) name 
+brand products which include A -2000 Pronto, 
+R&C, Rid and Triple X that all contain the active 
+ingredient Pyrethrins.  Pyrethrins are natural 
+extracts from the chrysanthemum flower.  Though 
+safe and effective, pyrethrins only kill  crawling 
+lice, not unhatched nits.  A second treatment is 
+recommended in 7- 10 days to kill any newly 
+hatched lice.  Treatment failures are common. 
+ 
+
+
+PEDICULOSIS CAPITIS (Head Lice) cont. 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+Nix is another commonly available OTC 
+medication that c ontains the active ingredient 
+Permethrin.  Permethrin is safe and effective and 
+may continue to kill newly hatched lice for 
+several days after treatment.  A second treatment 
+may be necessary in 7 -10 days to kill any newly 
+hatched lice that may have hatched  after residual 
+medication from the first treatment was no longer 
+active.  Treatment failures are common. 
+ 
+Prescription medications used to treat head lice 
+include Lindane (Kwell) and Malathion (Ovide).  
+Consult with your healthcare provider on the 
+proper use of these prescription medications.  For 
+these medications, retreats in 7 -10 days ONLY if 
+crawling bugs are found. 
+ 
+Although these products will kill lice, none will 
+kill 100% of the nits.  Nit removal after 
+shampooing may be time -consuming and difficult 
+due to their firm attachment to the hair.  A 
+solution of vinegar and water may help make 
+removal easier.  Special, fine- tooth combs can be 
+used to aid in nit removal.  Most treatment 
+requires retreatment in 7 -10 days.  A daily nit 
+check for the next ten days is advisable.  If there 
+is evidence of new nits (less than ¼ -inch from the 
+scalp) or newly hatched lice, it may be necessary 
+to repeat treatment.  (NOTE:  Unless reinfection 
+occurs, more than two treatments are unnecessary 
+and can be dangerous). 
+ 
+Treating the surroundings/personal 
+items in the childcare center. 
+Head lice can only survive 24-48 hours if they fall 
+off a person and cannot feed.  You don’t need to 
+spend a lot of time or money on cleaning 
+activities.  Follow these steps to help avoid re -
+infestation by lice that have recently fallen off the 
+hair or crawled onto clothing or furniture. 
+1. Machine-wash in HOT water all washable 
+items belonging to the daycare facility that 
+may contain lice. 
+2. Non-washable (e.g., furry toys, pillows) 
+can be put in a HO T dryer for 20 -minutes 
+or dry-cleaned. 
+3. Things that cannot be washed, dried, or 
+dry-cleaned can be sealed in a plastic bag 
+for two weeks, the duration of the life 
+cycle of the louse. 
+4. Soak combs and brushes for 1 hour in 
+rubbing alcohol, Lysol™, or wash with 
+soap and hot (130  F) water. 
+5. Vacuum the floor and furniture.  The risk 
+of getting re-infested from a louse that has 
+fallen onto the carpet or sofa is very small. 
+6. Insecticide sprays are not recommended 
+and can be harmful to people and animals. 
+ 
+How can the  spread of this disease be 
+prevented? 
+1. General cleanliness at the center, as 
+previously outlined, should be practiced. 
+2. Children should not share personal items 
+such as clothing, brushes, combs, hats, etc. 
+3. Each child should have his/her own crib 
+mat and should not switch. 
+4. Children’s personal belongings should be 
+stored separately. 
+5. Caregivers should learn to recognize nits 
+and should help regularly check children’s 
+hair when there is a known case of head 
+lice in the center. 
+6. If a case is identified, the center should 
+follow cleaning procedures outlined 
+above. 
+ 
+Who should be excluded? 
+Routine exclusion of school -aged children with 
+head lice is not recommended.   The child’s 
+parents or guardian should be notified when head 
+lice is identified by a care provider or t eacher.  
+The child’s parent or guardian should be 
+telephoned/emailed or a note sent home with the 
+child at the end of the school day
+ stating that 
+prompt, proper treatment of this condition is in 
+the best interest of the child and his/her 
+
+PEDICULOSIS CAPITIS (Head Lice) cont. 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+classmates.  A chi ld should be allowed to return 
+to school after proper treatment even if nits are 
+still present.  “No Nits Policies” are not effective 
+and should be discouraged.  Mass screenings are 
+also not recommended but close contact s should 
+be checked ideally.   
+ 
+Children in preschool or daycare settings who 
+have visible live lice may need to be excluded 
+only if direct head to head contact cannot be 
+avoided. 
+ 
+Reportable? 
+No.  Pediculosis is not reportable by New 
+Hampshire law.  However, the Bureau of 
+Infectious Disease Control professionals are 
+available for consultation at (603) 271-4496.  
+

Text_Files/Pertussis_Whooping_Cough.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+PERTUSSIS (Whooping Cough) 
+ 
+ 
+Pertussis is a very contagious bacterial infection of 
+the respiratory tract.  Usually it causes a persistent 
+cough that follows a normal cold.  The child has 
+episodes of violent coughing that end with the 
+typical high -pitched Whoop, and occasionally 
+vomiting is seen.  Between bursts of coughing the 
+child appears well. Coughing attacks may 
+continue to occur for 10- 12 weeks.  Petussis is 
+frequently complicated by pneumonia and ear 
+infections, particularly in infants.  Death from  
+pertussis is rare. 
+ 
+Who gets this disease? 
+Petussis occurs in all age groups.  Untreated cases 
+in older children and adults can spread pertussis to 
+infants and young children at home.  It is 
+important that all infants and young children be up 
+to date with  pertussis vaccination.  The most 
+serious disease and complications are seen in 
+infants and very young children. 
+ 
+How is it spread? 
+The bacterium is spread by direct contact with 
+discharge from the nose or throat of an infected 
+person, or by breathing in i nfected droplets in the 
+air when an infected person coughs.  The period of 
+greatest risk of spread is during the early “cold” 
+stage. 
+ 
+What are the symptoms? 
+The disease begins with the cold like symptoms 
+such as runny nose and watery eyes, and cough.  
+The cough becomes more persistent.   Within 2 
+weeks the cough occurs as bouts of uncontrollable 
+cough often with a “whoop” sound.  Vomiting 
+often follows the cough.  The “whoop” sound may 
+be absent in older children and adults. 
+What if a child is exposed to pertussis? 
+1. All close contacts younger than 7 years of 
+age who have not completed the four -dose 
+primary series should complete the series 
+with the minimum intervals. 
+2. Close contacts who are 4 -6 years of age 
+and who have not yet received the second 
+booster dos e (usually the fifth dose of 
+DTaP) should be vaccinated. 
+3. Any close contact 11 years old and older 
+can receive a single dose of Tdap if it has 
+been at least 2 years since the previous Td. 
+4. Your physician may recommend 
+antibiotics for your child and all close  
+contacts. 
+ 
+How can the spread of this disease be 
+prevented? 
+A combination vaccine of Diphtheria, Tetanus and 
+acellular Pertussis  (DTaP) is required for both 
+childcare and school attendance.  The Advisory 
+Committee on Immunization Practices (ACIP) 
+recommends immunizing children against 
+pertussis, along with diphtheria and tetanus, 
+beginning as early as six weeks of age.  The five 
+dose series should be completed at 2 months, 4 
+months, 6 months, and 15- 18 months, and 4- 6 
+years of age. If the child has a contr aindication to 
+the pertussis vaccine, they would receive a vaccine 
+called DT which does not contain the pertussis 
+antigen. 
+ 
+A single booster dose of Diphtheria, Tetanus, and 
+acellular Pertussis (Tdap) is recommended for 
+adolescents 11 -18 years of age who h ave 
+completed the recommended childhood 
+DTP/DTaP vaccination series and have not 
+received Tetanus and diptheria (Td) booster dose. 
+Adults who are 18 and older should receive one 
+dose of Tdap If they have received the Td booster 
+an interval of at least 2 years between Td and 
+
+
+PERTUSSIS (Whooping Cough) cont. 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+Tdap is encouraged to reduce the risk for local and 
+systemic reactions after Tdap vaccination.  The Td 
+booster is recommended every 10 years thereafter 
+to provide protection. 
+ 
+Reportable? 
+Yes.  Pertussis is reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease Control at (603) 271-
+4496.  
+

Text_Files/Pinworms.txt

@@ -0,0 +1,81 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+PINWORMS (Enterobuius Vermicularis) 
+ 
+Pinworms are tiny worms that live in the lower 
+intestine of people.  Most often at night, female 
+worms come out to the anus of an infected person 
+and lay their microscopic eggs. 
+ 
+Who gets this disease? 
+Anyone can.  It  is particularly common in 
+preschool and school -aged children and therefore 
+in daycare centers. 
+ 
+How is it spread? 
+Pinworm eggs can be transferred orally from the 
+infected individual to another person.  The eggs 
+can also be transferred indirectly through 
+clothing, bedding, food and other contaminated 
+articles. 
+ 
+What are the symptoms? 
+People may be without symptoms or they may 
+have anal itching, feel irritable and/or have 
+disturbed sleep. 
+ 
+How soon do the symptoms appear? 
+Symptoms usually appear between two-weeks and 
+two-months.  The life cycle requires two to six 
+weeks to complete. 
+ 
+Can a person have this disease without 
+knowing it? 
+Yes.  Often, members of an infected child’s 
+household are also unknowingly infected and, if 
+not treated, can reinfect a treated  child and other 
+people. 
+ 
+What is the treatment? 
+There are several medicines available to treat this 
+infection.  Often healthcare providers will treat 
+the entire family if one member of the home is 
+infected. 
+How can the spread of this disease be 
+prevented? 
+1. Wash hands thoroughly after using the 
+toilet and after diapering children. 
+2. Children should be bathed in the morning 
+so that  any eggs laid at night can be 
+removed.  
+3. Wash hands thoroughly before preparing 
+food. 
+4. If you suspect a child has pinworms, based 
+on symptoms, this child should see a 
+physician for the correct diagnosis and 
+treatment. 
+5. Each child’s dirty clothing should be 
+stored separately in plastic bags and sent 
+home for laundering. 
+6. All bedding and clothing should be 
+washed in HOT water. 
+7. Every child should have his/her own crib 
+or mat and should not switch sheets with 
+other children.  Mats should be kept clean. 
+8. Clean and vacuum play and sleeping areas 
+daily for several days after diagnosis. 
+ 
+Who should be excluded? 
+Once the diagnosis of pinworms is ma de, the 
+child should be appropriately treated.  After the 
+treatment the child does not need to be kept out of 
+childcare. 
+ 
+Reportable? 
+No, pinworms are not reportable by New 
+Hampshire law to the Division of Public Health 
+Services, Bureau of Infectious Disea se Control .  
+However, Public Health Professionals are 
+available for consultation at (603) 271-4496.  
+
+

Text_Files/Poliomyelitis_Polio.txt

@@ -0,0 +1,53 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+POLIOMYELITIS (Polio) 
+ 
+Poliomyelitis is caused by a virus.  Polio typically 
+produces weakening of the muscles, sometimes to 
+the point of requiring assistance to move about.  
+The illness ranges widely in severity. 
+ 
+Who gets this disease? 
+Today, polio case s occur mainly among 
+unimmunized young children or among members 
+of groups that refuse immunization. 
+ 
+How is it spread? 
+The virus is spread by direct contact with infected 
+stool and throat secretions.  Infected persons are 
+most contagious during 7-10 days before and after 
+onset of symptoms. 
+ 
+What are the symptoms? 
+The illness ranges in severity from a mild, 
+unnoticed febrile illness to meningitis (an 
+inflammation of the covering of the brain and 
+spinal cord), to paralysis and even death. 
+ 
+How can the spread  of this disease be 
+prevented? 
+Two types of polio vaccine have been available: 
+trivalent oral polio vaccine (TOPV) and 
+inactivated polio vaccine (IPV).  The national 
+Advisory Committee on Immunization Practices 
+(ACIP) recommends four doses of polio vaccine . 
+The four dose series should be completed at 2 
+months, 4 months, 6- 18 months, and 4- 6 years. 
+The vaccine is required  for both childcare and 
+school attendance.  
+ 
+Who should be excluded? 
+Children and staff should be excluded during the 
+acute phase of illness. 
+ 
+ 
+ 
+Reportable? 
+Yes.  Poliomyelitis (polio) is reportable by New 
+Hampshire law to the Division of Public Health 
+Services, Bureau of Infectious Disease Control at 
+(603) 271-4496.  
+ 
+ 
+
+

Text_Files/RSV.txt

@@ -0,0 +1,64 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+RESPIRATORY SYNCYTIAL VIRUS 
+INFECTION (RSV) 
+ 
+RSV is an infection of the small air passages of 
+the lung causing bronchiolitis and pneumonia.  
+RSV is most common in children under 1 year of 
+age but it can affect anyone at any age.  Most 
+children have been infected with RSV by the time 
+they turn 2 years of age, but only a few will 
+develop serious illness.  Re -infection can occur 
+throughout life. 
+ 
+What are the symptoms of RSV? 
+Small infants may have irritability, decreased 
+activity and breathing difficulties as early 
+symptoms.  Older children may have symptoms 
+similar to any other respiratory infection, such as 
+cough, sneezing, fever, runny nose, wheezing, and 
+decrease in appetite. 
+ 
+How is RSV spread? 
+RSV is spread when the infected person sneezes 
+or coughs the droplets into the air.  The person 
+who is at risk then inhales the virus from the air.  
+The infection can be spread by direct contact with 
+nasal or oral secretions from the infected person.  
+Activities such as kissing the face of a child or 
+coming into c ontact with surfaces that have been 
+infected with secretions and then rubbing the eyes 
+or nose can spread RSV.  RSV is common in 
+winter and early spring. 
+ 
+What is the incubation period for RSV? 
+The incubation period can range from 2 -  8 days 
+but is usually 4 - 6 days. 
+ 
+How can RSV be prevented? 
+Steps can be taken to limit exposure and to help 
+stop the spread of RSV infection: 
+• Cover coughs and sneezes, 
+• Wash hands frequently and correctly, 
+• Avoid sharing cups and eating utensils with 
+others, 
+• Refrain from kissing others, 
+• Cleaning contaminated surfaces frequently 
+(i.e., door knobs, toys, etc.) 
+ 
+Should the child with RSV be excluded? 
+Children with fever and respiratory symptoms 
+should be excluded from childcare until they no 
+longer have a fever.  Children with re spiratory 
+symptoms should be kept separated from children 
+with high-risk conditions. 
+ 
+Is RSV Reportable? 
+No. RSV is not reportable by New Hampshire 
+state law to the Division of Public Health 
+Services, Bureau of Infectious Disease Control;  
+Public Health Pro fessionals are available for 
+consultation at (603) 271-4496.  
+
+

Text_Files/Rabies.txt

@@ -0,0 +1,159 @@
+RABIES (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+RABIES 
+ 
+Rabies is a viral disease that attacks the central 
+nervous system.  It can be transmitted to people 
+through contact with the saliva or brain and spinal 
+cord tissue of a rabid animal as described below.  
+It is a fatal disease for humans but may be  
+effectively prevented.  Rabies in certain animals, 
+especially wildlife, is common throughout New 
+Hampshire. 
+ 
+What are the signs of rabies in animals? 
+Animals may act friendly or become vicious.  
+Animals that are usually active only at night may 
+be found a ctive during the day.  Animal behavior 
+may be unusually aggressive.  Animals infected 
+may seem withdrawn, hide in corners or refuse 
+food.  The most important thing to remember is 
+that a rabid animal will usually be infectious to 
+people or other animals for  a varying period of 
+time before a change in their appearance or 
+behavior. 
+ 
+Who gets this disease? 
+People can get rabies through two types of 
+exposure:  bite exposure and non-bite exposure. 
+• Bite exposure:
+  Any penetration of the 
+skin by the teeth of an inf ected animal.  All bites 
+regardless of location, pose a potential risk for 
+rabies. 
+• Non-bite exposure:   Infectious saliva, 
+brain or spinal cord tissue from a rabid animal 
+comes into contact with the lining of a person’s 
+eye, nose or mouth or with a cut, abrasion or other 
+pre-existing break in the person’s skin. 
+ 
+What about bats and rabies? 
+Bats are responsible for the majority of 
+domestically acquired human cases of rabies.  
+People usually know when a bat has bitten or 
+otherwise exposed them to rabies.  Howe ver, 
+because bats have small teeth that may not leave 
+obvious marks, there are certain situations when a 
+person may be considered exposed to rabies even 
+in the absence of an obvious bite, including: 
+• If a person awakens to find a bat in their 
+room 
+•          A bat is seen in the room of an unattended 
+child, or 
+• A bat is seen in the room of a mentally 
+impaired or intoxicated person. 
+ 
+People cannot get rabies from having contact with 
+bat guano (feces), blood or urine.  If an exposure 
+is possible, and the bat is a vailable, the local 
+animal control authority should be contacted to 
+aid in capturing the animal for testing. 
+ 
+What are the symptoms of rabies in 
+humans? 
+Symptoms of rabies in people include 
+apprehension, anxiety , headaches, fever, 
+tiredness, paralysis, mus cle spasm in the throat 
+leading to fear of water, delirium /hallucinations, 
+convulsions, and, in almost all cases, death.  
+Symptoms are progressive and without medical 
+intervention the usual duration is 2- 6 days; death 
+is often due to respiratory or cardiac failure. 
+ 
+What is the treatment? 
+If a person is bitten or has a non- bite exposure, 
+immediately wash the wound thoroughly with 
+soap and water for several minutes.  (NOTE:  
+flush an exposed eye, nose or mouth with water or 
+saline).  This is extremely import ant as it may 
+prevent the rabies virus from entering the body 
+tissue and prevent infection.  Then, the person 
+should be seen immediately by a physician or go 
+to an emergency department for examination and 
+any needed treatment.   
+ 
+If indicated, a series of shots should be given.  
+One of the shots (Human Rabies Immune 
+Globulin) is injected around the site of the 
+
+
+RABIES (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+exposure to provide immediate protection while 
+the rabies vaccine is given in the arm muscle.  A 
+total of 5shots ( 4 shots of vaccine and one of 
+Human Rabies Immune Globulin- may be more 
+than one and is based on body weight ) are given 
+over one month.  If an individual has had rabies 
+vaccine in the past, this treatment will vary.  To 
+work best, these shots should be given as soon as 
+possible after the exp osure.  If the animal has 
+been caught and will be tested for rabies or 
+quarantined for 10 days (dogs, cats, and ferrets 
+only), treatment can usually be delayed until 
+results are available or quarantine is over.  
+Contact the local animal control authority to aid in 
+capturing the animal for confinement and 
+observation or testing. 
+ 
+Is there a cure? 
+There is no cure for rabies once the infected 
+person becomes ill with the disease.  Appropriate 
+rabies immunizations given before the onset of 
+illness are effective in preventing the disease.  
+People whose work or hobbies bring them 
+frequently into contact with potentially rabid 
+animals should have a series of three rabies 
+vaccine shots before they are exposed.  They will 
+then require only two vaccine shots after 
+exposure. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Do not handle wild animals.  Teach 
+children to avoid wildlife, strays and all 
+other animal s they don’t know.  Call the  
+New Hampshire Fish and Game 
+Department at (603) 271- 3361 to report 
+dead, sick or  injured animals.  Call the 
+local animal control officer for domestic 
+animal exposures. 
+2. If bitten by a wild or domestic animal, 
+seek medical attention immediately and 
+notify the local animal control officer. 
+3. All bites by wild animals or contact with 
+their s aliva or brain or spinal cord tissue 
+should be considered as possible exposure 
+to rabies and must be evaluated medically. 
+4. Keep trash containers tightly closed.  
+Garbage attracts animals like skunks and 
+raccoons. 
+5. Vaccinate all dogs and cats against rabies 
+and make sure their shots are kept up -to-
+date.   
+6. If another animal has injured a dog, cat or 
+other pet, handle it only with thick rubber 
+gloves and have it examined by a 
+veterinarian right away.  Saliva from an 
+attacking rabid animal remains infectious 
+on t he attacked pet’s fur until it has 
+thoroughly dried. 
+ 
+Reportable? 
+Yes.  Rabies in animals and humans is reportable 
+by New Hampshire law to the Division of Public 
+Health Services, Bureau of Infectious Disease 
+Control at (603) 271-4496.  
+

Text_Files/Ringworm.txt

@@ -0,0 +1,79 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+Ringworm (Tinea) 
+ 
+Tinea, more commonly called ring worm is a skin 
+infection caused by a fungus that lives on the skin, 
+surfaces of items, or household items –  like 
+bedding, clothing, or toys. Ringworm can affect 
+any part of the body including the scalp.   
+ 
+Who get this disease? 
+Anyone can get the disease. It is transmitted 
+through direct contact with the fungus  including 
+touching another person or surface containing the 
+fungus. Ringworm can also be transmitted by 
+contact with animals (e.g. cats and dogs).  
+ 
+What are the symptoms? 
+Ringworm affecting the skin causes a red, circular 
+patch to form. The patch usually has a raised 
+edge. Ringworm between the toes, or more 
+commonly called athlete’s foot, causes the skin 
+between the toes to appear cracked and peelin g. 
+Ringworm of the scalp can cause redness of the 
+scalp or loss of hair.   
+ 
+Symptoms typically appear between 4 -14 days 
+after contact with the fungus.  
+ 
+ 
+How is it diagnosed and treated? 
+A diagnosis of ringworm is made by a healthcare 
+provider based on the clinical features of the skin. 
+The healthcare provider may feel necessary to 
+take a scraping of the skin for a culture.  
+ 
+Ringworm of the skin can be treated with an over-
+the-counter antifungal cream or lotion. Ringworm 
+of the scalp can only be treated wi th a prescribed 
+antifungal medication from the child’s health care 
+provider. 
+ 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Items frequently touched by children (i.e. 
+toys and surfaces) should be washed or 
+wiped down frequently. This can be done 
+with a diluted bleach solution.  
+2. Children should not be allowed to walk 
+barefoot 
+3. Do not allow children to share personal 
+items like brushes or combs.  
+4. Children should wash their hands with 
+soap and warm water after touching any 
+animals  
+5. Socks should be changed daily or if they 
+become wet for any reason.  
+6. While under treatment swimming pools 
+should be avoided. 
+ 
+Who should be excluded? 
+The child’s parent or guardian should be 
+telephoned/emailed or a note sent home 
+at the end 
+of the school day stating that the child needs to be 
+seen by his/her health care provider related to the 
+potential for infection.  
+ 
+The child should be excluded until treatment is  
+started.  
+ 
+Reportable? 
+No, ringworm is not reportable by New 
+Hampshire law.  However, the Bureau of 
+Infectious Disea se Control professionals are 
+available for consultation at (603) 271-4496.  
+
+

Text_Files/Roseola.txt

@@ -0,0 +1,73 @@
+ 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ROSEOLA (Exanthema Subitum) 
+ 
+Roseola is the most common viral rash illness that 
+occurs in young children.  It is sometimes referred 
+to as Sixth Disease or, less commonly, “baby 
+measles”.  Roseola is caused by a virus called 
+human herpesvirus 6 (HHV -6) an d, possibly, 
+human herpesvirus 7 (HHV-7). 
+ 
+Who gets this disease? 
+Roseola usually occurs in children aged 6 months 
+to 2 years of age.  It is uncommon for the disease 
+to occur in children under the age of 3 months or 
+over the age of 4 years.  There is no known risk to 
+pregnant women.  Cases are not seasonal and 
+usually occur throughout the year. 
+ 
+How is Roseola spread? 
+Humans are the only known source for roseola.  It 
+is not known how the disease is spread or what 
+the infectious period is.  It is not conside red to be 
+very infectious. 
+ 
+How soon do symptoms appear? 
+Symptoms usually begin 4- 10 days after 
+exposure. 
+ 
+What are the symptoms? 
+Roseola usually begins with a high fever that lasts 
+3 to 5 days followed by a rash that lasts 1- 2 days.  
+When the fever disappears, a rash appears, usually 
+on the face and body.  Irritability, runny nose, 
+eyelid swelling and tiredness are sometimes 
+present during the time of the fever.  Most 
+children, however, are alert and playful during 
+this time. 
+ 
+How is it diagnosed and treated? 
+While Roseola can be diagnosed through 
+laboratory conformation, a healthcare provider 
+typically diagnoses the disease based on the 
+symptoms.  A rash occurring immediately after 
+the fever breaks is characteristic of the disease.  
+The healthcare provider  may recommend 
+supportive treatment of symptoms but there is no 
+treatment that is specific for roseola. 
+ 
+How can the spread of this disease be 
+prevented?
+ 
+There is no vaccine to prevent this disease, but  
+good hand washing can help prevent the spread.   
+ 
+Who should be excluded? 
+Generally, a child with a rash and fever should be 
+excluded from childcare until seen by a healthcare 
+provider.  A child with a rash and no fever may 
+return to childcare.  There are no 
+recommendations for preventive therapy for other 
+children attending the childcare or for childcare 
+personnel. 
+ 
+Reportable? 
+No.  Roseola is not reportable by New Hampshire 
+state law to the Division of Public Health 
+Services, Bureau of Infectious Disease Control.  
+However, Public Health Professionals are 
+available for consultation at (603) 271-4496.  
+
+

Text_Files/Rotavirus.txt

@@ -0,0 +1,71 @@
+Division of Public Health Services Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control REVISED –January 2018 
+Rotavirus 
+Rotavirus is a virus that causes diarrhea and 
+vomiting. It is the most common cause of 
+diarrhea in children under two years old.  
+What are the symptoms? 
+Rotavirus typically causes non-bloody 
+diarrhea, nausea, and vomiting.  
+T
+he symptoms usua lly last 3 -8 days but the 
+virus can be present before diarrhea begins 
+and last up to three weeks after symptoms 
+disappear.  
+How is the disease spread? 
+Rotavirus is spread by direct contact (fecal -
+oral route) with contaminated food or 
+objects (i.e. toys or  surfaces frequently 
+touched by children).  
+How is it diagnosed and treated? 
+Your child’s healthcare provider may make 
+a diagnosis of rotavirus based on your 
+child’s symptoms. While not typically done, 
+a stool sample may be collected and 
+analyzed to confirm diagnosis.  
+T
+here is no  treatment for Rotavirus. The 
+virus is self -limiting. Your child may need 
+extra fluids in order to prevent dehydration. 
+If you notice a decrease in your child’s urine 
+output or if your child cries with few or no 
+tears, had a dry mouth, is unusually sleepy 
+or fussy contact your child’s healthcare 
+provider.  
+H
+ow can the spread of the disease 
+be prevented? 
+1. Good handwashing especially before
+preparing meals and after diapering a
+child.
+2. Clean all meal preparation surfaces
+and sur faces children touch
+frequently.
+3. Clean children’s toys frequently – a
+diluted bleach mixture can be used to
+clean and sanitize items or surfaces.
+T
+he Advisory Committee on Immunization 
+Practices (ACIP), recommends  routine 
+vaccination of children against Rotavirus. 
+Two vaccines are available to prevent the 
+spread of Rotavirus. Rotateq is a 3 dose 
+series and is recommended to be given at 2 
+months, 4 months, and 6 months. Rotarix is 
+a 2 dose series recommended to be given at 
+2 months and 4 months.  
+Who should be excluded? 
+Children should be excluded from childcare 
+if they are experiencing more than 2 loose 
+stools per day or diarrhea cannot be 
+contained in diapers as it impedes the 
+caregiver’s ability to care for other children 
+in a safe and sanitary manner.  
+Reportable? 
+No, rotavirus is not reportable by New 
+Hampshire law.  However, the Bureau of 
+Infectious Disease Control professionals 
+are available for consultation at (603) 
+271-4496. 
+
+

Text_Files/Rubella_German_Measles.txt

@@ -0,0 +1,68 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+RUBELLA (GERMAN MEASLES) 
+ 
+Rubella is a childhood viral disease, which causes 
+a rash, low -grade fever and swollen glands in the 
+area behind the ears.  Some children may have a 
+very mild illness with no rash at all.  However, if 
+a pregnant woman without pr otection against 
+rubella is exposed to the disease, there could be 
+harmful effects to her baby.  Pregnant women 
+should consult their physician at once if they 
+have been exposed to rubella! 
+ 
+Who gets this disease? 
+Some young adults remain susceptible to rubella 
+due to high school graduation prior to the school 
+rubella vaccination laws.  Rubella is most often 
+seen in unimmunized children and in this 
+susceptible adolescent and young adult group. 
+ 
+How is it spread? 
+The virus is spread by large droplets spread 
+through the air from sneezing or coughing, or by 
+direct contact with infected nasal or saliva 
+secretions. 
+ 
+What are the symptoms? 
+1. A two to three day rash that begins on the 
+face and quickly spreads downward over 
+the entire body. 
+2. A low- grade fever of 101- degrees 
+Fahrenheit or less. 
+3. Swollen glands behind the ears. (NOTE: 
+this may appear before the rash). Joint and 
+body pain is most commonly experienced 
+in adults. 
+4. Symptoms appear 12 -23 days after 
+exposure; usually 16-18. 
+ 
+Infected persons are contagious from one week 
+before to 5-7 days after the appearance of the 
+rash.  A small percentage of properly immunized 
+children may be infected with rubella due to 
+occasional vaccine failure. 
+How can the spread of this disease be 
+prevented? 
+The national Advisory Committee  on 
+Immunization Practices (ACIP) recommends that 
+children be immunized against rubella after 12-
+months of age.  The two dose vaccine should be 
+completed at 12 -15 months of age and 4- 6 years. 
+This immunization is  required for both childcare 
+and school atte ndance. The vaccine is  usually 
+combined with measles and mumps vaccine.   
+Who should be excluded? 
+A child or staff member with rubella or suspect 
+rubella should not return to daycare until seven 
+days after the onset of the rash. 
+ 
+Reportable? 
+Yes.  Rubella is reportable immediately  by New 
+Hampshire law to the Division of Public Health 
+Services, Bureau of Infectious Disease Control  at 
+(603) 271-4496.  
+ 
+
+

Text_Files/Salmonellosis.txt

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+SALMONELLOSIS (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+SALMONELLOSIS 
+ 
+ 
+Salmonella is an illness caused by the bacterium 
+Salmonella of which there are numerous types.  
+Salmonellosis most commonly causes intestinal 
+illness but occasionally may infect the blood 
+stream.  The bacterium is passed in the stool of 
+infected individuals. 
+ 
+Who gets this disease? 
+Any person can become infected with Salmonella.  
+The disease is more likely to cause a severe 
+infection in the very young, the very old and in 
+people with underlying diseases, such as cancer. 
+ 
+How is it spread? 
+In the childcare setting, Salmonella is usually 
+spread by the fecal-oral route.  The bacterium can 
+also be spread by contaminated food or drink.  It 
+is commonly found in uncooked or undercooked 
+meat (especially beef), poultry and eggs , and 
+unpasteurized mi lk.  Salmonella can also be 
+spread to children and adults from infected pets 
+such as turtles, lizards, snakes, dogs, cats, 
+ducklings, chickens and other birds.  (NOTE: 
+Because of this hazard, these types of animals 
+should not be in childcare facilities.) 
+ 
+What are the symptoms? 
+The intestinal illness caused by Salmonella is 
+characterized by diarrhea (mild or severe), fever, 
+abdominal cramps and occasional vomiting. 
+ 
+How soon do symptoms appear? 
+The symptoms generally appear from 6 -72 hours 
+after exposure, usually appearing 12 -36 hours. 
+Sometimes symptoms take up to 7 days to appear. 
+Can a person have this disease and not 
+know it? 
+Yes.  Some people may not have symptoms 
+serious enough to cause them to seek medical 
+attention.  In some cases of Salmonella infe ction, 
+after the diarrhea illness is over the organism may 
+be excreted in the stool for months to over a year.  
+This is called the carrier state. 
+ 
+What is the treatment? 
+Although most people with Salmonellosis will 
+recover on their own, in some cases healt hcare 
+providers may prescribe antibiotics.  Some 
+antibiotics may lengthen the amount of time the 
+bacteria are found in the stool, however. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Wash hands thoroughly after using the 
+toilet and diapering children. 
+2. Wash hands thoroughly before preparing 
+food. 
+3. Be certain all foods in the childcare center 
+are thoroughly cooked – especially beef, 
+poultry and eggs. 
+4. Any leftover food should be discarded. 
+5. Food preparation surfaces (e.g., tables, 
+counters, cutting boards,  kitchen utensils) 
+should be carefully washed and 
+disinfected after preparing food. 
+6. Unpasteurized milk (goat or cow) is 
+frequently contaminated with Salmonella 
+and other bacteria; it should not be used in 
+a childcare setting. 
+7. Staff with active diarrhea or 
+gastrointestinal (GI) illness should not 
+work in a childcare facility until they are 
+free of symptoms for 48 hours. 
+8. Keep children with diarrhea at home. 
+9. High-risk animals like turtles and lizards 
+should not be in child care settings. 
+
+
+SALMONELLOSIS (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+Who should be excluded? 
+Infected persons shall be excluded from 
+foodhandling, working in a child care facility and 
+from direct care of hospitalized and 
+institutionalized patients until they are no longer 
+infectious or symptomatic (48 hours after 
+resolution of symptoms). 
+ 
+Reportable? 
+Yes.  Salmonella is reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease Control at (603) 
+271-4496.  
+

Text_Files/Scabies.txt

@@ -0,0 +1,103 @@
+SCABIES CONT. 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+SCABIES 
+ 
+Scabies is a common skin infestation caused by 
+microscopic parasites called a mite.  The female 
+mite burrows under the skin to lay her eggs, 
+which subsequently hatch and start the infestation 
+cycle again. 
+ 
+Symptoms of scabies do not appear until  weeks 
+after exposure.  The skin reaction is probably due, 
+in part, to a sensitization or “allergic” reaction to 
+the mites.  On re -exposure, symptoms can start 
+within days.  The infestation is in the form of an 
+intensely itchy rash, which consists of red bumps 
+and burrows (i.e., short, wavy, thread -like lines in 
+the skin). Itching tends to increase at night. 
+ 
+Who gets this disease? 
+Anyone who has contact with the mite can 
+become infested with scabies. 
+ 
+How is it spread? 
+The mite is spread by direct skin -to-skin contact, 
+or by skin contact with clothes, bedding, etc. that 
+the mites have crawled onto.  The mites can 
+survive only three days off the body and cannot 
+jump or fly.  They require direct contact with skin 
+to spread.  The incubation period for this dis ease 
+is two to six weeks after exposure. 
+ 
+How is it diagnosed and treated? 
+It can be diagnosed by the typical appearance of 
+the rash and accompanying symptoms and by 
+examining skin scrapings under the microscope to 
+see the mite or its’ eggs. 
+ 
+Scabies is treated with one of several prescription 
+mite-killing creams or lotions, which are applied 
+once to the skin and then washed off after a 
+specified period of time.  Medicine to relieve the 
+itching is often necessary.  (Note:  Even after 
+effective therapy, itching can persist for up to 2 to 
+4 weeks).  Treatment is recommended for all 
+household members – even those without 
+symptoms – due to the high likelihood of spread 
+within a household.  Prophylactic treatment is also 
+recommended for people who have had direc t 
+skin-to-skin contact with an infected individual. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Follow previously outlined principles of 
+hand washing and cleanliness at the 
+childcare facility. 
+2. Children should not share personal items, 
+cribs, mats or clothing. 
+3. Each child’s dirty clothing should be 
+stored separately and sent home for 
+laundering. 
+4. If a case of scabies occurs in the daycare 
+facility: 
+a. Wash and dry on the hot cycle all 
+washable items belonging to the 
+center that came into contact with 
+the child’s skin during the 72 hours 
+prior to treatment. 
+b. Difficult to wash items (e.g., 
+stuffed toys, pillows) can be stored 
+in tightly closed plastic bags for 
+four days and then used again.  
+(Note: The mite cannot live off the 
+body for more than three days). 
+c. Thoroughly vacuum any carpet or 
+upholstered furniture. 
+
+
+SCABIES CONT. 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+5. Pesticide sprays are not recommended and 
+can be harmful to people and animals. 
+6. If a rash, which appears suspicious for 
+scabies, is noticed on a child in the 
+childcare center, tell the parents the child 
+should be seen by a healthcare provider. 
+ 
+Who should be excluded? 
+Infected individuals should be excluded until 
+treatment is completed.  If two or more cases 
+occur in the daycare center, call the Division of 
+Public Health Services, Bureau of Infectious 
+Disease Control for further recommendations. 
+ 
+Reportable? 
+No, scabies is not reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease Control .  However, 
+Public Health Professionals are available for a 
+consultation at (603) 271-4496.  
+

Text_Files/Shigellosis.txt

@@ -0,0 +1,78 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+SHIGELLOSIS 
+ 
+Shigellosis is an intestinal illness caused by 
+Shigella, which is a family of bacteria that is 
+comprised of 40 different types. 
+ 
+Who gets this disease? 
+Anyone can, but shigellosis is recognized more 
+often in young children. 
+ 
+How is it spread? 
+Among small children in a childcare facility, the 
+fecal-oral route usually spreads Shigella.  It takes 
+very few swallowed Shigella bacteria to cause 
+infection (as opposed to Salmonella, which take 
+many bacteria to cause infection); so it can easily 
+become a problem in a childcare setting.  Shigella 
+can also be spread through stool -contaminated 
+food, drink or water. 
+ 
+What are the symptoms? 
+Shigella can cause mild or severe diarrhea.  In 
+mild cases, a person may have only watery stools 
+for several days.  In severe cases, the diarrhea 
+may have traces of blood or mucous and may lead 
+to dehydration.  Fever, severe cramps, vomiting, 
+headache and even convulsions (in young 
+children) can occur. 
+ 
+How soon do symptoms appear? 
+The symptoms usually occur 2 -4 days afte r 
+exposure, but it can be as long as seven days. 
+ 
+Can a person have this disease without 
+knowing it? 
+Yes, Shigella can be in the stool of children or 
+adult who are not sick and do not have diarrhea.  
+These asymptomatic carriers may transmit 
+infection; rare ly the carrier state persists for 
+months or longer. 
+What is the treatment? 
+Although most people with Shigellosis will 
+recover on their own, antibiotics shorten both the  
+length of the illness and the amount of time 
+bacteria is passed in the stool, which i s 
+particularly important in daycare settings. 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Wash hands thoroughly after using the 
+toilet or diapering a child. 
+2. Wash hands thoroughly before preparing 
+food. 
+3. Keep children who have diarrhea at home. 
+4. Staff w ith positive stool cultures for 
+Shigella should not prepare food or feed 
+children. 
+ 
+Who should be excluded? 
+Infected person s shall be excluded from food 
+handling, from childcare facilities and from direct 
+care of hospitalized or institutionalized patients 
+until stool cultures are free of Shigella on two 
+consecutive specimens collected not less than 24 
+hours apart.  If antibiotics have been taken, the 
+initial cultures shall be obtained at least 48 hours 
+after the last dose. 
+ 
+Reportable? 
+Yes.  Shigellosis is reportable by New Hampshire 
+law to the Division of Public Health Services, 
+Bureau of Infectious Disease Control  at (603) 
+271-4496, 
+ 
+
+

Text_Files/Strep_Throat_and_Scarlet_Fever.txt

@@ -0,0 +1,136 @@
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+STREP THROAT & SCARLET FEVER 
+ 
+Group-A Streptococci are bacteria that can cause 
+a variety of illnesses, the most common of which 
+are strep throat, scarlet fever and impetigo. 
+ 
+Strep Throat is a sore throat caused by this 
+bacterium.  Cold viruses, not stre p bacteria, cause 
+the vast majority of sore throats in both children 
+and adults.  Strep sore throats tend to be 
+accompanied by fever, tender swollen neck 
+glands, headache and stomach ache but can also 
+occur with cough, runny nose, or other cold 
+symptoms. 
+ 
+Scarlet Fever is a form of strep infection caused 
+by bacteria that produce a substance, which 
+causes a skin rash.  The rash is usually red with 
+fine bumps that feel like sand paper and is most 
+noticeable on the neck, chest, groin, or on the 
+inner surface o f the knees, thighs and elbows.  
+The rash does not usually involve the face, but 
+cheeks are flushed and there is paleness around 
+the mouth.  The tongue may be reddish and look 
+like the surface of a strawberry.  The rash may 
+only last a few hours.  Scarlet fever is no more 
+serious then strep throat.   
+ 
+Treatment of strep infections with antibiotics may 
+not dramatically change the length or severity of 
+the sore throat symptoms or rash.  It is important 
+to treat strep infections in children to prevent its 
+spread to others and the possible development of 
+rheumatic fever. 
+ 
+Note:  Rheumatic Fever (i.e., abnormalities of the 
+heart valves and inflammation of the joints) is 
+very rare in the United States today, but can 
+develop five to six weeks after any type of 
+untreated strep infection.  In rare instances, 
+kidney disease can also occur following a strep 
+infection. 
+ 
+Who can get this disease? 
+Anyone can get strep throat or scarlet fever, but it 
+is uncommon in children under three years of age 
+(as is rheumatic fever).  It is most common in 
+school-aged children, in winter months and in 
+crowded situations (e.g., schools, childcare 
+centers).  Often if one person in a family gets it, 
+other do also, especially brothers and sisters. 
+ 
+How is it spread? 
+During infections, strep  is in nose and mouth 
+secretions so it can be coughed, sneezed or 
+smeared around on hands, dishes, food, toys and 
+similar objects.  The incubation period is two to 
+five days.  Unlike colds, children are probably not 
+infectious during this incubation period.  Children 
+are most likely to pass strep to others when they 
+have symptoms and until they have been on 
+antibiotic treatment for 24 hours. 
+ 
+How soon do symptoms appear? 
+The symptoms generally appear within one to 
+three days. Because of a possible associati on with 
+Reye’s Syndrome (i.e., vomiting, liver problems 
+and coma), salicylate -containing products (i.e., 
+aspirin) are not recommended for control of fever. 
+ 
+How are they diagnosed and treated? 
+The diagnosis of strep throat is made by a throat 
+culture.  It usually takes 24- 48 hours to grow the 
+bacteria.  There are several recently developed 
+rapid tests, which can diagnose a strep infection in 
+less time.  Strep infections are treated with an oral 
+antibiotic for 10 days.  Occasionally a healthcare 
+provider may give a single long -lasting injection.  
+Depending on the symptoms, the healthcare 
+provider may give antibiotics immediately or wait 
+for the throat culture results. 
+
+
+STREP THROAT & SCARLET FEVER 
+(cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+ 
+How can the spread of this disease be 
+prevented? 
+1. Enforce handwashing and general 
+cleanliness in the childcare facility.  If a 
+case of strep throat has been diagnosed, it 
+is particularly important to remember that: 
+a. Staff and children should wash 
+their hands after wiping/blowing 
+noses and before eating or 
+preparing food. 
+b. Toys and surfaces should be 
+washed and disinfected daily. 
+c. Each child should have his/her 
+own cup; preferably, disposable 
+cups should be used. 
+d. Food should not be shared. 
+e. All eating utensils should be 
+carefully washed in hot, soapy 
+water, disinfected and air -dried.  A 
+dishwasher is best. 
+2. Keep children’s noses clean and dry; wash 
+hands immediately after wiping noses. 
+3 Teach children to cough/sneeze to one side 
+toward the floor and into a tissue.  They 
+need to wash their hands afterward. 
+4 If there is a case of strep throat in the 
+facility, children and staff who develop 
+sore throat symptoms should be seen by 
+their healthcare provider to be tested for 
+strep.  Generally, children and staff who 
+do not have symptoms do not need to be 
+cultured. 
+ 
+Who should be excluded? 
+Children and staff shoul d be excluded until 24 
+hours after beginning antibiotic therapy and until 
+there is no fever present. 
+ 
+Reportable? 
+No, this type of Streptococcal infection is not 
+reportable by New Hampshire law to the Division 
+of Public Health Services, Bureau of Infectio us 
+Disease Control .  However, Public Health 
+Professionals are available for consultation at 
+(603) 271-4496.  
+

Text_Files/Swimmers_Itch.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+SWIMMER’S ITCH (Cercarial Dermatitis) 
+ 
+Swimmer’s itch (Cercarial Dermatitis) is caused 
+by human contact with a parasite that normally is 
+found in some species of birds or small animals.  
+The adult stage of the parasite lives in the 
+animals’ intestines and is shed into the water with 
+excreted feces.  Snails feed off the waste and 
+release the young parasite (called cercaria) into 
+the water.  When this parasite burrows into a 
+person’s skin it causes an allergic, itchy rash.  The 
+parasite is commonly found at  the water’s surface 
+and near the shore. 
+ 
+Who gets this disease? 
+Anyone who swims in water where this parasite 
+lives is susceptible.  The parasite may live in both 
+fresh and salt water. 
+ 
+How is it spread? 
+Most commonly, individuals get the infection by 
+swimming or wading in infested water and then 
+allowing water to evaporate off the skin rather 
+than drying the skin with a towel.  The parasite 
+(cercaria) will borrow underneath the person’s 
+skin.  Because these parasites cannot develop 
+inside a human, they so on die.  The infection is 
+not spread from person-to-person. 
+ 
+What are the symptoms? 
+The symptoms include an initial prickling 
+sensation after leaving the water shortly followed 
+by an itchy rash, which reaches maximum 
+intensity in 2 to 3 days and can persis t for a week.  
+Scratching the area may result in secondary 
+bacterial infections.  Repeated exposure increases 
+a person’s sensitivity to the parasite, possibly 
+resulting in more severe symptoms. 
+What is the treatment? 
+It is best to check with a physician f or treatment.  
+Sometimes medication is given to ease the itching 
+and allergic reaction.  If secondary infection 
+develops, antibiotic treatment may be indicated. 
+ 
+How can Swimmer’s Itch be prevented? 
+1. Avoid swimming in known infested 
+waters.  Swim in deeper water.  The 
+parasite is usually found in shallow 
+waters.  Babies sitting along the shore are 
+most vulnerable. 
+2. Vigorously towel your entire body 
+immediately upon leaving the water.  This 
+will help brush off any cercaria that may 
+be on the skin, also rinsing  off with a 
+quick shower as soon as you leave the 
+water may be helpful. 
+3. Use a waterproof sunscreen.  This forms a 
+chemical barrier that may prevent the 
+parasite from sticking to the body. 
+ 
+Who should be excluded? 
+There is no need to exclude someone from a 
+facility since Swimmer’s Itch is not spread from 
+person-to-person. 
+ 
+Reportable? 
+No, Swimmer’s Itch is not reportable by New 
+Hampshire law to the Division of Public Health 
+Services, Bureau of Infectious Disease Control.  
+However, public health professionals are available 
+for consultation at (603)-271-4496. 
+ 
+For questions in sampling public swimming areas, 
+please contact the NH Department of 
+Environmental Services, Public Beach Sampling 
+Program at (603) 271-0698. 
+
+

Text_Files/Tetanus.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+TETANUS 
+ 
+Tetanus is a bacterium that lives in the soil and 
+can enter the body through a cut or wound.  The 
+bacteria produce a poisonous substance – 
+exotoxin – that causes the clinical illness. 
+ 
+Who gets this disease? 
+Tetanus occurs almost exclusively in 
+unimmunized or inadequately immunized 
+persons. Previously having tetanus does not result 
+in immunity to subsequent infections. Vaccination 
+is required after initial recovery. 
+ 
+How is it spread? 
+Unlike other vaccine-preventable diseases, tetanus 
+is not spre ad from person- to-person.  It occurs 
+when the bacterium in soil or dust is introduced 
+into the body through a wound. 
+ 
+What are the symptoms? 
+The poisonous exotoxin produced by the 
+Clostridium tetani  bacteria causes muscles  to go 
+into spasms  of the face/neck, abdomen, or area 
+where the initial infection occurred.  Paralysis and 
+death can result.  Sometimes tetanus is called 
+“lockjaw”. 
+ 
+How can Tetanus be prevented? 
+The Advisory Committee on Immunization 
+Practices (ACIP) recommends immunizing 
+children against  tetanus – along with diphtheria 
+and pertussis – beginning as early as six weeks of 
+age. The diphtheria-tetanus-acellular pertussis 
+(DTaP) vaccine is required  for both childcare 
+and school attendance. The five dose series should 
+be completed at 2 months, 4 months, 6 months, 
+and 15-18 months, and 4-6 years of age 
+Tdap/Tetanus diphtheria and acellular pertussis 
+should be given once between the ages of 11- 18 
+years.  Booster doses of tetanus -diphtheria toxoid 
+(Td) vaccine every 10 years after finishing the 
+childhood primary immunization series are 
+necessary to maintain protection against tetanus.  
+Tdap is available as a one time dose for adults 
+who have not recently received a tetanus vaccine. 
+Also, it is important to be sure that all cuts, 
+scrapes and puncture  wounds are cleaned well 
+with soap and water.  Consult your healthcare 
+provider for need of tetanus vaccine after a 
+wound. 
+ 
+Who should be excluded? 
+There is no need for the child or the childcare 
+worker to be excluded as tetanus  is not spread 
+from person-to-person. 
+ 
+Reportable? 
+Yes, tetanus is reportable by New Hampshire law 
+to the Division of Public Health Services, Bureau 
+of Infectious Disease Control at (603) 271-4496.  
+
+

Text_Files/Tuberculosis.txt

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+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+TUBERCULOSIS 
+ 
+Tuberculosis (TB) is a disease caused by a certain 
+type of bacterium. A person who is sick  with 
+active tuberculosis disease may spread the germ 
+when they cough or sneeze.  If others inhale the 
+bacteria from the air, they may become infected .  
+But not everyone who is exposed will become 
+infected.  A person with Latent TB infection does 
+not feel sick and cannot spread the germs to 
+others. 
+ 
+Does infection mean you will be sick? 
+No.  Many people were infected with TB many 
+years ago when the dise ase was very common.  
+Only 5-10% of people who are infected will ever 
+get the disease unless they have an impaired 
+immune system. 
+ 
+What is a TB  test? 
+A skin test is a method of determining if a person 
+has been infected with the TB germ.  A positive 
+TB ski n test reaction, however, does NOT 
+necessarily mean the person has TB disease.  
+ 
+Like the skin test there is a blood test that can test 
+for tuberculosis infection. This test is often called 
+an IGRA (Interferon gamma release assay). The 
+IGRA does not diagnose active TB disease.  The 
+IGRA is currently not recommended for children 
+under two. 
+ 
+How is the test given? 
+For the skin test--a small amount of PPD (purified 
+protein derivative) is injected just under the 
+surface of the skin on the fore arm.  In 48 to 72 
+hours, a healthcare provider or nurse will read the 
+test by inspecting the skin. 
+The IGRA is a simple blood draw and there is no 
+return visit for reading necessary and a doctor will 
+help determine the results. 
+  
+ 
+Who should have tuberculosis test? 
+Persons who have been exposed to an active case 
+of TB, persons born in a foreign country (where 
+TB is common), people infected with HIV 
+(human immunodeficiency virus), healthcare 
+workers and pre-school age childcare staff.  It is a 
+law that persons with a positive IGRA be reported 
+to the Bureau of Infectious Disease Control. 
+Persons who have a documented positive reaction 
+to a TB skin test do not need repeat skin tests.  All 
+persons with a positive skin test or a positive 
+IGRA should be evaluated yearly for signs of  
+active disease.   
+ 
+How can TB be prevented? 
+People who have a positive reaction to a TB skin 
+test or a positive IGRA can prevent disease by 
+taking medications. 
+ 
+Who should be excluded? 
+A person with a positive TB skin test or positive 
+IGRA should have a m edical examination and a 
+chest x-ray and discuss with a healthcare provider 
+about taking preventive therapy.  Persons 
+diagnosed or suspected to have  active TB disease 
+should be reported immediately to the Bureau of 
+Infectious Disease Control and should be 
+excluded from attending or working in a childcare 
+center until they are determined to be non-
+infectious by both a healthcare provider and the 
+Bureau of Infectious Disease Control. 
+ 
+Reportable? 
+Yes.  Suspect and cases of active t uberculosis and 
+persons with a positive IGRA are reportable by 
+New Hampshire law to the Division of Public 
+Health Services, Bureau of Infectious Disease 
+Control at (603) 271-4496.  
+ 
+ 
+ 
+
+

Text_Files/West_Nile_Virus.txt

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+West Nile Virus (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+WEST NILE VIRUS 
+ 
+ 
+What is West Nile virus? 
+West Nile virus (WNV) is an uncommon but 
+serious mosquito- borne infection.  The virus can 
+be transmitted to horses, other animals, and, in 
+rare cases, people. 
+ 
+How do people get West Nile virus? 
+WNV is spread by  the bite of an infected 
+mosquito.  Mosquitoes become infected when 
+they feed on infected birds.  Infected mosquitoes 
+can then spread WNV to humans and other 
+animals when they bite.  In a very small number 
+of cases, WNV also has been spread through 
+blood t ransfusions or organ transplants, 
+breastfeeding and even during pregnancy from 
+mother to baby.  WNV is not spread through 
+casual contact such as touching or kissing a 
+person with the virus. 
+ 
+What are the symptoms of West Nile 
+virus in humans? 
+Most WNV infe ctions do not cause any 
+symptoms.  Mild WNV infections can cause 
+fever, headache and body aches, often with a skin 
+rash and swollen lymph glands.  In a small 
+percentage of people infected by the virus, the 
+disease can be serious, even fatal.  Most severe 
+infections can cause headache, high fever, neck 
+stiffness, stupor, disorientation, coma, tremors, 
+convulsions, paralysis, and sometimes death. 
+ 
+How soon after exposure do symptoms 
+appear? 
+Symptoms of WNV usually appear 2 to 14 days , 
+but usually 2- 6 days  after the bite of an infected 
+mosquito. 
+ 
+How is West Nile virus diagnosed? 
+Diagnosis is based on tests of blood or spinal 
+fluid. 
+ 
+Who is at risk for West Nile virus? 
+Anyone can get WNV, but some people are at 
+increased risk, such as people living in or visit ing 
+areas where the disease is common, or people 
+who work outside or participate in outdoor 
+recreational activities in areas where the disease is 
+common.  Persons older than 50 years of age are 
+more likely to develop serious symptoms of WNV 
+if they do get sick and should take special care to 
+avoid mosquito bites.  All donated blood is 
+checked for WNV before being used.  The risk of 
+getting WNV through blood transfusions and 
+organ transplants is very small, and should not 
+prevent people who need surgery from  having it.  
+If you have concerns, talk to your health care 
+professional. 
+ 
+What is the treatment for West Nile 
+Virus? 
+There is no specific treatment for WNV.  In more 
+severe cases, intensive supportive therapy is 
+indicated, i.e., hospitalization, intravenous (IV) 
+fluids and nutrition, airway management, 
+ventilator support (ventilator) if needed, and 
+prevention of secondary infections (pneumonia, 
+urinary tract, etc). 
+ 
+How common is West Nile virus? 
+WNV was first identified in NH in 2000.  WNV 
+has been found in horses, mosquitoes and several 
+species of birds.  Since 2010 three human cases of 
+WNV were reported in the state.  
+ 
+How can West Nile virus be prevented? 
+A vaccine is available for horses, but not for 
+humans.  Prevention of the disease centers around 
+controlling mosquitoes and on individual action to 
+avoid mosquito bites.  To avoid being bitten by 
+the mosquitoes that transmit WNV: 
+
+
+West Nile Virus (cont.) 
+Division of Public Health Services  Disease Handbook for Childcare Providers 
+Bureau of Infectious Disease Control   REVISED –January 2018 
+• If possible, stay inside between dusk and 
+dawn, when mosquitoes are most active. 
+• When outside between dusk and dawn, 
+wear long pants and long-sleeved shirts. 
+• Use an insect repellent with DEET or 
+Picaridin according to manufacture’s 
+directions when outside.  Oil of lemon 
+eucalyptus and IR3535 have been found to 
+provide protection similar to repellents 
+with low concentrations of DEET. 
+• Put screens on windows and make sure 
+they do not have holes. 
+• Eliminate standing water and other 
+mosquito breeding locations from your 
+property.  Do not alter natural water 
+bodies.  The management of ponds and 
+wetlands is regulated by the Department of 
+Environmental Services and any 
+alterations require a permit before work 
+may begin. 
+ 
+For specific concerns about West Nile virus, call 
+the New Hampshire Division of Public Health 
+Services, Bureau of Infectious Disease Control  at 
+(603) 271-4496. For further information, refer to 
+the Centers for Disease Control and Prevention 
+website at www.cdc.gov
+ or the New Hampshire 
+department of Health & Human Services website 
+at 
+www.dhhs.nh.gov. 
+ 
+ 
+