After illness: When can the child return to daycare or school??
Sickness is often quite sudden. Getting well, on the other hand, can take time. In daycare centers, kindergartens and schools, children and adolescents come into close contact with other children and caregivers or teachers. This favors the spread of contagious diseases. In order to prevent this as much as possible, the Infection Protection Act regulates the illnesses for which special precautions must be taken and what they look like in each case.
A selection of common childhood diseases and the respective guidelines are presented here.
Diarrheal disease caused by rotaviruses
Pathogens and disease: Rotaviruses are the most common cause of intestinal infections in children caused by viruses. Typical symptoms are severe diarrhea, vomiting and fever. In Western industrialized countries, infants and children between the ages of 6 months and 2 years are the most likely to contract the disease because there is not yet sufficient immunity. By the age of 3 years, 90% of all children have experienced a rotavirus infection, and by the age of 5 years, 90% have been infected with the virus. By the age of 16, almost all children have become infected with rotaviruses. The younger a child is when first infected, the greater the risk that the child will lose a lot of fluid. Hospital admissions are frequent. Even life-threatening conditions are possible.
Duration of infection : During the acute phase of the disease, the virus is excreted. This usually lasts no longer than 8 days. During this time, comprehensive hand hygiene (after going to the toilet, changing diapers or before preparing meals) and disinfection of objects and surfaces are important to prevent further spread of the virus.
When to return to daycare, kindergarten, school : Children under 6 years of age are not allowed in a community facility until 48 hours after symptoms have subsided, or when approved by the pediatrician.
Prevention : To protect as much as possible especially the smallest, who are particularly threatened by a diarrhea of vomiting, there is a vaccination for infants. This must be taken at the latest by 32. The first contact with the virus must be at least one week old.
Pathogen and disease: Whooping cough (pertussis) is a highly contagious, bacterial infection of the upper respiratory tract. Typical symptoms of the respiratory disease are cramp-like, painful coughing attacks, which occur intermittently and last for several weeks. Whooping cough is caused by the bacterium Bordetella pertussis, which multiplies in the mucous membranes of the human respiratory tract after infection. There it releases toxins. Damages the tie. Infection occurs from person to person via droplet infection during coughing, sneezing or talking.
Whooping cough can be contracted at any age. If children are affected, the symptoms are often very pronounced with severe coughing fits. In adults, the symptoms are often not so clear, so that the infection is often overlooked. Then unprotected persons can be infected.
Duration of infection: The incubation period, i.e. the time between infection and the outbreak of an infectious disease, usually lasts 9 to 10 days for whooping cough, but in rare cases up to 20 days. Even before the first symptoms appear, there is a high risk of infection for unvaccinated persons. The infection phase begins before the onset of the typical whooping cough attacks. If untreated, contagiousness peaks in the first two weeks of the illness. Can last from the time of the coughing attacks up to another 3 weeks. In infants, the contagiousness can even last up to 6 weeks. When to return to nursery, kindergarten, school: An illness is treated with an antibiotic. As a rule, 5 days after the start of effective treatment with an antibiotic, the sick child is no longer contagious and can again attend a community facility. If no antibiotic is given, the child may not return to daycare or school until 21 days after the onset of the cough.
Prevention : Vaccination protects against the disease. According to the recommendation of the STIKO, children should be vaccinated three times as infants in order to build up good protection. If this is not the case, the vaccination should be given at the latest when the child enters elementary school. Booster vaccinations are recommended at the age of 5-6 years, 9-16 years and in adulthood together with tetanus and diphtheria vaccination.
Vaccinated persons do not get whooping cough or get it only weakly. However, they can still be temporarily colonized with the pathogens and infect unprotected people. This means that even close contacts who have been vaccinated should, if necessary, take chemoprophylaxis as a precaution if there are unvaccinated or incompletely vaccinated persons in the vicinity (e.g., children who have not been vaccinated). B. infants, pregnant women). The doctor decides on the procedure.
Pathogen and disease : Chickenpox is triggered by the first contact with the varicella-zoster virus. The disease is highly contagious. Virtually everyone becomes infected with chickenpox during their lifetime, usually as a child. Often the disease is inconspicuous except for the unpleasant itchy rash, but more or less severe complications are possible.
Duration of infection: Already 1 to 2 days before the rash and 5 to 7 days after the last appearance of the skin changes, one is contagious for others.
When to return to daycare, kindergarten, school : One week after the onset of an uncomplicated disease or. When all blisters are completely crusted, the danger of infection is over. Then children can visit a community facility again.
Attention must also be paid to the direct contact persons (e.g., the patient's parents). B. Siblings). Under certain circumstances, they may also not be able to visit the respective community facility. This is the case when there is no immunity, that is, when the child has not had chickenpox or has not been vaccinated twice against chickenpox. In such a case, the sibling must remain at home for the duration of the incubation period, i.e. the time that elapses from infection to the outbreak of the disease. On average, the incubation period is 16 days (8-28 days).
Prevention : Against chickenpox there is a vaccination recommended by the STIKO for children. The first vaccination can be given from 11 months of age. The second vaccination should be carried out 6 months after the first vaccination.
"Corona", SARS-CoV2 and Covid-19
Pathogen and disease: The novel coronavirus SARS-CoV2 causes the disease Covid-19. Typical for an infection are symptoms such as cough, fever, rhinitis, disturbances of the sense of smell and taste. However, other signs of illness have also been observed, while the most common symptoms may not always occur. For this reason, it is not possible to diagnose an infection on the basis of the clinical picture alone. This requires detection of the pathogen from a nasal and/or throat swab. SARS-CoV2 is transmitted via droplet infection. Aerosols transmitted in the air you breathe. Wearing appropriate and well-fitting mouth and nose protection reduces the risk of infection.
Duration of infection: The average incubation period is 5-6 days. A maximum of 14 days has been described. The infectious period lasts about 12 days. It begins 2 days before the onset of symptoms in the case of a disease course with symptoms, and on day 3 after contact with an infectious person in the case of a course without symptoms (asymptomatic course). If symptomatic (mild): No earlier than 10 days after the onset of symptoms. At least 48 hours after the last symptoms have subsided. This is decided by a physician. – In case of asymptomatic course: No earlier than 10 days after the first detection of the pathogen.
As a rule, the responsible public health department ies a 14-day quarantine in the case of a positive corona test. After 14 days, including 48 hours of freedom from symptoms, the child is allowed to return to school or kindergarten.
In contact persons of those tested positive, a distinction is made according to the type of contact. Contact persons 1. Grade there are often in daycare centers or schools, if people have been in a room with high concentration together with an infected person for more than 30 minutes. In this case a 14-day quarantine is possible. This is decided by the public health department. Prevention : A preventive vaccination for adults. Children is currently (as of October 2020) not yet available in Germany. For this reason, the so-called AHA rules apply as prevention:
– Distance : Keep at least 1.5 meters away from other people. – Hygiene: regular hand washing for at least 20 seconds, hand disinfection, observance of cough and sneeze etiquette. – Everyday masks: wear mouth-nose protection whenever sufficient distance cannot be guaranteed.
These rules are supplemented by the use of the Corona warning app and regular airing.
Pathogen and disease : head lice are annoying but harmless. They live only on the human head, lay their eggs on the hair roots. They bite into the scalp and suck blood, which can (but does not have to) result in severe itching.
Duration of infection: Head lice are transmitted from head to head. As long as one person has lice, they can continue to crawl onto the next person's head during close contact and when hairs come together.
When to return to daycare, kindergarten, school : The child can return to a community facility when a suitable, approved head lice remedy has been properly applied and the hair has been combed out with a lice comb. Approved remedies against head lice are available on prescription from the pediatrician (up to the age of 12) or over-the-counter at the pharmacy. The application must be done exactly according to the instructions. On day 8, 9 or 10 after the first application, a second treatment with lice remedy is mandatory. Only in this way can the larvae that have hatched in the meantime also be killed off. If the second treatment is not carried out, the lice will multiply again.
Prevention : Prevention is practically impossible. Most children get head lice at some point, simply because they play with other children and have such close contact with each other. The best prevention consists of early detection. Regular control of the hair in case of conspicuous scratching of the head and, if necessary, a quick and consequent treatment are most effective.