Certain symptoms in children may suggest the presence of a communicable disease. Excluding an ill child may decrease the spread of the disease to others in a childcare and school setting. Recommended exclusion varies by the disease or infectious agent. Children with the symptoms listed below should be excluded from a childcare or school setting until symptoms improve, or a healthcare provider has determined that the child can return; or children can participate in routine activities without more staff supervision than usual. *

*NOTE: It is recommended that childcare/preschool providers and schools have policies that are clearly written for excluding sick children and staff. These policies should be placed in the student handbook and on the childcare or school website. Parents/guardians and staff should be given or directed to these resources at the beginning of each school year, when a child is enrolled, or when a new staff member is hired. This will help prevent problems later when the child or staff member is ill.

Exclude children with any of the following:

Illness – Unable to participate in routine activities or needs more care than is usually provided by the childcare/school staff.

Fever – With an elevation of body temperature above normal when accompanied by behavior changes, stiff neck, difficulty breathing, rash, sore throat, and/or other signs or symptoms of illness; or is unable to participate in routine activities. Measure temperature before giving medications to reduce fever.

Elevated body temperature, i.e., fever, is defined as having:

• Axillary (armpit) temperature: 100° F or higher
• Oral temperature: 101° F or higher
• Ear temperatures are not recommended because of inconsistent and inaccurate results. Each manufacturer may have different temperature ranges, which makes setting standards difficult. The child or staff member must be excluded until they have been fever free for 24 hours without the use of fever reducing medications.

Signs/Symptoms of Possible Severe Illness – Exclude until a healthcare provider has done an evaluation to rule out severe illness when the child is unusually tired, has uncontrolled coughing, unexplained irritability, persistent crying, difficulty breathing, wheezing, or other unusual signs for the child.

Diarrhea – Exclude until diarrhea has stopped for 24 hours or until a medical exam indicates that it is not contagious. Diarrhea is defined as an increased number of stools compared with a child’s normal pattern (can be as little as 2-3, but 6 stools in 24 hours is considered diarrhea). The stools may have decreased stool form and/or are watery, bloody, or contain mucus. Any stool that is uncontained in a diaper or the child was not able to make it to the toilet is considered diarrhea.

Vomiting – Vomiting two or more times in the previous 24 hours or one projectile vomit, unless determined to be caused by a non-communicable condition (e.g., Pyloric stenosis, etc.) and the child is not in danger of dehydration.

Mouth Sores with Drooling – Exclude until a medical exam indicates the child is not contagious* and may return or until sores have healed.

Rash with Fever or Behavior Change -Exclude until a medical exam indicates these symptoms are not those of a communicable disease* that requires exclusion.

Eye Drainage – When purulent (pus) drainage and/or fever or eye pain is present, or a medical exam indicates that a child may return*.

Unusual Color of Skin, Eyes, Stool, or Urine – Exclude until a medical exam* indicates the child does not have hepatitis A. Symptoms of hepatitis A include yellow eyes or skin (jaundice), gray or white stools, or dark (tea or cola-colored) urine.

*Please Note: When a facility is experiencing an outbreak and if a child or staff member associated with that facility exhibits signs or symptoms consistent with the suspected etiological agent causing the outbreak they may be excluded for longer periods of time even if they have received a medical exam and have a doctor’s note releasing them back to school or work.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 775-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: stateepi@health.nv.gov

See individual fact sheets for exclusion and other information on the diseases listed below.

Acute Bronchitis (Chest Cold)/Bronchiolitis – Exclude until the fever is gone and the child is well enough to participate in routine activities.

Campylobacteriosis – Exclude until diarrhea has stopped for 24 hours. Children who have Campylobacter in their stools but who do not have symptoms do not need to be excluded, but a pediatric healthcare provider should be informed. Everyone with Campylobacter should NOT use swimming beaches, pools, spas, water parks, or hot tubs until 2 weeks after diarrhea has stopped. Staff with Campylobacter may be restricted from working in food service. Call your local health department to see if these restrictions apply. See: NAC 441A.480

Chickenpox (Varicella – Zoster) – Exclude until all the blisters have dried into scabs or on day 6 after the rash began. It takes 10 to 14 days after receiving vaccine to develop immunity. Vaccine failure occasionally occurs. The incubation period is 10 to 21 days.

Therefore, exclude children who: appear to have chickenpox regardless of whether or not they have received varicella vaccine, or develop blisters within 10 to 21 days after vaccination. Chickenpox can occur even if someone has had the varicella vaccine. These are referred to as “breakthrough infections” and are usually less severe and have an atypical presentation. The bumps rather than blisters may be present; therefore, scabs may not be present. These cases should be excluded until all bumps/blisters/scabs (sores) have faded and no new sores have occurred within a 24-hour period, whichever is later. Sores do not need to be completely resolved. Although extremely rare, the vaccine virus has been transmitted to susceptible contacts by vaccine recipients who develop a rash following vaccination. Therefore, exclude vaccine recipients who develop a rash after receiving varicella vaccine, using the above criteria.

Conjunctivitis (Pinkeye) –

• Purulent Conjunctivitis (redness of eyes and/or eyelids with thick white or yellow eye discharge and eye pain): Exclude until examined by a healthcare provider and approved for readmission or 24 hours after treatment has been started.
• Nonpurulent conjunctivitis (redness of eyes with a clear, watery eye discharge but without fever, eye pain, or eyelid redness): Exclusion is not required.

Croup – Exclude until the fever is gone for 24 hours without the use of fever reducers and the child is well enough to participate in routine activities.

Cryptosporidiosis – Consult Health District. Additional testing may be required prior to readmission. Exclusion is necessary until Health Authority approves readmission. Everyone with Cryptosporidium should NOT use swimming beaches, pools, water parks, spas, or hot tubs for 2 weeks after diarrhea has stopped. Staff with Cryptosporidium may be restricted from working in food service. Call your local health department to see if these restrictions apply. See: NAC 441A.505

Cytomegalovirus (CMV) Infection – Exclusion is not required.

Diarrhea (Infectious) – Exclude until diarrhea has stopped. The length of time may vary depending on the germ. Consult Health District, additional testing may be required prior to readmission if cause is one of the reportable conditions. For some infections, the person must also be treated with antibiotics or have negative stool tests before returning to childcare. (See fact sheet for specific organism when known.) Everyone with diarrhea should NOT use swimming beaches, pools, water parks, spas, or hot tubs for at least 72 hours after diarrhea has stopped. (See specific disease information for additional times.) Staff with diarrhea may be restricted from working in food service. Call your local health department to see if these restrictions apply.

Enterohemorrhagic E. coli Infection – Exclude until asymptomatic or until two stool cultures obtained at least 24 hours apart have tested negative for Enterohemorrhagic E. coli. Everyone with Enterohemorrhagic E. coli should NOT use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped. Staff with Enterohemorrhagic E. coli may be restricted from working in food service. Call your local health department to see if these restrictions apply. See: NAC 441A.515

Fifth Disease (Parvovirus) – Exclusion not required if other rash-causing illnesses are ruled out by a healthcare provider. Persons with fifth disease are no longer infectious once the rash begins.

Giardiasis – Children infected with Giardia who have symptoms should be excluded until treatment has been started and diarrhea has stopped for 24 hours. Children who have Giardia in their stools but who have no symptoms may be readmitted with permission from the Health District. Everyone with Giardia should NOT use swimming beaches, pools, spas, water parks, or hot tubs for 2 weeks after diarrhea has stopped. Staff with Giardia may be restricted from working in food service. Call your local health department to see if these restrictions apply. See: NAC 441A.535

Haemophilus influenzae type B (Hib) Disease – Exclude until the disease is no longer in communicable form and a medical professional has cleared the child for readmission. Other children in the classroom or childcare facility must initiate antimicrobial prophylaxis as a condition of readmission, unless directed otherwise by a medical professional. See: NAC 441A.550

Hand, Foot, and Mouth Disease (Coxsackie Virus) – Exclude until fever-free for 24 hours after discontinuing the use of any fever reducing medication(s), all sores are dry or have scabbed over and child is well enough to participate in routine activities.

Head Lice – Exclude until the first treatment is completed and no live lice are seen. Nits are NOT considered live lice. Follow school district policy in school settings.

Hepatitis A – Consult with your local or state health department. Each situation must be looked at individually to decide if the person with hepatitis A can spread the virus to others. Exclusion must occur until the health authority determines that the child is not infectious. See: NAC 441A.560

Hepatitis B – Exclusion is not required unless the hepatitis B-infected child has unusually aggressive behavior (e.g., biting) that cannot be controlled, oozing sores that cannot be covered, or bleeding problems. A team of medical experts should assess on a case-by-case basis to determine whether exclusion from some activities is necessary.

Hepatitis C – Exclusion is not required unless the hepatitis C-infected child has oozing sores that cannot be covered or bleeding problems. A team of medical experts should assess on a case-by-case basis to determine whether exclusion from some activities is necessary.

Herpes, Oral

• Primary infection: Exclude until those children who do not have control of their oral secretions no longer have active sores inside the mouth.
• Recurrent infections (fever blisters and cold sores): Exclusion is not required.

HIV/AIDS – Exclude if a child with HIV infection has unusually aggressive behavior (e.g., biting) that cannot be controlled, oozing sores that cannot be covered, or bleeding problems.

Impetigo – If impetigo is confirmed by a healthcare provider, exclude until 24 hours after treatment and sores are drying or improving.

Influenza – Exclude until the fever, sore throat, nausea/vomiting are gone for 24 hours without medication and the child is well enough to participate in routine activities.

Measles (Rubeola) – Exclude for at least 5 days after the rash appears. A child with measles should not attend any activities during this time period. Exclude unvaccinated children and staff, who are not vaccinated within 72 hours of exposure, for at least 2 weeks after the onset of rash in the last person who developed measles. See: NAC 441A.610

Meningococcal Disease – Exclude until the child has been on appropriate antibiotics for at least 24 hours and is well enough to participate in routine activities.

Methicillin-Resistant Staphylococcus aureus (MRSA) – Exclude if draining sores are present and cannot be completely covered and contained with a clean, dry bandage or if a person cannot maintain good personal hygiene. Children who are only colonized do not need to be excluded.

Activities: Children with draining sores should not participate in any activities where skin-to-skin contact is likely to occur until their sores are healed. This means no contact sports.

Molluscum Contagiosum – Exclusion is not required. Encourage parents/guardians to cover bumps with clothing when there is a possibility that others will come in contact with the skin. If not covered by clothing, cover with a bandage.

Activities: Exclude any child with bumps that cannot be covered with a water-tight bandage from participating in swimming or other contact sports.

Mononucleosis – Exclusion is not required as long as the child is well enough to participate in routine activities. Because students/adults can have the virus without any symptoms, and can be contagious for such a long time, exclusion will not prevent spread.

Mumps – Exclude until the 6th day after swelling begins. Exclude unvaccinated children and staff if two or more cases of mumps occur. Exclusion will last through at least 25 days after the onset of parotid gland swelling in the last person who developed mumps. Once vaccinated, students and staff can be readmitted.

Norovirus – Exclude until diarrhea and vomiting have stopped for 48 hours. Everyone with vomiting and/or diarrhea should NOT use pools, swimming beaches, water parks, spas, or hot tubs for at least 72 hours after diarrhea and/or vomiting symptoms have stopped. Staff must avoid food preparation when diarrhea and vomiting are present and for at least 72 hours after diarrhea and/or vomiting have stopped. Norovirus can remain in feces of infected persons for a week or more, even after symptoms stop. Call your local health department to see if additional restrictions apply.

Parapertussis – No exclusion necessary, if the child is well enough to participate in routine activities.

Pertussis (Whooping Cough) – Exclude until the 6th day after appropriate antibiotic treatment begins. During this time the person with pertussis should NOT participate in any childcare or community activities. If not treated with 5 days of antibiotics, exclusion should be for 21 days after cough onset. If there is a high index of suspicion that the person has pertussis, exclude until 5 days of antibiotics are completed or until the laboratory test comes back negative. Consult with the health district in regard to possible outbreak of Pertussis. See: NAC 441A.630

Pinworms – Exclusion is not required.

Pneumococcal Infection – No exclusion necessary if the child is well enough to participate in routine activities.

Pneumonia – Exclude until the fever is gone and the child is well enough to participate in routine activities.

Respiratory Infection (Viral) – Exclude until the fever is gone and the child is well enough to participate in routine activities.

Respiratory Syncytial Virus (RSV) Infection – Exclude until the fever is gone and the child is well enough to participate in routine activities.

Ringworm – Exclude until the treatment has been started or if the lesion cannot be covered. Or if on the scalp, until 24 hours after treatment has been started. Any child with ringworm should not participate in gym, swimming, and other close contact activities that are likely to expose others until 72 hours after treatment has begun or the lesions can be completely covered.

Roseola – Exclude until the fever is gone and other rash illnesses, especially measles, have been ruled out.

Rotaviral Infection – Exclude until diarrhea has stopped (child is asymptomatic). See: NAC 441A.670

Rubella (German Measles) – Exclude for at least 7 days after the rash appears. Exclude unvaccinated children and staff in which a case of rubella occurs for at least 3 weeks after the onset of rash in the last reported person who developed rubella. See: NAC 441A.675

Salmonellosis – Exclude until diarrhea has stopped (the child is asymptomatic). Children who have Salmonella in their stools but who do not have symptoms do not need to be excluded. Exclusion may be necessary during outbreaks. Everyone with Salmonella should NOT use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped. Staff with Salmonella may be restricted from working in food service. Call your local health department to see if these restrictions apply. See: NAC 441A.680

Scabies – Exclude until 24 hours after treatment begins.

Shigellosis – Exclude until 24 hours after treatment with antibiotics has been started and diarrhea has stopped (child is asymptomatic). Children who have Shigella in their stools but who do not have symptoms may need to be treated, but do not need to be excluded. Everyone with Shigella should NOT use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped. Staff with Shigella may be restricted from working in food service. Call your local health department to see if these restrictions apply. See: NAC 441A.690

Shingles (Zoster) – Exclusion is not required if blisters can be completely covered by clothing or a bandage. If blisters cannot be covered, exclude until the blisters have crusted. Persons with severe, disseminated shingles should be excluded regardless of whether the sores can be covered.

Staph Skin Infection – Exclude if draining sores are present and cannot be completely covered and contained with a clean, dry bandage or if the person cannot maintain good personal hygiene. Also, exclusion is required until 24 hours after antibiotic treatment under the direction of a healthcare professional has begun. Children who are only colonized do not need to be excluded.

Activities: Children with draining sores should not participate in activities where skin-to-skin contact is likely to occur until their sores are healed. This means no contact sports.

Streptococcal Infection (Strep Throat/Scarlet Fever) – Exclude until 24 hours after antibiotic treatment begins and until the child has been without fever for 24 hours. Children without symptoms, regardless of a positive throat culture, do not need to be excluded from childcare. Persons who have strep bacteria in their throats and do not have any symptoms (carriers) appear to be at little risk of spreading infection to those who live, attend childcare, or work around them.

Tuberculosis (TB) – Individuals who are actively coughing should be excluded until they have contacted/met with a healthcare provider for further instruction. Consult with your local or state health department. Each situation must be evaluated individually to determine whether the person is contagious and poses a risk to others. A person with a positive tuberculin skin test (TST) but without symptoms should not be excluded but should see a healthcare provider as soon as possible after the positive test is detected for further evaluation and possible treatment for latent TB infection.

Viral Meningitis – Exclude until the fever is gone or diarrhea has stopped, and the child is well enough to participate in routine activities.

Warts – Exclusion is not required.

Yeast Infection (Candidiasis) – Exclusion is not required.

Other communicable diseases Consult your local or state health department or the child’s healthcare provider regarding exclusion guidelines for other infections not described in this manual. Special exclusion guidelines may be recommended in the event of an outbreak of an infectious disease in a childcare setting.

Report all diseases of extraordinary (not usual) or outbreak/epidemic occurrence (in higher number than usually expected) to your local health department.

Southern Nevada Health District (Clark County) 775-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: dpbhepi@health.nv.gov

See individual fact sheets for more information on the diseases listed below.

Acute Bronchitis (Chest Cold)/Bronchiolitis – Exclude until the fever is gone and the child is well enough to participate in routine activities.

Campylobacteriosis – Exclusion is not required unless the child is not feeling well and/or has diarrhea and needs to use the bathroom frequently. Exclusion may be necessary during outbreaks. Everyone with Campylobacter should NOT use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped. Staff with Campylobacter may be restricted from working in food service. Call your local health department to see if these restrictions apply. See: NAC 441A.480

Chickenpox – Exclude until all the blisters have dried into scabs; usually by day 6 after the rash began. It takes 10 to14 days after receiving vaccine to develop immunity. Vaccine failures occasionally occur. The incubation period is 10 to 21 days.

Therefore, exclude children who:

• appear to have chickenpox regardless of whether or not they have received varicella vaccine, or
• develop blisters within 10 to 21 days after vaccination.

Chickenpox can occur even if someone has had the varicella vaccine. These are referred to as “breakthrough infections” and are usually less severe and have an atypical presentation. The bumps rather than blisters may be present; therefore, scabs may not present. These cases should be excluded until all bumps/blisters/scabs (sores) have faded and no new sores have occurred within a 24-hour period, whichever is later.

Sores do not need to be completely resolved. Although extremely rare, the vaccine virus has been transmitted to susceptible contacts by vaccine recipients who develop a rash following vaccination. Therefore, exclude vaccine recipients who develop a rash after receiving varicella vaccine, using the above criteria.

Conjunctivitis (Pinkeye)

• Purulent Conjunctivitis – (redness of eyes and/or eyelids with thick white or yellow eye discharge and eye pain): Exclude until examined by a healthcare provider and approved for readmission or 24 hours after treatment has started.
• Nonpurulent conjunctivitis (redness of eyes with a clear, watery eye discharge but without fever, eye pain, or eyelid redness): Exclusion is not required.

Cryptosporidiosis – Consult Health District. Additional testing may be required prior to readmission. Exclusion is necessary until Health Authority approves readmission. See: NAC 441A.505 Everyone with Cryptosporidium should NOT use swimming beaches, pools, water parks, spas, or hot tubs for 2 weeks after diarrhea has stopped. Staff with Cryptosporidium may be restricted from working in food service. Call your local health department to see if these restrictions apply.

Cytomegalovirus (CMV) Infection – Exclusion is not required.

Diarrhea (Infectious) – Exclusion is not required unless the child is not feeling well and/or has diarrhea and needs to use the bathroom frequently. Exclusion may be necessary during outbreaks. For some infections, the person must also be treated with antibiotics or have negative stool tests before returning to childcare. (See fact sheet for specific organism when known.) Everyone with diarrhea should NOT use swimming beaches, pools, water parks, spas, or hot tubs for at least 72 hours after diarrhea has stopped. Staff with diarrhea may be restricted from working in food service. Call your local health department to see if these restrictions apply.

Enterohemorrhagic E. coli Infection – Exclusion is not required unless the child is not feeling well and/or has diarrhea and needs to use the bathroom frequently. Exclusion may be necessary during outbreaks. Until asymptomatic or until two stool cultures obtained at least 24 hours apart have tested negative for Enterohemorrhagic E. coli. Everyone with Enterohemorrhagic E. coli should NOT use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped.

Staff with Enterohemorrhagic E. coli may be restricted from working in food service. Call your local health department to see if these restrictions apply. See: NAC 441A.515

Fifth Disease (Parvovirus) – Exclusion is not required, if other rash-causing illnesses are ruled out by a healthcare provider. Persons with fifth disease are no longer infectious once the rash begins.

Giardiasis – Exclusion is not required unless the child is not feeling well and/or has diarrhea and needs to use the bathroom frequently. Exclusion may be necessary during outbreaks. Children infected with Giardia who have symptoms should be excluded until treatment has been started and diarrhea has stopped for 24 hours. Children who have Giardia in their stools but who have no symptoms may be readmitted with permission from the Health District. Everyone with Giardia should NOT use swimming beaches, pools, spas, water parks, or hot tubs for 2 weeks after diarrhea has stopped. Staff with Giardia may be restricted from working in food service. Call your local health department to see if these restrictions apply. See: NAC 441A.535

Haemophilus influenzae type B (Hib) Disease – Exclude until the disease is no longer in communicable form and a medical professional has cleared the child for readmission. Other children in the classroom or childcare facility must initiate antimicrobial prophylaxis as a condition of readmission, unless directed otherwise by a medical professional. See: NAC 441A.550

Hand, Foot, and Mouth Disease – Exclude until fever-free for 24 hours after discontinuing the use of any fever reducing medication(s), all sores are dry or have scabbed over, and child is well enough to participate in routine activities.

Head Lice – Exclude until first treatment is completed and no live lice are seen. Nits are NOT considered live lice. Follow school district policy.

Hepatitis A – Consult with your local or state health department. Each situation must be looked at individually to decide if the person with hepatitis A can spread the virus to others. Exclusion must occur until the health authority determines that the child is not infectious. See: NAC 441A.560

Hepatitis B – Exclusion is not required unless the hepatitis B-infected child has unusually aggressive behavior (e.g., biting) that cannot be controlled, oozing sores that cannot be covered, or bleeding problems. A team of medical experts should assess on a case-by-case basis to determine whether exclusion from some activities is necessary. See: NAC 441A.570

Hepatitis C – No exclusion necessary, unless the hepatitis C-infected child has oozing sores that cannot be covered or bleeding problems. A team of medical experts should assess on a case-by-case basis to determine whether exclusion from some activities is necessary. See: NAC 441A.570

Herpes Gladiatorum – Contact Sports: Exclude from practice and competition until all sores are dry and scabbed. Treatment with oral medication may shorten exclusion time. Follow the athlete’s healthcare provider’s recommendations and specific sports league rules for when the athlete can return to practice and competition.

Herpes, Oral – Exclusion is not required.

HIV/AIDS – Exclusion is not required.

Impetigo – If impetigo is confirmed by a healthcare provider, exclude the child until 24 hours after treatment and till the sores start drying or improving.

Influenza – Exclude until fever is gone and the child is well enough to participate in routine activities.

Measles – Exclude until at least the 5 days after the rash appears. A child with measles should not attend any activities during this time. Exclude unvaccinated children and staff, who are not vaccinated within 72 hours of exposure, for at least 2 weeks after the onset of rash in the last person who developed measles. See: NAC 441A.610

Meningococcal Disease – Exclude until the child has been on appropriate antibiotics for at least 24 hours and is well enough to participate in routine activities.

Methicillin-Resistant Staphylococcus aureus (MRSA) – If draining sores are present and cannot be completely covered and contained with a clean, dry bandage, or if a person cannot maintain good personal hygiene. Children who are only colonized do not need to be excluded.

Activities: Children with draining sores should not participate in any activities where skin-to-skin contact is likely to occur until their sores are healed. This means no contact sports.

Molluscum Contagiosum – Exclusion is not required. Encourage parents/guardians to cover bumps with clothing when there is a possibility that others will come in contact with the skin. If not covered by clothing, cover with a bandage.

Activities: Exclude any child with bumps that cannot be covered with a watertight bandage from participating in swimming or other contact sports.

Mononucleosis – Exclusion is not required as long as the child is well enough to participate in routine activities. Because students/adults can have the virus without any symptoms, and can be contagious for such a long time, exclusion will not prevent spread.

Sports: Contact sports should be avoided until the student has recovered fully, and the spleen is no longer palpable.

Mumps – Exclude until the 6th day after swelling begins. Exclude unvaccinated children and staff if two or more cases of mumps occur. Exclusion will last through at least 25 days after the onset of parotid gland swelling in the last person with mumps. Once vaccinated students and staff can be readmitted.

Norovirus – Exclude until diarrhea and vomiting have stopped for 48 hours. Everyone with vomiting and/or diarrhea should NOT use pools, swimming beaches, water parks, spas, or hot tubs for at least 72 hours after diarrhea and/or vomiting symptoms have stopped. Staff must avoid food preparation when diarrhea and vomiting are present and for at least 72 hours after diarrhea and/or vomiting have stopped. Call your local health department to see if these restrictions apply.

Parapertussis – Exclusion is not required if the child is well enough to participate in routine activities.

Pertussis (Whooping Cough) – Exclude until the 6th day after appropriate antibiotic treatment begins. During this time, the person with pertussis should NOT participate in any school or community activities. If not treated with 5 days of antibiotics, exclusion should be for 21 days after cough onset. If there is a high index of suspicion that the person has pertussis, exclude until 5 days of antibiotics are completed or until the laboratory test comes back negative. Consult with the health district in regard to possible outbreak of Pertussis. See: NAC 441A.630

Pinworms – Exclusion is not required.

Pneumococcal Infection – Exclusion is not required if the child is well enough to participate in routine activities.

Pneumonia – Exclude until the fever is gone and the child is well enough to participate in routine activities.

Respiratory Infection (Viral) – Exclude until the fever is gone and the child is well enough to participate in routine activities. Exclusion is not required for respiratory infections without fever, as long as the child is well enough to participate in routine activities.

Ringworm – Exclude until the treatment has been started or if the lesion cannot be covered. If lesions are identified on the scalp, exclude until 24 hours of treatment has been completed. Any child with ringworm should not participate in gym, swimming, and other close contact activities that are likely to expose others until 72 hours after treatment has begun or the lesions can be completely covered. Sports: Follow athlete’s healthcare provider’s recommendations and the specific sports league rules for when the athlete can return to practice and competition.

Rotavirus Infection – Exclude until diarrhea has stopped (child is asymptomatic). See: NAC 441A.670

Rubella (German Measles) – Exclude until 7 days after the rash appears. Exclude unvaccinated children and staff in which a case of rubella occurs for at least 3 weeks after the onset of rash in the last reported person who developed rubella. See: NAC 441A.675

Salmonellosis – Exclude until diarrhea has stopped (the child is asymptomatic). Children who have Salmonella in their stools but who do not have symptoms do not need to be excluded. Exclusion may be necessary during outbreaks. Everyone with Salmonella should NOT use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped. Staff with Salmonella may be restricted from working in food service. Call your local health department to see if additional restrictions apply. See: NAC 441A.680

Scabies – Exclude until 24 hours after treatment begins.

Shigellosis – Exclude until 24 hours after treatment with antibiotics has been started and diarrhea has stopped (child is asymptomatic). Children who have Shigella in their stools but who do not have symptoms may need to be treated, but do not need to be excluded. Everyone with Shigella should NOT use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped. Staff with Shigella may be restricted from working in food service. Call your local health department to see if additional restrictions apply. See: NAC 441A.690

Shingles (Zoster) – Exclusion is not required if blisters can be completely covered by clothing or a bandage. If blisters cannot be covered, exclude until the blisters have crusted. Persons with severe, disseminated shingles should be excluded regardless of whether the sores can be covered.

Staph Skin Infection – Exclude if draining sores are present and cannot be completely covered and contained with a clean, dry bandage or if the person cannot maintain good personal hygiene. Also, until 24 hours after antibiotic treatment under the direction of a healthcare professional has begun. Children who are only colonized do not need to be excluded.

Activities: Children with draining sores should not participate in activities where skin-to-skin contact is likely to occur until their sores are healed. This means no contact sports.

Streptococcal Infection (Strep Throat/Scarlet Fever) – Exclude until 24 hours after antibiotic treatment begins and until the child has been without fever for 24 hours. Children without symptoms, regardless of a positive throat culture, do not need to be excluded from school. Persons who have strep bacteria in their throats and do not have any symptoms (carriers) appear to be at a little risk of spreading infection to those who live, attend school, or work around them.

Tuberculosis (TB) – Individuals who are actively coughing should be excluded until they have contacted/met with a healthcare provider for further instruction. Consult with your local or state health department. Each situation must be evaluated individually to determine whether the person is contagious and poses a risk to others. A person with a positive tuberculin skin test (TST) but without symptoms should not be excluded but should see a healthcare provider as soon as possible after the positive test is detected for further evaluation and possible treatment for latent TB infection.

Viral Meningitis – Exclude until the fever is gone or diarrhea has stopped, and the child is well enough to participate in routine activities.

Warts – Exclusion is not required.

Yeast Infection (Candidiasis) – Exclusion is not required.

Other communicable diseases – Consult your local or state health department or the child’s healthcare provider regarding exclusion guidelines for other infections not described in this manual. Special exclusion guidelines may be recommended in the event of an outbreak of an infectious disease in a school setting.

Report all diseases of extraordinary (not usual) or outbreak/epidemic occurrence (in higher number than usually expected) to your local health department.

For more information, please contact your local health department.

Southern Nevada Health District (Clark County) 775-759-1300 (24 hours)

Northern Nevada Public Health  (Washoe County) 775-328-2447 (24 hours)

Carson City Health & Human Services (Carson City, Douglas, Lyon Counties) 775-887-2190 (24 hours)

Division of Public and Behavioral Health (All other Counties) 775-400-0333 (24 hours)

Email: dpbhepi@health.nv.gov