HEALTH
HISTORY AND IMMUNIZATION POLICY
FOR CHILD CARE PROVIDERS
Children,
especially those in groups, are more likely to get infectious diseases
than are adults. As a child care provider, you will be exposed to infectious
diseases more frequently than will someone who has less contact with children.
To protect yourself and children in your care, you need to know what immunizations
you received as a child and whether you had certain childhood diseases.
If you are not sure, your health care provider can test your blood to
determine if you are immune to some of these diseases and can vaccinate
you against those to which you are not immune. The Advisory Committee
on Immunization Practices has not developed official recommendations for
vaccination of child care providers. The table on the next page lists
the immunizations that CDC believes are appropriate for child care providers,
based on the official recommendations for vaccination of adults in other
occupations and settings.
Tuberculosis
Screening
Persons who
are beginning work as child care providers should have a TB skin test
(Mantoux method using tuberculin purified protein derivative (PPD)) to
check for infection with the TB germ, unless there is documentation of
a positive test result in the past or of active TB that has been treated
already. The first time that they are tested, persons who cannot document
any previous TB skin test results should have a two-step test. (That is,
if the first test result is negative, the skin test is repeated within
one month.) Persons who have negative results from their skin tests when
they start child care work should have their skin tests repeated every
2 years while the results are still negative. Also, in family home child
care settings, all persons aged 12 years and older who are present while
the children are there should receive TB skin tests under this same schedule,
even if they are not providing child care.
Anyone who
has a positive result from the skin test may be infected with the TB germ
and should be evaluated promptly by a physician, who will check for active
TB. Regardless of TB skin test results, persons who have symptoms of active
TB, such as a cough that “won’t go away,” coughing up blood,
weight loss, night sweats, or tiredness should not attend, work, or volunteer
at a child care facility until they have been evaluated by a physician.
Persons who have active TB should not return to a child care setting until
the local health department has determined that they are no longer contagious.
Recommended
Immunization Schedule for Child Care Providers
| Immunization |
How
Often |
Why
|
| Influenza |
All
child care providers, especially those who have chronic health conditions
or are over 65 years of age should be vaccinated against influenza.
Vaccination is given yearly, in October or November (before the flu
season), because a new influenza vaccine is developed each year to
protect against the viruses expected that year. |
Influenza
causes fever, chills, headache, muscle ache, sore throat, cough, and
cold symptoms. Influenza may lead to pneumonia and other severe illness
among the elderly and those with chronic illnesses or weak immune
systems. |
Measles,
Mumps,
Rubella (MMR) |
Child
care providers should be immune to measles, mumps, and rubella. Providers
born before 1957 can be considered immune to measles and mumps. Others
can be considered immune if they have a history of measles or mumps
disease or have received at least one dose of rubella vaccine on or
after their first birthday. Because a history of rubella disease is
often unreliable, only a blood test indicating Immunity to rubella
or documented receipt of at least one dose of rubella vaccine is adequate
proof of immunity. Measles, mumps, and rubella vaccines are usually
given together as MMR. Many experts recommend two doses of MMR for
persons without other evidence of immunity. |
Measles:
2-3 people out of every 1,000 who contract measles die from complications
such as pneumonia or encephalitis. Encephalitis is an inflammation
of the brain, which can lead to convulsions, deafness, or mental retardation.
Measles during pregnancy increases the risk of premature labor, spontaneous
abortion, and low birth weight.
Mumps:
15% of cases are in adolescents and adults. Mumps may cause inflammation
of the pancreas or sexual organs and may cause permanent deafness
or sterility.
Rubella:
15% of young adults are susceptible. Rubella may cause miscarriage,
stillbirth, and multiple birth defects (congenital disorders, mental
retardation) if contracted in the first trimester of pregnancy.
|
| Tetanus,
Diphtheria (Td) |
Child
care providers should have a record of receiving a series of 3 doses
(usually given in childhood) and a booster dose given within the past
10 years. |
Tetanus
(lockjaw) causes painful muscular contractions. 40%-50% of persons
who contract tetanus die.
Diphtheria
affects throat and nasal passages, interferes with breathing, and
produces a toxin that damages the heart, kidneys, and nerves. 10%
of cases are fatal.
|
| Polio |
Child
care providers, especially those working with children who are not
toilet-trained, should have a record of a primary series of 3 doses
(usually given in childhood) and a supplementary dose given at least
6 months after the third dose in the primary series. |
Polio
attacks the nervous system and can cause paralysis in legs or other
areas. When children are vaccinated using live polio vaccine, they
may shed live polio vaccine virus in their feces or urine for several
weeks after receiving the vaccine. Very rarely, the vaccine virus
can change into a more dangerous form and cause paralytic polio. Anyone
who is in frequent contact with recently vaccinated children, especially
changing diapers, should be certain she or he has been vaccinated
against polio. |
| Hepatitis
A |
Hepatitis
A vaccine is not routinely recommended for child care providers but
may be indicated if the local health department determines that the
risk of hepatitis A in the community is high. Any person who travels
frequently should consider getting hepatitis A vaccine. |
Hepatitis
A is a liver infection that causes fever, a loss of appetite, nausea,
diarrhea, and generally ill feeling that may persist for weeks. During
an outbreak in a child care setting, hepatitis A spreads easily and
quickly. However, in the absence of an outbreak, the risk to child
care providers in general does not seem to be increased. |
| Chickenpox |
Child
care providers who know they have had chicken pox can assume they
are immune. All other providers should consider getting vaccinated
against chicken-pox because of the high risk of exposure to chickenpox.
Persons who believe they have never had chickenpox or are unsure can
be vaccinated. In some areas, blood tests may be available to determine
if a person is susceptible and in need of vaccination. |
Chickenpox
can be a severe disease in adults. Child care providers are at high
risk of being exposed to chickenpox in the child care setting. |
| Hepatitis
B |
Child
care providers who may have contact with blood or blood-contaminated
body fluids or who work with developmentally disabled or aggressive
children should be vaccinated against hepatitis B with one series
of 3 doses of vaccine. |
Hepatitis
B causes serious illness and 1 in 20 persons will develop chronic
hepatitis, which can destroy the liver and raise the risk of getting
liver cancer. Persons who develop chronic hepatitis B are infectious
to others for the rest of their life. |
Provider
Exclusion/Readmittance Criteria
A child care
provider should be temporarily excluded from providing care to children
if she or he has one or more of the following conditions.
| Condition |
Exclude
from Child Care Facility |
| Chickenpox |
Until
6 days after the start of rash or when sores have dried/crusted. |
| Shingles |
Only
if sores cannot be covered by clothing or a dressing; if not, exclude
until sores have crusted and are dry. A person with active shingles
should not care for immune suppressed children. |
| Rash
with fever or joint pain |
Until
diagnosed not to be measles or rubella. |
| Measles
|
Until
5 days after rash starts. |
| Rubella
|
Until
6 days after rash starts. |
| Mumps
|
Until
9 days after glands begin to swell. |
| Diarrheal
illness |
If 3
or more episodes of loose stools during previous 24 hours, or if diarrhea
is accompanied by fever, until diarrhea resolves. |
| Vomiting |
If 2
or more epidsodes of vomiting during the previous 24 hours, or if
accompanied by a fever, until vomiting resolves or is determined to
be due to such noninfectious conditions as pregnancy or a digestive
disorder. |
| Hepatitis
A |
For
1 week after jaundice appears or as directed by health department,
especially when no symptoms are present. |
| Pertussis |
Until
after 5 days of antibiotic therapy. |
| Impetigo
(a skin infection) |
Until
24 hours after antibiotic treatment begins and lesions are not draining. |
| Active
Tuberculosis (TB) |
Until
the local health department approves return to the facility. |
| Strep
throat (or other streptococcal infection) |
Until
24 hours after initial antibiotic treatment and fever has ended. |
| Scabies/head
lice/etc. |
Until
24 hours after treatment has begun. |
| Purulent
conjunctivitis |
Until
24 hours after treatment has begun. |
| Other
conditions mandated by state public health law. |
As required
by law (consult your local health department). |
Health
Risks for Pregnant Child Care Providers
Knowing your
health history is especially important if you are pregnant or could become
pregnant and are providing child care. Several childhood diseases can
harm the unborn child, or fetus, of a pregnant woman exposed to these
diseases for the first time. These diseases are:
- Chickenpox
or Shingles (Varicella Virus)--First-time exposure to this virus during
pregnancy may cause miscarriage, multiple birth defects, severe disease
in newborns. Chickenpox can be a serious illness in adults. Most people
(90% to 95% of adults) were exposed to chickenpox as children and are
immune. For women who do not know if they had chickenpox as a child,
a blood test can verify if they are immune. If they are not immune,
a chickenpox vaccine is now available. Vaccination against chickenpox
before you get pregnant may reduce the risk of passing the virus to
your fetus should you become pregnant in the future and then are exposed
to chickenpox. Because the vaccine may harm a fetus, the vaccine is
not given to pregnant women. Your physician will ask you if you are
pregnant before giving you the vaccination and will advise you to avoid
pregnancy for 1 month following each dose of vaccine.
- Cytomegalovirus
(CMV)--First-time exposure to CMV during pregnancy may cause hearing
loss, seizures, mental retardation, deafness, and/or blindness in the
newborn. In the United States, cytomegalovirus is a common infection
passed from mother to child at birth. Providers who care for children
under 2 years of age are at increased risk of exposure to CMV. Most
people (and 40% to 70% of women of childbearing age) have been exposed
to CMV and are immune. There is no licensed vaccine against CMV.
- Fifth
Disease (erythema infectiosum)--First-time exposure to fifth disease
during pregnancy may increase the risk of fetal damage or death. Most
people (and 30% to 60% of women of childbearing age) have been exposed
to the virus and are immune. There is no vaccine licensed for fifth
disease.
- Rubella
(German or 3-day measles)--First-time exposure to rubella during the
first 3 months of pregnancy may cause fetal deafness, cataracts, heart
damage, mental retardation, miscarriage, or stillbirth. Rubella can
also be a severe illness in adults. Everyone who works in a child care
facility should have proof of immunity to rubella on file at the facility.
Child care providers can be considered immune only if (a) they have
had a blood test for rubella antibodies and the laboratory report shows
antibodies or (b) they have been vaccinated against rubella on or after
their first birthday. Providers who are not immune should be vaccinated.
Because it is not known whether the vaccine may harm a fetus, a woman
should not be vaccinated if she is pregnant. After vaccination, a woman
should avoid getting pregnant for 3 months.
|
