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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.
Note: This information is not intended to take the place of your state's or locality's child care regulations and laws. In every case, the laws and regulations of the city, county, and state in which the child care facility is located must be carefully followed even if they differ from these recommendations.

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