Disease information and exposure notices for schools and child care

Last content update: 4/15/24

The County of Santa Clara Public Health Department provides guidance and exposure notices for schools and child care providers responding to cases or outbreaks of communicable disease.

Schools and child care providers should notify the Public Health Department's Communicable Disease Program at (408) 885-4214 when there are cases of certain diseases. See Table 1 below for criteria for reporting diseases to Public Health.

The following diseases should be immediately reported if there is one case or more: E. coli/Shiga toxin-producing E. coli, hepatitis A, measles, meningococcal disease, pertussis, Salmonella, Shigella, or typhoid/paratyphoid fever.

Communicable Disease Case and Outbreak Toolkit

For guidance on reporting and responding to specific communicable diseases commonly encountered in school and child care settings, refer to the Communicable Disease Case and Outbreak Toolkit for Schools and Childcare (PDF).

This toolkit includes links to requirements and guidance (for example, cleaning instructions) for disease prevention in schools and child care sites. All outbreak management steps are formatted as a checklist. Public Health recommends printing the toolkit for use in outbreak situations and bookmarking or downloading the toolkit for easy reference.

Consider reviewing this toolkit with staff twice a year.

Image 1. Communicable Disease Case and Outbreak Toolkit for Schools and Childcare

Disease reporting requirements

Under Title 17, California Code of Regulations §2508, schools and childcare providers are required to report individual cases of Title 17 diseases (for example, measles, pertussis) and outbreaks that meet the criteria below. To report a disease or outbreak, call (408) 885-4214, select option 3 and ask for a Public Health Nurse.

Table 1. Disease and outbreak reporting thresholds

Gastrointestinal (GI) illnesses	Respiratory illnesses	Reportable Title 17 diseases
3 or more cases of vomiting and/or diarrhea (diarrhea is 3 or more loose stools in a 24-hour period) in a student or staff member, with symptom onset occurring within 72 hours and within the same group (such as a single classroom, sports team, or after-school group) Note: Also distribute the vomiting/diarrhea exposure notice to students and staff - English \| Spanish \| Vietnamese	10% or more of the total population of students and staff, facility-wide, are absent with influenza-like illness¹ within a 3-day period 20% or more of students and staff in the same group (such as a single classroom, sports team, or after-school group) with influenza-like illness¹, with a minimum of 5 ill, within a 3-day period Note: If 5% of the total population of students and staff, facility-wide, test positive for COVID-19, see the County's COVID-19 reporting guidelines ¹ Influenza-like illness is defined as fever (100°F/37.8°C or higher) plus cough and/or sore throat	1 or more cases of Title 17 diseases² ²For COVID-19, refer to the County's COVID-19 reporting requirements

Gastrointestinal (GI) illnesses

Respiratory illnesses

Reportable Title 17 diseases

3 or more cases of vomiting and/or diarrhea (diarrhea is 3 or more loose stools in a 24-hour period) in a student or staff member, with symptom onset occurring within 72 hours and within the same group (such as a single classroom, sports team, or after-school group)

Note: Also distribute the vomiting/diarrhea exposure notice to students and staff - English | Spanish | Vietnamese

10% or more of the total population of students and staff, facility-wide, are absent with influenza-like illness¹ within a 3-day period
20% or more of students and staff in the same group (such as a single classroom, sports team, or after-school group) with influenza-like illness¹, with a minimum of 5 ill, within a 3-day period

Note: If 5% of the total population of students and staff, facility-wide, test positive for COVID-19, see the County's COVID-19 reporting guidelines

¹ Influenza-like illness is defined as fever (100°F/37.8°C or higher) plus cough and/or sore throat

1 or more cases of Title 17 diseases²

²For COVID-19, refer to the County's COVID-19 reporting requirements

Disease information, exposure notices, and exclusion/return criteria for children and staff

Refer to Table 2 below for information on common childhood diseases as well as reporting requirements, PDF exposure notices (available in English, Spanish, and Vietnamese), and exclusion and return criteria for children and staff.

Table 2. Common childhood disease exposure notices and exclusion/return criteria

Disease/Condition Linked to additional information.	Reporting Is this disease reportable to Public Health?	Notification Exposure notice needed?	Exclusion Exclude from school/childcare while symptomatic?	Return When can the individual return?
Amebiasis	No, unless individual is a food handler	No, unless instructed by Public Health in the case of a food handler	Yes	If not a food handler, 48 hours after symptoms resolve If a food handler, when directed by Public Health
Bed bugs	No	No	No	N/A
Campylobacter	Yes	No	Yes	After diarrhea³ resolves
Chickenpox	No, unless individual is hospitalized, died, or is part of an outbreak	Yes, and consult with Public Health if there are concerns for exposure to pregnant or immunocompromised people English \| Spanish \| Vietnamese	Yes, and non-immune siblings of cases should also be excluded from day 8 after sibling's rash appeared through day 21	For cases: after all blisters have scabs For non-immune siblings of cases: after 21 days have passed since the sibling's rash appeared
Clostridioides difficile (C. diff)	No	No	Yes	48 hours after diarrhea³ resolves
COVID-19	Yes, see COVID-19 reporting guidance for childcare and TK-12 schools	No, but schools are encouraged to send a general notification to the entire school community during times of elevated community transmission of COVID-19	Yes	Follow CDPH COVID-19 guidelines
Cryptosporidiosis	Yes	Yes, if recreational water exposure occurred on site - contact Public Health for exposure notice	Yes	48 hours after symptoms resolve, and stay out of public swimming pools until 2 weeks after diarrhea³ resolves
E. coli O157:H7/Shiga toxin-producing E. coli	Yes	Yes English \| Spanish \| Vietnamese	Yes	If restricted⁴, when directed by Public Health If not restricted, 48 hours after symptoms resolve
Giardia	No	Yes English \| Spanish \| Vietnamese	Yes	48 hours after symptoms resolve
Hand, foot, and mouth disease	No	Yes English \| Spanish \| Vietnamese	Yes, if symptoms include fever or uncontrolled drooling with mouth sores	After fever-free for 24 hours without the use of fever-reducing medication; children should not return with difficulty or pain while eating or drinking
Head lice	No	Yes English \| Spanish \| Vietnamese	Yes, but they do not need to be sent home immediately; they can stay until the end of the day	After receiving appropriate treatment
Hepatitis A	Yes	Yes - contact Public Health for exposure notice	Yes	7 days after onset of jaundice (or onset of symptoms if no jaundice) AND diarrhea³ resolves
HiB (Haemophilus influenzae type b) - Invasive	Yes (if less than 5 years of age, any invasive disease is reportable; if 5 and older, only meningitis cases are reportable)	Yes - contact Public Health for exposure notice	Yes	When 24 hours have passed after starting antibiotics and symptoms are improving
Impetigo	No	Yes English \| Spanish \| Vietnamese	Yes, but they do not need to be sent home immediately; they can stay until the end of the day (keep blisters covered)	After starting appropriate treatment; keep blisters covered until they are dry
Influenza	No, unless individual is less than 18 years of age and died	No	No, unless case meets sign/symptom-based exclusion criteria	After exclusion criteria are resolved
Measles	Yes	Yes - contact Public Health for exposure notice	Yes	Per direction of the Public Health Department
Meningococcal meningitis	Yes	Yes - contact Public Health for exposure notice	Yes	Per direction of the Public Health Department
MRSA (Methicillin-resistant Staphylococcus aureus)	No	No	No	N/A
Mumps	Yes	Yes - contact Public Health for exposure notice	Yes	Per direction of the Public Health Department
Norovirus	No, unless a food handler or outbreak	Yes - use vomiting/diarrhea exposure notice English \| Spanish \| Vietnamese	Yes	If not a food handler and there is not an outbreak, after symptoms resolve If a food handler or part of an outbreak, 48 hours after symptoms resolve
Parvovirus B19 (Fifth disease)	No	Yes English \| Spanish \| Vietnamese	No, unless they have a fever	After fever-free for 24 hours without the use of fever-reducing medication
Pertussis (Whooping cough)	Yes	Yes - contact Public Health for exposure notice	Yes	After 5 days of appropriate antibiotic treatment
Pink eye (Conjunctivitis)	No	Yes English \| Spanish \| Vietnamese	No	N/A
Pinworm	No	Yes English \| Spanish \| Vietnamese	No	N/A
Respiratory infection (undiagnosed/cause unknown)	No, unless an outbreak	Yes, if there is an outbreak English \| Spanish \| Vietnamese	No, unless they meet sign/ symptom-based exclusion criteria	After exclusion criteria are resolved
Respiratory syncytial virus (RSV)	No, unless individual is less than 5 years of age and died	Yes English \| Spanish \| Vietnamese	No, unless they meet sign/ symptom-based exclusion criteria	After exclusion criteria are resolved
Ringworm	No	Yes English \| Spanish \| Vietnamese	Yes, but they do not need to be sent home immediately; they can stay until the end of the day	General population: After starting treatment Athletes with tinea corporis: 72 hours after starting treatment unless the affected area can be covered
Roseola (Sixth disease)	No	Yes English \| Spanish \| Vietnamese	No, unless individual has a fever	After fever-free for 24 hours without the use of fever-reducing medication
Rotavirus	No, unless a food handler or an outbreak	Yes - use vomiting/diarrhea exposure notice English \| Spanish \| Vietnamese	Yes	If not a food handler and there is not an outbreak, after symptoms resolve If a food handler or part of an outbreak, 48 hours after symptoms resolve
Rubella	Yes	Yes - contact Public Health for exposure notice	Yes, and unvaccinated close contacts of cases should also be excluded	For cases: 7 days after rash appeared For unvaccinated close contacts: once they receive the MMR vaccine or 23 days after last exposure to a case
Salmonella	Yes	Yes English \| Spanish \| Vietnamese	Yes	If restricted⁴, when directed by PHD If not restricted, 48 hours after symptoms resolve
Scabies	No	Yes English \| Spanish \| Vietnamese	Yes	After receiving appropriate treatment
Shingles	No	Yes English \| Spanish \| Vietnamese	No, unless rash cannot be covered	When rash can be covered or when all lesions have crusted
Shigella	Yes	Yes English \| Spanish \| Vietnamese	Yes	If restricted⁴, when directed by PHD If not restricted, 48 hours after symptoms resolve
Strep throat/Scarlet fever	No	Yes English \| Spanish \| Vietnamese	Yes	When 24 hours have passed after starting antibiotics and symptoms are improving
Typhoid/Paratyphoid fever	Yes	Yes English \| Spanish \| Vietnamese	Yes	If restricted⁴, when directed by Public Health If not restricted, 48 hours after symptoms resolve
Vomiting/diarrhea³ (undiagnosed/cause unknown)	No, unless a food handler or an outbreak	Yes, if there is an outbreak English \| Spanish \| Vietnamese	Yes	If not a food handler and there is not an outbreak, after symptoms resolve If a food handler or part of an outbreak, 48 hours after symptoms resolve

³Diarrhea is when 3 or more episodes of loose stools occur in a 24-hour period OR an occurrence of loose stools that is above normal for the person.

⁴Certain staff (food, health care, or child care staff) and some children (5 years of age and under OR over 5 and need toileting assistance) may be restricted from work/school/group care by the Public Health Department. This means they can go back only when their stool is tested by the Public Health Department Laboratory confirming no bacteria or toxins are found.

Frequently Asked Questions (FAQ)

I have a child/student who is sick. What should I do?

For cases of specific communicable diseases, use Table 2 above to answer the following questions:

Is this disease reportable?
Do I need to post an exposure notice?
Does the individual need to be excluded?
When can the individual return, if excluded?

If a disease or condition is not specified, you may refer to the more general CDPH guidance for responding to symptoms of illness in child care or school.

Can I use my own exposure notice?

No, only use exposure notices from the County of Santa Clara Public Health Department for all diseases listed above.

Where should exposure notices be posted?

The school or child care provider can determine where to post the exposure notice so that all parents are notified. You may send the exposure notice home with the child, tape it to the classroom door, email it, and/or post it next to a sign-in/sign-out sheet.

I'm a childcare, preschool, or daycare provider with more questions. Who can I talk to?

Please call the County of Santa Clara Public Health Department Child Care Health Consultant at (408) 937-2250.

Disease information and exposure notices for schools and child care

Communicable Disease Case and Outbreak Toolkit

Disease reporting requirements

Table 1. Disease and outbreak reporting thresholds

Disease information, exposure notices, and exclusion/return criteria for children and staff

Disease/Condition

Linked to additional information.

Reporting

Is this disease reportable to Public Health?

Notification

Exposure notice needed?

Exclusion

Exclude from school/childcare while symptomatic?

Return

When can the individual return?

Frequently Asked Questions (FAQ)

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