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OVERVIEW OF INFECTIOUS DISEASE IN CHILDREN

• Disease that occur in age group below 18 years.

• Infectious diseases are illnesses caused by germs (microbes).

• Not all germs (bacteria, viruses, fungi, and parasites) cause disease.

• Normal flora: a host of bacteria normally live on the skin, eyelids, nose, and mouth and in the gut are considered normal inhabitants.

• Carrier: person with the bacteria.

• It is not always clear why the same strains of bacteria cause carriage in one child, mild illness in another, and serious infection in others.

• Important factors in the child include age, immunity, nutrition, genetic makeup, and general health.

TERMINOLOGIES• Normal flora: Bacteria that live on or in a child

• Pathogen: A germ that can cause a disease

• Colonization: Presence of a germ in or on the child without disease.

• Intoxication: Illness due to a toxin made by a germ

• latent infection: A germ (most often a virus) in a resting state

• Incubation: Time between infection and symptoms

• Reactivation: The latent germ wakes up and reproduces

• Carrier: A child who is colonized but not sick

• Contagious: Able to spread the illness

• Carriage of the bacteria: bacteria present on a body surface such as the nose or throat or in the bowels, but there is no illness.

WHAT CAUSES INFECTIONS ?

• Prions: Infectious proteins. The smallest known infectious agents

• Viruses: Very small. Viruses take over your cells to reproduce themselves

• Bacteria: Two types: free-living, normal inhabitants (normal flora); pathogens that produce disease

• Fungi: Molds and yeasts. Fungi colonize (live on or in a child) and are pathogens

• Parasites: Forms range from single cells (amoeba, protozoa) to worms

• New-borns are at risk because their protective systems are not yet tested and are not always mature.

• Infants are at risk because they tend to put everything into their mouths and rarely clean their hands.

• Older children are less at risk because their hygiene is better and they have become immune through prior infection or carriage of bacteria.

WHO ARE AT RISK ?

• Another important factor for a child is the use of medical devices such as catheters and other tubes.

• These catheters and tubes provide a direct path for bacteria and fungi to get into the blood, bladder, or lungs.

• Medicines such as corticosteroids (used in asthma and many other conditions) and cancer chemotherapy can interfere with a child’s ability to fight infection.

• Even antibacterials can be a factor by killing the normal protective flora.

• Infections are a normal part of childhood.

• Most children will have at least 6 to 8 respiratory (breathing tract) infections each year.

• These include colds, ear infections, sinus infections, bronchitis, and pneumonia. Infections of the bowels also are common.

• When children gather together in child care settings and school, there is the opportunity for infections to spread from one child to another.

• Not all infections are contagious (able to spread from person to person).

• Ear and bladder infections are not spread from child to child, while diarrhoea and colds are easily spread.

• Sometimes the incubation is short (e.g., a day or so for the flu), while other times it is quite long (Eg, 2 weeks for chickenpox and many years for HIV)

• Inflammation can be harmful to the child as well. Inflammation can harm organs, cause pain, and interfere with normal body functions.

• In some cases, a person is contagious during the incubation period, while in others the person is not contagious until the illness begins.

• The amount of time a child remains contagious depends on the infection and the child.

• Young children are often contagious for longer than older children.

• Infections are sometimes so mild that there are few or no symptoms. Other infections cause more severe illness.

Common cold/Flu• Symptoms:

• A congested or runny nose• Nasal discharge that may be clear at first but then usually becomes

thicker and turns shades of yellow or green• A low-grade fever of about 100.4 F (38 C)• Sneezing• Coughing• Decreased appetite• Irritability• Difficulty sleeping• Trouble nursing or taking a bottle due to nasal congestion

• Method of spread: Direct• Incubation Period: 2 – 5 days• Contagious period: Until the symptoms persist.

Nasal allergies• Cause: dust mites, pet dander, mold, and pollen.• Symptoms:• Runny and itchy nose• Congestion• Frequent sneezing• Chronic cough• Red, watery eyes• Allergic shiners -- dark rings under the eyes• Mouth breathing, especially while asleep• Exhaustion, because of poor sleep quality• Symptoms that last longer than a couple of weeks

Acute bronchitis• Swelling and irritation in your child's air passages.• Acute bronchitis often starts because of another illness,

such as a cold or the flu.• Bronchitis is often called a chest cold. • Acute bronchitis lasts about 2 weeks and is usually not a

serious illness.• Symptoms• Constant cough• Fever, body aches, and chills.• Sore throat and a runny or stuffy nose• Short of breath and wheezes• More tired than usual.

Asthma• A respiratory condition marked by attacks of spasm in the

bronchi of the lungs, causing difficulty in breathing.• Symptoms:• Frequent coughing spells, which may occur during play, at night, or

while laughing or crying• A chronic cough (which may be the only symptom)• Less energy during play• Rapid breathing (intermittently)• Complaint of chest tightness or chest "hurting"• Whistling sound when breathing in or out -- called wheezing.• See-saw motions in the chest from labored breathing. These

motions are called retractions.• Shortness of breath, loss of breath• Tightened neck and chest muscles• Feelings of weakness or tiredness

Disease burden of Asthma:• Asthma is the leading cause of chronic illness in children. • It affects about 7 million children in the United States

and, for unknown reasons, is steadily increasing. • Asthma can begin at any age (even in the very elderly),

but most children have their first symptoms by age 5.• Risk Factors:• Nasal allergies (hay fever) or eczema (allergic skin rash)• A family history of asthma or allergies• Frequent respiratory infections• Low birth weight• Exposure to tobacco smoke before or after birth• Black or Puerto-Rican ethnicity• Being raised in a low-income environment

Pneumonia• Pneumonia is a general term for lung infections that can

be caused by a variety of germs (viruses, bacteria, fungi, and parasites). • Most cases, though, are caused by viruses, including

adenoviruses, rhinovirus, influenza virus (flu), human metapneumovirus, and parainfluenza virus.• Often, pneumonia begins after an upper respiratory

tract infection, with symptoms starting after 2 or 3 days of a cold or sore throat. It then moves to the lungs.

• Fluid, white blood cells, and debris start to gather in the air spaces of the lungs and block the smooth passage of air, making it harder for the lungs to work well.

• Symptoms vary depending on a child's age and what caused the pneumonia, but can include:• Fever• Shaking chills• Cough• Stuffy nose• Very fast breathing (in some cases, this is the only symptom)• Breathing with grunting or wheezing sounds• Working hard to breathe; this can include flaring of the nostrils,

belly breathing, or movement of the muscles between the ribs• Vomiting• Chest pain• Abdominal pain, which often happens because a child is

coughing and working hard to breathe• Less activity• Loss of appetite (in older kids) or poor feeding (in infants), which

may lead to dehydration• In extreme cases, bluish or grey colour of the lips and fingernails

Urinary Tract Infection• Symptoms:• A fever not caused by the flu or another known illness.• Urine that has a strange smell.• Vomiting.• The child not being hungry.• The child acting fussy.• Older children are more likely to have common symptoms,

such as:• Pain or burning when they urinate.• Needing to urinate often.• Urinary incontinence.• Red, pink, cloudy, or foul-smelling urine.• Pain in the flank, which is felt just below the rib cage and above

the waist on one or both sides of the back.• Lower belly pain.

Acute otitis media• Acute otitis media means that fluid (usually pus) is in the

middle ear, causing pain, redness of the eardrum, and possible fever.

• Symptoms• The fluid in the middle ear may push on the eardrum, causing ear

pain. Older kids are able to complain of an earache, but a younger child might just tug at the ear or simply act irritable and cry more than usual.

• Lying down, chewing, and sucking also can cause painful pressure changes in the middle ear, so a child may eat less than normal or have trouble sleeping.

• If the pressure from the fluid build up gets high enough, it can rupture the eardrum, causing fluid to drain from the ear. This releases the pressure behind the eardrum, usually bringing relief from the pain.

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Acute Otitis Media

Chickenpox (varicella-zoster virus)• Symptoms: Sudden onset with slight fever. Blister-type

rash occurs in successive crops. Scabs form after the blister stage. Spots or blisters usually appear first on the body, face and scalp, then later spread to the limbs.

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• Method of Spread: by sneezing and coughing. Direct contact with Spread secretions from nose, throat and mouth of infected people.

• Incubation: Usually 14 - 21 days from date of contact.

• Communicable Period : From 2 days before spots appear to 5 days after the first crop of blisters.

• Control: Exclude from school when spots first appear until 5 days after onset.

• Suggested treatment: Control fever with acetaminophen. Aspirin contraindicated. Cut fingernails short to prevent scratching. Calamine lotion, baking soda paste or tepid baths with oatmeal or baking soda may help to relieve itching, antihistamines may also reduce itching.

Fifth Disease (Human Parvovirus)

• Symptoms: Raised, red, warm rash, first appearing on cheeks (slapped cheek appearance). After 1 - 4 days, a lace-like rash spreads to the rest of the body. Rash fades but may recur for 1 – 3 weeks on exposure to sunlight.

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• Method of spread: Contact with infected respiratory secretions; also from mother to foetus.

• Incubation: 4 - 20 days from date of contact.

• Communicable period: Greatest before onset of the rash and probably not after Period the rash.

• Control: Careful hand-washing and disposal of articles soiled with nose and throat secretions.

Hand / Foot / Mouth Disease (Coxsackie virus)

• Symptoms: Sudden onset. Fever, sore throat, small greyish blisters in mouth lasting 4 - 6 days. Blisters may also appear on palms, fingers and soles for 7 - 10 days.

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• Method of Spread: by coughing and sneezing. Direct contact with nose Spread and throat secretions and faeces of infected persons.• Incubation period: 3 - 5 days from date of contact.• Communicable Period: While sick and sometimes longer.• Control: Avoiding close contact. Careful disposal of

articles soiled with discharge. Careful hand-washing, especially after toileting. Isolation of case and children with fever, pending diagnosis.• Treatment: Acetaminophen for fever.• Prevention: Promote hand-washing and hygiene

measures in home and particularly in day-cares.

Herpes “cold sores” (virus)

• Symptoms: Superficial clear vesicles (blisters) with red base, usually on face or lips, which crust and heal within days.

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• Method of Spread: Direct contact with secretions from throat and mouth of infected people.

• Incubation period: 2 - 12 days from date of contact.

• Communicable period: Up to 7 weeks after onset.

• Control Avoid direct contact with secretions or infectious materials.

• Prevention Education to minimize transmission of infectious material, avoiding contact with children with eczema or burns and the immunocompromised.

Impetigo (staphylococcal or streptococcal bacteria)

• Symptoms: A skin infection with moist, purulent, yellow crusted sores surrounded by redness. Spreads forming new sores. Usually found on the face.

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• Method of Spread: Direct contact with secretions from open sores and nose. Can also be spread person-to-person via hands.• Incubation: Staphylococcal: 4 - 10 days from date of contact.

Streptococcal: 1 - 3 days from date of contact.• Communicable Period: If untreated, as long as sores are present,

or 24 hours after antibiotic therapy has been started.• Control: Avoid close contact with infants and debilitated people.

Keep out of school or day-care for 24 hours after start of antibiotics. Wash clothes and linens. Provide separate towels and soap.• Prevention: Keep affected areas clean and covered, if wet.

Encourage children not to touch sores. Keep nails short and clean. Wash hands frequently. Avoid sharing toilet articles.

Influenza (virus)• Symptoms: Fever, headache, muscular aches and pains,

exhaustion, running nose, sore throat. Sometimes nausea, vomiting, diarrhoea, but this is more common in children.

• Method of Spread: Spread by sneezing and coughing, particularly in crowded conditions, and by direct contact with nose and throat secretions.

• Incubation period: Usually 1 - 3 days from date of contact.

• Communicable period: Probably 3 - 5 days in adults, up to 7 days for young children.

Measles “red measles” (Rubeola virus)

• Symptoms: Fever, inflamed eyes, dry cough, runny nose, dusky red blotchy rash 3 - 7 days later spreading downwards from face, white spots in mouth.

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• Method of Spread: Spread by sneezing or coughing, or by direct contact with nose and throat secretions. Highly contagious.

• Incubation: 7 - 18 days from exposure to onset of fever, usually 14 days until rash appears.

• Communicable Period: From just before the symptoms start to 4 days after the rash appears.

• Control: Excluding from school and non-family contacts until 4 days after rash appears. Immunizing susceptible contacts. Immune globulin available for infants under 1 year, immuno-compromised people, and those who can not have the vaccine due to medical reasons.

• Prevention: 2 doses of measles vaccine (age 12 months and 18 months)

Meningitis• Meningitis is an inflammation of the membranes that

surround the brain and spinal cord. • Meningitis can be caused by a bacteria or a virus.• Bacteria that cause meningitis include: • Haemophilus Influenzae type B (Hib) • Meningococcal Meningitis• Streptococcus pneumoniae• Group B Streptococcus

• About 90% of cases of viral meningitis are caused by members of a group of viruses known as enteroviruses, such as coxsackieviruses and echoviruses. • Polioviruses, mumps virus, and herpes simplex virus can also

cause meningitis.

Meningococcal Meningitis (bacteria)• Symptoms: Sudden onset with fever, intense headache,

nausea, vomiting, stiff neck, and often a pinpoint rash. • Confirmed with: test of blood and cerebral spinal fluid

(CSF).

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• Method of Spread: Spread by direct contact with nose and throat secretions.

• Incubation: 2 - 10 days from exposure to onset of fever, usually 14 days until rash appears.

• Communicable Period: Until 24 hours after start of appropriate antibiotic therapy.

• Prevention: Immunization during outbreaks

Haemophilus Influenzae type B (Hib) • Hib was the most common cause of bacterial meningitis in

children aged 2months to 5 years of age before the introduction of Hib vaccine in 1988.

• The majority of cases in children now occur in unimmunized children or in children who are too young to have received their primary series of vaccines at 2, 4, and 6 months of age.

• Signs and symptoms of Hib meningitis:• Fever• Vomiting• Tiredness• Bulging fontanelle (soft spot) in infants• Stiff back and neck in older children

• How is it spread?Through contact with secretions from the nose and throat of an infected person. • Breathing in air contaminated with the bacteria after an

infected person has coughed or sneezed • Close face to face contact• Kissing • Sharing food, utensils, drinks, soothers, bottles, or toys used by

other children.

• Incubation period: 2 – 4 days• Communicable period: • As long as the organism is present, which may be a long period

if individual is not treated with antibiotics.• no longer contagious after receiving 24 – 48 hours of

antibiotics.

Diarrhoeal Diseases• Diarrhoeal disease is the second leading cause of death in

children under five years old. It is both preventable and treatable.• Each year diarrhoea kills around 760 000 children under

five.• A significant proportion of diarrhoeal disease can be

prevented through safe drinking-water and adequate sanitation and hygiene.• Globally, there are nearly 1.7 billion cases of diarrhoeal

disease every year.• Diarrhoea is a leading cause of malnutrition in children

under five years old.

• There are three clinical types of diarrhoea:• Acute watery diarrhoea – lasts several hours or days, and includes

cholera;• Acute bloody diarrhoea – also called dysentery; and• Persistent diarrhoea – lasts 14 days or longer.

• Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms, Rotavirus and Escherichia coli are the two most common etiological agents of diarrhoea in developing countries.• Prevention and treatment• access to safe drinking-water;• use of improved sanitation;• hand washing with soap;• exclusive breastfeeding for the first six months of life;• good personal and food hygiene;• health education about how infections spread; and• rotavirus vaccination.

Dehydration• The most severe threat posed by diarrhoea is dehydration. • During a diarrhoeal episode, water and electrolytes (sodium,

chloride, potassium and bicarbonate) are lost through liquid stools, vomit, sweat, urine and breathing. Dehydration occurs when these losses are not replaced.• The degree of dehydration is rated on a scale of three.

• Early dehydration – no signs or symptoms.• Moderate dehydration:

• Thirst• Restless or irritable behaviour• Decreased skin elasticity• Sunken eyes

• Severe dehydration:• Symptoms become more severe• Shock, with diminished consciousness, lack of urine output, cool, moist

extremities, a rapid and feeble pulse, low or undetectable blood pressure, and pale skin.

E. Coli: Diarrhea Illness andHaemolytic Uremic Syndrome

Signs and symptoms of E. coli infection may include: • Loose, watery diarrhoea that may change to bloody diarrhoea• Mild to severe abdominal cramps• Vomiting • Fever (usually less than 38.5°C)

HUS is an acute disease characterized by haemolytic anaemia, acute renal failure (uraemia), and a low platelet count. • Symptoms of HUS may include: • Decreased urine output• Irritation• Fatigue• Pale skin

Mode of spread:E. coli is spread when a person gets tiny (usually invisible) amounts of human or animal faeces in their mouth: • Eating raw or undercooked beef, especially hamburger • Eating raw fruits and vegetables that have not been

washed or peeled • Drinking unpasteurized milk or juice • Touching surfaces accidentally contaminated with

stool from an infected person (e.g., toys, bathroom fixtures such as taps and light switches, changing tables, or diaper pails)

• Incubation period: Usually 3 – 4 days (range is 2 – 10 days)

• Communicable period: Usually for the duration of diarrhoea (1 week or less). Young children may continue to shed the bacteria in their stool for up to 3 weeks.

• Prevention: Exclude child from school and child care until diarrhoea has stopped.• Exclude any individual with symptoms from food handling and

child care. • In a child care setting, advise ill child or care provider to get a

medical assessment before returning to the child care facility.

Rotavirus• Rotavirus is the most common cause of severe diarrhoea

among young children. • It usually affects children between the ages of 6 months

and 2 years.• Signs and symptoms: • Fever (may be as high as 40°C)• Vomiting• About 12 – 24 hours later, child starts to pass large amounts

of watery diarrhoea• Abdominal pain

• The illness usually lasts 3 – 7 days.

Mode of Spread:• Through direct contact:• changing an infected child’s diaper or assisting a child with

toileting

• Through indirect contact: • touching an object (e.g., toy, faucet, doorknob) that was

contaminated with rotavirus. The virus is able to survive for long periods on hard surfaces, in contaminated water, and on hands.

• Incubation period: Usually 1 – 3 days• Contamination period: During the acute stage of illness

and until diarrhoea stops

Head Lice (Pediculosis) Head lice are tiny insects that live on the scalp. Lice have 3 stages in their life cycle: • Nits (eggs) • Nymphs are young lice. • Adult lice

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• Signs and symptoms: • Itchy scalp (may be worse at night)• Scratching marks or small red lesions like a rash• Child may have head lice and not have any symptoms

• Method of spread: Direct hair contact & Indirect contact

• Incubation period: Period from laying of eggs to emerging adult lice is 10 – 20 days.

Hepatitis A Hepatitis A is an infection of the liver caused by the Hepatitis A virus. It is usually mild and rarely causes permanent liver damage. Hepatitis A is usually more serious in adults than children.

Signs and symptoms: • Fever• Fatigue• Loss of appetite, nausea, and vomiting• Abdominal pain• Jaundice (yellowing of the skin and eyes)

Incubation period: Usually 25 – 30 days (range is 15 – 50 days)

• Method of spread:• Direct contact with the stool of an infected person• Direct contact with the hands of an infected person• Direct contact with an object contaminated with the virus• Eating food prepared by an infected person• Drinking contaminated water

• Communicable period: From about 14 days before onset of symptoms until about 7 days after onset of jaundice. Infants and children may continue to shed virus in their stool for up to 6 months.

• Prevention: Excluding child from school or child care facility for 14 days from the onset of illness or 7 days from the onset of jaundice.

Mononucleosis (“Mono”)Mono is caused by the Epstein-Barr virus (EBV). It is most common in older children and adolescents.

• Signs and symptoms: • Fever• Sore throat• Swollen lymph glands• Lethargy (exhaustion)• Enlarged liver and spleen • Jaundice (yellowing of the skin and eyes) occurs occasionally

• Incubation period: 4 – 6 weeks

Method of spread:• Through direct and indirect contact with the nose and

throat secretions of an infected child: • Kissing• Sharing anything that children put in their mouths (e.g., toys,

Sippy cups, food, drinks, soothers) • Touching something contaminated with an infected person’s

saliva

Mumps• Caused by the mumps virus.• Signs and symptoms: • Fever• Headache• Swollen and painful salivary glands (found in front of and below

the ear or under the jaw)

• Complications of mumps disease include: • Meningitis in 20% of people infected • Orchitis in 20-30% of post-pubertal males • Oophoritis in 5% of post-pubertal females • Deafness and infertility occur occasionally

• Incubation period: Usually 16 – 18 days from contact with an infected person but can range from 14 – 25 days

Method of spread: • Through direct or indirect contact with nose and throat

secretions of an infected person • Breathing air contaminated with the virus when an infected

person has coughed or sneezed • Touching the nose and throat secretions of an infected person • Kissing • Sharing anything that is put in the mouth (e.g., cups, toys)

Communicable Period: From 7 days before to 9 days after the onset of swelling• Child is most contagious 2 days before to 4 days after the onset

of illness.

Pertussis (Whooping Cough)

• Caused by the bacteria Bordetella pertussis.• Infants under one year of age are at highest risk.• If a pregnant woman has pertussis 2-3 weeks before labour,

the infant is at high risk of pertussis disease.

• Signs and symptoms: • Runny nose, low grade fever, and mild cough• After 1 – 2 weeks, the cough worsens • Child will cough violently and rapidly, over and over, until no air is

left in their lungs. Child will then inhale with characteristic “whooping” sound • Child will sometimes vomit after coughing• Coughing will last for several weeks

Method of spread: • Through direct contact with the respiratory secretions of

an infected person• Breathing in air contaminated with pertussis when an infected

person has coughed or sneezed• Sharing anything that is put in the mouth (e.g., cup, toys)• Kissing• Touching the nose and throat secretions of an infected person

or touching articles freshly soiled by an infected person. • Infected adults or adolescents with mild illness or no symptoms

may infect infants.

• Incubation period :Usually 7 – 10 days (range is 5 – 21 days)

Communicable period: Usually from the time when first symptoms develop (1 – 2 weeks before severe coughing starts) until about 3 weeks after cough starts • A child who is started on antibiotics is not infectious after 5 days

of antibiotic therapy.

Pink Eye (Conjunctivitis)• Pink eye is an infection of the covering of the eyeball and

the inside of the eyelid. • It is usually caused by a virus, but may be caused by

bacteria or other irritant.• Children under 5 years of age are most often affected.

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• Signs and symptoms: • Teary, red, itchy, painful eye(s)• Eyelid(s) may be swollen• Pus or thick discharge (yellow or yellowish-green colour) can

make eyelids sticky, especially during sleep• Fever • Eye(s) may be sensitive to sunlight

• Mode of Spread: both direct & indirect

• Incubation period: Usually 1 – 3 days from contact with an infected person

• Contamination Period: During active infection when the child has symptoms

RingwormSigns and symptoms of a ringworm infection may include: • Ring shaped rash that is reddish and may be itchy• Rash may be dry and scaly or wet and crusty• If ringworm infection is on the scalp, there may be patches of

hair loss or hair thinning

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• Mode of spread: • Through direct contact with an area of ringworm infection.• Contact with infected articles• It is possible to become infected by contact with infected

animals such as dogs, cats, and farm animals.

• Incubation period: Usually 4 – 14 days

• Communicable period: As long as lesions are present.

Rubella (German Measles)Signs and symptoms:• Low-grade fever• Malaise, tiredness• Raised, red, pinpoint rash that starts on the face and spreads

downwards• Rash lasts 3 – 5 days• 50% of adolescents and adults with rubella develop muscle and

joint pain

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• Rubella infection during pregnancy can cause severe birth defects, miscarriage, or stillbirth. • 85% of foetuses who are infected with rubella in the first

10 weeks of pregnancy will develop Congenital Rubella Syndrome(CRS). • CRS may include deafness, eye problems, heart defects,

liver, spleen, and brain damage.

• Incubation period: Usually 14 – 21 days from contact with an infected person

• Contamination period: 1 week before and at least 4 days after onset of rash. A child with rubella is most infectious when the rash is erupting.

Scabies• Signs and symptoms of scabies may include: • Intense itching, especially at night• A pimple – like rash may be present• Itching and rash may be all over the body but the most common

sites are between the fingers, wrists, elbows, armpits, groin area, nipples, waist, buttocks, and shoulder blades. • Tiny burrows that look like greyish-white or skin-coloured lines on

the skin may be seen.

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• Mode of transmission: Both direct & indirect

• Incubation period: Usually 2 – 6 weeks in people who have not had scabies before

• Contamination Period: Until mites and eggs are destroyed by treatment

Streptococcal Infections: Scarlet Fever andStrep Throat

• Scarlet fever and strep throat are both caused by streptococcal bacteria.

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Scarlet Fever

Signs and symptoms of scarlet fever: • Red rash that looks like sunburn and feels like rough sandpaper• Rash most often begins on chest and stomach and then spreads

to rest of body• Rash usually lasts 2 – 7 days• When rash fades, skin on hands and feet may start to peel• Fever• Nausea and vomiting• Sore throat• Red, swollen lips, strawberry – like tongue• Flushed cheeks and pale area around mouth

Signs and symptoms of strep throat: • Fever• Very sore throat• Swollen lymph glands• Swollen tonsils • Loss of appetite

• Mode of spread: both direct & indirect

• Incubation period: Usually 1 – 3 days from contact with an infected person

• Contamination period: In untreated cases, 10 – 21 days. Untreated cases of strep throat may carry the organism for weeks or months.

REFERENCES

• Healthychildren.org• American Academy of Pediatrics. (2006). Red Book:

Report of the Committee of Infectious Diseases (27th ed.) Elk Grove, IL: American Academy of Pediatrics.• Frankowski, B. et al (2002). American Academy of

Paediatrics Clinical Report: Head Lice. Paediatrics. Vol 110:3. • Heymann, D. (2004). Control of Communicable Diseases

Manual (18th ed.). Washington, DC• BCCDC Laboratory Services (2003)• http://www.caringforkids.cps.ca/index.htm• http://www.chop.edu/consumer/your_child/index.jsp