Caring for Our Children (CFOC)

Chapter 7: Infectious Diseases

7.4 Enteric (Diarrheal) Infections and Hepatitis A Virus (HAV)

7.4.0

7.4.0.2: Staff Education and Policies on Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections

Content in the STANDARD was modified on 4/5/2017.

 


To prevent and control infections of the gastrointestinal tract (mainly diarrhea) and hepatitis A, facilities should follow these guidelines, conduct staff education, and follow policies:
a.  The facility should conduct continuing education for staff members to address:
1. Methods of germ transmission that cause diarrhea and hepatitis A;
2. Symptoms of diarrhea and disease associated with hepatitis A virus (HAV) infection; and
3. Prevention of diarrhea and disease associated with hepatitis A virus (HAV) infection.
 
b.  All caregivers/teachers, food handlers, and maintenance staff should receive continuing education and monitoring concerning hand hygiene and cleaning of environmental surfaces as specified in the facility’s plan.

c.  At least annually, the director should review all procedures related to preventing diarrhea and HAV infections. Each caregiver/teacher, food handler, and maintenance person should review a written copy of these procedures or view a video, which should include age-specific criteria for inclusion and exclusion of children who have a diarrheal illness or HAV infection and infection control procedures.

d.  Guidelines for administration of immunization against HAV should be enforced to prevent infection in contacts of children and adults with hepatitis A disease (1,2).
RATIONALE
Routine immunization of infants with rotavirus vaccine (3) and of toddlers and older children with hepatitis A vaccine has decreased rates of these diseases in child care centers (4,5). In addition, staff training in hygiene and monitoring of staff compliance reduces the spread of diarrhea (1).
Caregivers/teachers should observe children for signs of disease to identify early detection and implement of control measures. Facilities should consult the local health department to determine whether the increased frequency of diarrheal illness requires public health intervention.
COMMENTS
Hepatitis A vaccine is not recommended for routine administration to caregivers/teachers but it can be administered to any person seeking protection from HAV (2). Caregivers/teachers should be informed of the availability of hepatitis A vaccine.
Hepatitis A vaccine is recommended for all children beginning at twelve months of age (6). Unimmunized infants and toddlers can develop HAV. They are usually asymptomatic or mildly ill and can easily transmit infection to susceptible adults who often develop signs and symptoms of disease including jaundice and who may become seriously ill.
For additional information regarding enteric (diarrheal) and HAV infections, consult the current edition of the Red Book from the American Academy of Pediatrics (AAP).
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
3.2.2.1 Situations that Require Hand Hygiene
3.2.2.2 Handwashing Procedure
3.2.2.3 Assisting Children with Hand Hygiene
3.2.2.4 Training and Monitoring for Hand Hygiene
3.2.2.5 Hand Sanitizers
3.3.0.1 Routine Cleaning, Sanitizing, and Disinfecting
3.3.0.2 Cleaning and Sanitizing Toys
3.3.0.3 Cleaning and Sanitizing Objects Intended for the Mouth
3.3.0.4 Cleaning Individual Bedding
3.3.0.5 Cleaning Crib Surfaces
3.6.1.1 Inclusion/Exclusion/Dismissal of Children
3.6.1.2 Staff Exclusion for Illness
3.6.1.3 Thermometers for Taking Human Temperatures
3.6.1.4 Infectious Disease Outbreak Control
7.4.0.1 Control of Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections
Appendix G: Recommended Childhood Immunization Schedule
Appendix H: Recommended Adult Immunization Schedule
REFERENCES
  1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, 4th Edition. Elk Grove Village, IL: American Academy of Pediatrics.
  2. American Academy of Pediatrics. School Health In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 138-146


  3. Centers for Disease Control and Prevention. 2009. Prevention of rotavirus gastroenteritis among infants and children. MMWR 58 (RR02). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5802a1.htm.
  4. Centers for Disease Control and Prevention. 2006. Prevention of hepatitis A through active or passive immunization. MMWR 55 (RR07). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.htm.
  5. American Academy of Pediatrics, Committee on Infectious Diseases. 2007. Policy statement: Hepatitis A vaccine recommendations. Pediatrics 120:189-99.
  6. Centers for Disease Control and Prevention. 2016. Hepatitis A questions and answers for the public. https://www.cdc.gov/hepatitis/hav/afaq.htm#overview
  7. ADDITIONAL REFERENCE:
     
    Centers for Disease Control and Prevention. 2016. Viral hepatitis - Hepatitis A information. https://www.cdc.gov/hepatitis/hav/havfaq.htm#B1
  8. American Academy of Pediatrics. Hepatitis A Virus (HAV) In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 392-400
NOTES

Content in the STANDARD was modified on 4/5/2017.