7.7.4.2: Exclusion of Children with Varicella-Zoster (Chickenpox) Virus

The varicella-zoster virus causes shingles and chickenpox. Chickenpox is very contagious and can spread in early care and education programs.¹ Programs with children and staff who have chickenpox should temporarily exclude them, using the following exclusion and inclusion criteria: 

• Exclude all staff and children with chickenpox until all lesions have crusted over and no new lesions appear in the last 24 hours.^2–3
• Staff and children who are vaccinated for chickenpox and develop chickenpox lesions without crusts should be excluded until no new lesions appear in the last 24 hours.²
• Children may return when their lesions are crusted over for 24 hours or more, when they can fully participate, and when staff can care for the child without compromising the care of other children.³

The varicella-zoster virus causes shingles in people who have had chickenpox or the chickenpox vaccine. Shingles is spread through direct contact. Programs with children and staff who have shingles should use the following exclusion and exclusion criteria:^3–4

• Exclude staff and children if they can’t cover the lesions.
• Staff and children may attend if they can cover their lesions or when all lesions have crusted over.
• Staff and children may return when the lesions that cannot be covered are crusted over, when children can fully participate, and when staff can care for the child without compromising the care of other children.³
  

RATIONALE

Varicella-zoster is highly contagious and can easily spread in early care and education programs. The virus spreads from person to person by direct contact, by inhaling the virus that gets into the air from open lesions, and through infected respiratory secretions in the air. A person with chickenpox is contagious beginning one to two days before a rash develops until all the lesions have crusted over. These people are contagious until no new lesions have appeared for 24 hours. Some people are at a higher risk for severe illness if they get chickenpox: people who are immunocompromised, newborns, and pregnant people.¹ Staff and children who have chickenpox should be excluded from early care and education programs to help control spread and to limit contact with high-risk people. 

Varicella-zoster is a vaccine-preventable disease. Staff and children should get all recommended vaccines to help prevent infections in early care and education programs.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.6.1.1 Inclusion/Exclusion/Dismissal of Ill Children
3.6.1.2 Staff Exclusion for Illness
3.6.1.3 Guidelines for Taking Children’s Temperatures
3.6.1.4 Infectious Disease Outbreak Control
3.6.2.1 Exclusion and Alternative Care for Children Who Are Ill

REFERENCES

1. Centers for Disease Control and Prevention. Chickenpox (Varicella). CDC.gov Web site. Last reviewed April 28, 2021. Accessed April 21, 2022. https://www.cdc.gov/chickenpox/hcp/index.html

2. American Academy of Pediatrics. Section 2: Recommendation for care of children in special circumstances; children in group childcare and schools. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2021:116-126. 

3. American Academy of Pediatrics. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. Aronson SS, Shope TR, eds. 5th ed. Itasca, IL: American Academy of Pediatrics; 2020

4. Centers for Disease Control and Prevention. Shingles (Herpes Zoster. CDC.gov Web site. Last reviewed April 28, 2021. Accessed April 21, 2022. https://www.cdc.gov/shingles/hcp/clinical-overview.html

NOTES

Content in the standard was modified on 7/05/2022.