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INFECTIOUS DISEASES IN SCHOOLSThis document gives NUT guidance for members on the subject of infectious diseases in schools. It does not seek to provide detailed information about different infectious diseases but looks instead at general principles about how to manage cases of infectious illness, such as the principles governing children’s attendance and exclusion periods, and identifies the best sources of advice on individual cases.
When should children be absent from school?
The basic principle advocated by Public Health England (PHE) inguidance on this area, is that children who are unwell with an infectious disease should not be at school or nursery. When the risk of infection to others has passed and the children have recovered, they should return to school whether or not vestiges of the disease are visible. It is important that parents and school staff understand this principle in order that children do not return before they should do. It is also important that school staff know where they can find information and obtain advice about such matters as exclusion periods. The full PHE guidance “Infection Control in Schools and other Childcare Settings”, is available at:
Many local authorities have published guidelines for their schools, often in co-operation with the health authorities, on dealing with cases of infectious disease. Such guidelines may include information on steps to be taken when children appear to be suffering from infectious disease, exclusion periods for particular conditions and requirements for notifying the local authority about cases of “notifiable diseases” or outbreaks of other diseases. Where such local authority guidelines exist, they should in all cases be followed. The following sections outline the NUT’s guidance on these and other areas.
The situation is of course very different in hospital schools. Teachers who work in hospital schools should be given full guidance on working with pupils who have infectious diseases or other medical conditions. Teachers who are employed as home tutors should also be given appropriate guidance in any case where they are expected to visit pupils who are at home due to medical reasons.
What if you suspect a child is suffering from an infectious disease?
Children who attend school whilst suffering the early stages of infectious diseases can rapidly spread them among their fellow pupils. Clear directions should, therefore, be given to teachers and support staff in order that they know what to do when they suspect that a child is suffering some form of infectious disease.
The PHE guidance emphasises that diagnosis should only be undertaken by an appropriately qualified health professional. Teachers should, therefore, immediately notify the headteacher of their concerns. The headteacher should then make arrangements, in accordance with any local authority guidelines, for the child to be examined by a health professional. This may involve temporary exclusion of the child and, in some circumstances, of close contacts as well. In such circumstances parents should, of course, be fully consulted and involved wherever practicable.
What about exclusion periods?
As noted above, the PHE guidance advises that children should not attend school until after they have recovered and until the risk of infection to others has passed. The PHE guidance includes specific advice for schools on exclusion periods for individual infectious diseases and sets out recommendations on the length of time for which children suffering from particular infections should be kept away from school, once they are well again, to ensure that the risk of transmitting the illness to other pupils and adults has passed. It also includes information on other relevant matters such as hygiene control and immunisations.
The text of the PHEguidance is appended in full to this briefing. It is also available on the internet at:
Links to further guidance on specific infectious diseases are available on the PHE website, at:
Where can schools get individual advice about management of illness?
Schools should seek advice either from the school nurse or doctor or from the local authority’s Consultant in Communicable Disease Control (CCDC).
The Consultant in Communicable Disease Control must be contacted whenever there are any cases of “notifiable diseases” in the school among either pupils or staff. The CCDC should also be contacted if there appears to be an unusual number of cases of an infectious disease in a school or nursery. The CCDC’s advice should be sought urgently if a food handler in the school is suffering from diarrhoea or vomiting. The full list of ‘notifiable’ diseases is contained in Appendix 2 of this briefing, and can also be accessed at:
What about outbreaks of infectious diseases?
During outbreaks of infectious diseases, in particular serious conditions such as Meningitis, it is important that parents, pupils and staff are fully and regularly informed. It is sensible for schools to hold information on infectious diseases and on steps which may need to be taken if there are cases at the school. In the same way that all schools have a named individual to deal with accidents and injuries, it is also sensible for each school to have a named person who will co-ordinate the school’s response to this type of issue.
How can schools prevent the spread of infectious diseases?
The spread of some infectious diseases in schools, particularly diarrhoea and vomiting illnesses, including Dysentery and Hepatitis A, can be controlled through good hygiene procedures. Many local authorities give detailed guidance on hygiene control procedures and these should always be followed in every case.
These procedures include effective hand-washing with warm, running water and soap, after using the toilet and before eating. Paper towels or hand-dryers are best for drying hands. Spillages of body fluids e.g. blood, faeces, saliva or vomit, should be cleaned up immediately. Disposable gloves should always be worn. Surfaces on which body fluids have been spilled should be disinfected with household bleach, diluted one part bleach to ten parts water. The NUT is aware that some local authorities have banned the use of bleach. In such cases the alternative recommended by the local authority should be used. Whatever cleaning fluid is used must be stored securely, away from the reach of children. Secure disposal procedures must also be followed. All of the above should be the responsibility of support staff and teachers cannot be required to be involved in these matters.
Particular care needs to be taken to avoid transmission of infectious diseases to children from animals which are kept in schools or which are encountered during farm visits. The DfE and most local authorities produce detailed guidance on hygiene procedures in these areas which again should always be followed in every case.
How can teachers protect themselves against infection from pupils?
The most important measure is to ensure that children who are infectious are excluded as advised above. In the case of diarrhoea or vomiting, the hygiene measures described above are also essential. In other cases immunisation may be necessary. Due to the resurgence of TB in certain parts of the country, teachers may wish to consult their GP to discuss whether they are sufficiently protected against this disease. Teachers who work with children who are in high risk groups for Hepatitis B may also wish to discuss with their GP whether immunisation would be appropriate.
What if teachers themselves become ill with an infectious disease?
Teachers who become ill with an infectious disease should remain absent until they recover and no longer pose a risk of infection to others. In rare instances medical suspension may be necessary. Guidance on this and on the provisions of the teachers’ sick pay scheme is available from NUT regional/Wales offices and on the NUT website (
What about pregnant teachers?
During pregnancy, certain infectious diseases can pose dangers to unborn babies. Pregnant teachers should contact their GP or ante-natal clinic if they are concerned about possible exposure to an infectious disease at school. Women teachers who are considering becoming pregnant should, of course, check with their GP that they have immunity to Rubella. Other diseases of possible concern include Chickenpox and Slapped Cheek Disease (Parvovirus). Information on precautions to be taken with regard to these diseases is contained in the separate NUT briefing on “Women’s Health and Safety”, which is available at:
Medication and Pupils
Some children who are otherwise well may need to complete a course of medication during the school day. Detailed NUT guidance is available in the separate briefing on “Administration of Medicines” which in turn refers to the detailed DfE guidance on this area, and is available at: Administration of medication by teachers to pupils is entirely voluntary and the NUT will support members in their exercise of their professional judgement on this area.
Action Points for Safety Reps
Make sure that:
- your school has a copy of the PHE guidance on infection control; and
- your colleagues are aware of their responsibilities and rights in this area.
Further Guidance
Further NUT guidance on specific infectious diseases is available on the Health and Safety section of the website, and via the following links:
Dysentery:
Hepatitis:
Meningitis:
Tuberculosis:
NUT Health and Safety Briefing
April 2015
Appendix 1: Full Wording of PHE document: ‘Guidance on infection control in schools and other childcare settings’.
1. Introduction
The document provides guidance for schools and other childcare settings, such as nurseries, on infection control issues.
It is an updated version of guidance that was produced in 2010.
Prevent the spread of infections by ensuring:
- routine immunisation
- high standards of personal hygiene and practice, particularly hand washing
- maintaining a clean environment
For further information and advice visit or contact your local health PHE centre. See Appendix 1 for contact details.
2. Rashes and skin infections
Children with rashes should be considered infectious and assessed by their doctor.
Infection or complaint / Recommended period to be kept away from school, nursery or child-minders / CommentsAthlete’s foot / None / Athlete’s foot is not a serious condition. Treatment is recommended
Chickenpox / Until all vesicles have crusted over / See: Vulnerable Children and Female Staff – Pregnancy
Cold sores, (Herpes simplex) / None / Avoid kissing and contact with the sores. Cold sores are generally mild and self-limiting
German measles (rubella)* / Four days from onset of rash (as per “Green Book”) / Preventable by immunisation (MMR x2 doses). See: Female Staff – Pregnancy
Hand, foot and mouth / None / Contact your local HPT if a large number of children are affected. Exclusion may be considered in some circumstances
Impetigo / Until lesions are crusted and healed, or 48 hours after starting antibiotic treatment / Antibiotic treatment speeds healing and reduces the infectious period
Measles* / Four days from onset of rash / Preventable by vaccination (MMR x2). See: Vulnerable Children and Female Staff – Pregnancy
Molluscum contagiosum / None / A self-limiting condition
Ringworm / Exclusion not usually required / Treatment is required
Roseola (infantum) / None / None
Scabies / Child can return after first treatment / Household and close contacts require treatment
Scarlet fever* / Child can return 24 hours after starting appropriate antibiotic treatment / Antibiotic treatment is recommended for the affected child
Slapped cheek/fifth disease. Parvovirus B19 / None (once rash has developed) / See: Vulnerable Children and Female Staff – Pregnancy
Shingles / Exclude only if rash is weeping and cannot be covered / Can cause chickenpox in those who are not immune, ie have not had chickenpox. It is spread by very close contact and touch. If further information is required, contact your local PHE centre. See: Vulnerable Children and Female Staff – Pregnancy
Warts and verrucae / None / Verrucae should be covered in swimming pools, gymnasiums and changing rooms
3. Diarrhoea and vomiting illness
Infection or complaint / Recommended period to be kept away from school, nursery or child-minders / CommentsDiarrhoea and/or vomiting / 48 hours from last episode of diarrhoea or vomiting
E. coli O157 VTEC Typhoid* [and paratyphoid*] (enteric fever) Shigella (dysentery) / Should be excluded for 48 hours from the last episode of diarrhoea. Further exclusion may be required for some children until they are no longer excreting / Further exclusion is required for children aged five years or younger and those who have difficulty in adhering to hygiene practices.
Children in these categories should be excluded until there is evidence of microbiological clearance. This guidance may also apply to some contacts who may also require microbiological clearance. Please consult your local PHE centre for further advice
Cryptosporidiosis / Exclude for 48 hours from the last episode of diarrhoea / Exclusion from swimming is advisable for two weeks after the diarrhoea has settled
4. Respiratory infections
Infection or complaint / Recommended period to be kept away from school, nursery or child-minders / CommentsFlu (influenza) / Until recovered / See: Vulnerable Children
Tuberculosis* / Always consult your local PHE centre / Requires prolonged close contact for spread
Whooping cough* (pertussis) / Five days from starting antibiotic treatment, or 21 days from onset of illness if no antibiotic treatment / Preventable by vaccination. After treatment, non-infectious coughing may continue for many weeks. Your local PHE centre will organise any contact tracing necessary
5. Other infections
Infection or complaint / Recommended period to be kept away from school, nursery or child minders / CommentsConjunctivitis / None / If an outbreak/cluster occurs, consult your local PHE centre
Diphtheria * / Exclusion is essential. Always consult with your local HPT / Family contacts must be excluded until cleared to return by your local PHE centre. Preventable by vaccination. Your local PHE centre will organise any contact tracing necessary
Glandular fever / None
Head lice / None / Treatment is recommended only in cases where live lice have been seen
Hepatitis A* / Exclude until seven days after onset of jaundice (or seven days after symptom onset if no jaundice) / In an outbreak of hepatitis A, your local PHE centre will advise on control measures
Hepatitis B*, C*, HIV/AIDS / None / Hepatitis B and C and HIV are bloodborne viruses that are not infectious through casual contact. For cleaning of body fluid spills see: Good Hygiene Practice
Meningococcal meningitis*/ septicaemia* / Until recovered / Meningitis C is preventable by vaccination
There is no reason to exclude siblings or other close contacts of a case. In case of an outbreak, it may be necessary to provide antibiotics with or without meningococcal vaccination to close school contacts. Your local PHE centre will advise on any action is needed
Meningitis* due to other bacteria / Until recovered / Hib and pneumococcal meningitis are preventable by vaccination. There is no reason to exclude siblings or other close contacts of a case. Your local PHE centre will give advice on any action needed
Meningitis viral* / None / Milder illness. There is no reason to exclude siblings and other close contacts of a case. Contact tracing is not required
MRSA / None / Good hygiene, in particular hand washing and environmental cleaning, are important to minimise any danger of spread. If further information is required, contact your local PHE centre
Mumps* / Exclude child for five days after onset of swelling / Preventable by vaccination (MMR x2 doses)
Threadworms / None / Treatment is recommended for the child and household contacts
Tonsillitis / None / There are many causes, but most cases are due to viruses and do not need an antibiotic
* denotes a notifiable disease. It is a statutory requirement that doctors report a notifiable disease to the proper officer of the local authority (usually a consultant in communicable disease control). In addition, organisations may be required via locally agreed arrangements to inform their local PHE centre. Regulating bodies (for example, Office for Standards in Education (OFSTED)/Commission for Social Care Inspection (CSCI)) may wish to be informed – please refer to local policy.
Outbreaks: if an outbreak of infectious disease is suspected, please contact your local PHE centre.
6. Good hygiene practice
Hand washing
Hand washing is one of the most important ways of controlling the spread of infections, especially those that cause diarrhoea and vomiting, and respiratory disease. The recommended method is the use of liquid soap, warm water and paper towels. Always wash hands after using the toilet, before eating or handling food, and after handling animals. Cover all cuts and abrasions with waterproof dressings.
Coughing and sneezing
Coughing and sneezing easily spread infections. Children and adults should be encouraged to cover their mouth and nose with a tissue. Wash hands after using or disposing of tissues. Spitting should be discouraged.
Personal protective equipment (PPE)
Disposable non-powdered vinyl or latex-free CE-marked gloves and disposable plastic aprons must be worn where there is a risk of splashing or contamination with blood/body fluids (for example, nappy or pad changing). Goggles should also be available for use if there is a risk of splashing to the face. Correct PPE should be used when handling cleaning chemicals.
Cleaning of the environment
Cleaning of the environment, including toys and equipment, should be frequent, thorough and follow national guidance. For example, use colour-coded equipment, COSHH and correct decontamination of cleaning equipment. Monitor cleaning contracts and ensure cleaners are appropriately trained with access to PPE.
Cleaning of blood and body fluid spillages
All spillages of blood, faeces, saliva, vomit, nasal and eye discharges should be cleaned up immediately (always wear PPE). When spillages occur, clean using a product that combines both a detergent and a disinfectant. Use as per manufacturer’s instructions and ensure it is effective against bacteria and viruses and suitable for use on the affected surface. Never use mops for cleaning up blood and body fluid spillages – use disposable paper towels and discard clinical waste as described below. A spillage kit should be available for blood spills. Guidance on infection control in schools and other childcare settings