Chapter 10

Communicable Disease Control

This chapter provides guidance on New Mexico statutes, administrative codes, policies, and regulations related to school health.

Reporting and Disease Outbreak Support

New Mexico Department of Health (NMDOH)’s Epidemiology and Response Division (ERD) 24/7 call line: (505) 827-0006.

Infectious diseases occur frequently in the school setting and sometimes result in disease outbreaks with subsequent need for treatment, surveillance, and contact tracing.

Medical events with community-wide consequences occur hundreds of times each year in New Mexico, some in the school setting. In such cases, there are resources available 24 hours a day, seven days a week through the NMDOH Epidemiology and Response Division (ERD).

This system is required by New Mexico statute and administrative code. Physician offices, laboratories, and other health care agencies are required to report suspected or actual cases of notifiable diseases to the NMDOH.

Under the same statutes and rules, the NMDOH is required to identify and control outbreaks of these diseases and to report this information to the Centers for Disease Control and Prevention (CDC) as a part of national data collection. Reports from health care providers to the NMDOH are forwarded to the CDC as New Mexico data.

To report a notifiable disease, receive expert consultation and support during a potential outbreak, or to speak with an epidemiologist, call (505) 827-0006.

Notifiable Conditions in New Mexico

Please see this link in the Manual for Investigation and Control of Selected Communicable Diseases for the list of notifiable conditions in New Mexico.

Reportable Communicable Disease Algorithm and NMDOH Contact List

Map of School Health Advocates

Procedures for Control of Communicable Diseases

Please see the NMDOH Communicable Disease Manual section on childcare settings:
Communicable Disease for Childcare Settings.

Classroom Cleanliness

Definition: Maintaining cleanliness to prevent the transmission of communicable diseases in the classroom.

Guidelines

Adequate hand-washing facilities should be available to students and staff. This includes a sink, hot and cold running water, liquid soap, and disposable paper towels. Provide separate storage areas for clean clothing and linens apart from soiled clothing and linens.
All soiled disposable items should be held in waste receptacles lined with plastic bags, which should be discarded by staff twice daily. THESE PLASTIC BAGS SHOULD NEVER BE REUSED! Contaminated items, including disposable diapers, should be placed in a separate plastic bag before being discarded in an uncovered waste receptacle.
Approved bactericidal solutions should be used to clean toys, tables, chairs, and other environmental surfaces. A solution of 1:9 bleach may be used, but it must be mixed fresh weekly if stored in an opaque container or daily if stored in a clear container to maintain efficacy.
Only washable toys should be available in the classroom.
All equipment, toys, tables, chairs, mats, therapy equipment, etc., used by students who drool or mouth them should be washed with appropriate disinfectant at the end of each day or before use by another student.
The use of non-washable furniture and equipment in the classroom is STRONGLY DISCOURAGED.
Wheelchairs and trays must be washed with soap and water after feeding. If students eat in the classroom, all soiled tables and chairs should be cleaned.
Physical or occupational therapists should be contacted before cleaning orthopedic equipment such as braces or splints to be sure disinfectant choice is appropriate.
The sink area should be cleaned with disinfectant at the end of each day. NEVER scrape food into the sink or rinse soiled dishes in the sink.
All eating utensils and equipment should be washed in a dishwasher. They should be collected in a washable container and taken to the kitchen as soon as possible.
Adaptive feeding equipment and other non-disposable dishes should be kept in a clean storage area.
Students’ personal grooming items should be kept in separate containers.
Soiled rugs or carpet should be cleaned immediately and not used until the area is dry. Students who are unable to control body fluids should NEVER be placed directly on a carpet/rug. Diapering should NEVER be done on carpet or a rug.
Changing tables, portable potties, and toilet seats should be nonporous and cleaned with approved disinfectant after each use.
All toilets, potties, sinks, diaper changing tables, and floors around changing mats should be disinfected daily.

Classroom Cooking

Definition: Preparing food for the purpose of teaching students cooking skills or meeting other educational goals.

Guidelines

Before use in classroom cooking, tables and work areas should be cleaned with an approved disinfectant.
Students and instructional personnel should wash hands with soap and water before and after handling food.
Students who have illness symptoms or who drool excessively should be excluded from the cooking activity.
Disposable scoops, spoons, tongs, gloves, dishes, and dinnerware are recommended whenever possible.
Students should not be allowed to use fingers to taste food from preparation bowls.
Leftovers should be properly stored or disposed of and not left out in the classroom or trash can overnight.
Any non-disposable dishes, pans, utensils, and adaptive equipment should be washed in a dishwasher or in the school cafeteria or kitchen.
Tables and work surfaces used in any cooking activity should be cleaned after the activity.

Diapering

Definition: Changing diapers in such a way that potential for communicable disease transmission is decreased.

Guidelines

Students who are not toilet-trained should be checked at least every 2–3 hours and changed when soiled.

Assemble the following equipment:

Wet disposable towelettes.
Dry disposable towels/pads.
Disposable diapers.
Covered waste receptacle lined with plastic bag.
Small plastic bag for disposing of diapers if they contain feces or blood.
Disposable gloves.
Washable changing table.
Disinfectant for cleaning changing table.
Place student on changing table with a nonporous surface in the bathroom or other appropriate setting. Diapers should NEVER be changed in the classroom.
A STUDENT SHOULD NEVER BE LEFT UNATTENDED ON THE CHANGING TABLE.
Use disposable gloves according to universal precautions.
Remove diaper and discard directly into waste receptacle or plastic bag. NEVER place a soiled diaper on the floor, carpet, or furniture.
Wash the student’s hands before returning them to class.
Wash changing table with disinfectant.

Wash hands according to the hand-washing procedure described in this section.

Hand-washing

Purpose: Hand-washing is one of the most effective techniques in preventing transmission of infectious diseases.

Guidelines

Hands should be washed with soap:

Before eating and drinking.
Before handling dining equipment or utensils.
Before and after handling any food.
Before and after assisting in toileting, diapering, or feeding.
After contact with body fluids or blood.

Remove rings and bracelets before hand-washing because microorganisms hide under jewelry.

Recommended procedures for hand-washing:

Wet your hands with clean, running water, turn off the tap, and apply soap.
Lather your hands by rubbing them together with the soap.
Scrub your hands for at least 20 seconds.
Rinse well under clean, running water.
Dry your hands using a clean towel or air dry them.
Apply lotion as desired to prevent chapping.

To access curriculum, posters, brochures, and other hand-washing resources for use in the school setting, visit:

Bloodborne Pathogens Exposure Risk

Chapter 17 of this Manual contains the OSHA reference guidelines, a sample school exposure plan, and training material. Federal requirements can be accessed through the OSHA website at Bloodborne Pathogens and Needlestick Prevention.

Toileting

Definition: Training, monitoring, and/or assisting a student with toilet needs when the student is unable to do this independently, decreasing the risk of spreading diseases through fecal-oral contamination.

Guidelines

Assemble all equipment.
Suitable sized and adapted toilet/portable potty.
Toilet tissue or disposable towelettes.
Covered, plastic-lined waste receptacle.
Disinfectant.
Disposable gloves.
Disposable plastic bag.
Clean diaper if necessary.

Hand-washing by both the student and supervising adult is the most effective method to remove any fecal contamination before the student is returned to class.

Communicable Diseases Information Sheets

Introduction

Communicable Diseases Information sheets are designed to be used as educational and informational material for students, staff and parents, particularly when outbreaks occur in the school setting.

Disease fact sheets in English and Spanish are linked, where available, under each condition. They can also be found in the Manual for Investigation and Control of Selected Communicable Diseases in New Mexico.

More in-depth information on common diseases encountered in childcare settings can be found in the Communicable Diseases in Child Care Settings section.

Another good resource for disease-specific information is the CDC Index to Diseases and Conditions: https://www.cdc.gov/DiseasesConditions/.

Several general methods of disease prevention are listed below:

Medical Evaluation – referral of possible cases to a healthcare professional for diagnosis and treatment.

Reporting to the NMDOH – see list of reportable conditions; reports can be made to the Regional Health Officer or to the Epidemiology and Response Division hotline at (505) 827-0006. Immediate reporting of highly contagious diseases like measles and shigellosis, serious conditions such as meningitis, and outbreaks of gastroenteritis that may be due to a food or waterborne disease are especially important.

Contact Prophylaxis – some infections that are likely to affect close contacts of cases may be preventable by prophylaxis, or preventive treatment. Such treatment may be recommended by the NMDOH to close contacts.

Isolation – refers to the exclusion, such as from school, of a person with a communicable disease during the period when they are contagious.

Standard Precautions – an infection control practice that considers all persons’ blood and body fluids potentially infectious. Practices include avoidance of contact with blood, body fluids, and excreta; wearing gloves when contact might occur; frequent hand-washing; and frequent washing and decontamination of counters, sinks, play areas, toys, and similar surfaces.

Immunization – some vaccine-preventable disease outbreaks occurring in schools have been controlled by school-based immunization programs. Immunization programs in schools also offer protection to older students before they leave the “captive population” of the school.

Prevention Education – schools can model, teach, and reinforce the simple habits of personal hygiene, environmental cleanliness, and safe food-handling procedures that promote good health and minimize exposure to infectious diseases.

Fever – according to the American Academy of Pediatrics, while the average normal body temperature is 98.6°F, a normal temperature range is between 97.5°F and 99.5°F. Most pediatricians consider a temperature above 100.4°F as a sign of fever. (American Academy of Pediatrics, Signs and Symptoms of Fever).

Each specific condition includes the following topics:

Disease/Condition	Proper and commonly used name of the disease or condition.
Agent	Name of the infectious agent and its categorization, such as viral, bacterial, fungal, or parasitic.
Clinical Description	Mechanism by which the disease is produced, typical symptoms, and complications.
Transmission/Exposure	Modes of Transmission Direct: Individual to individual, such as exchange of body fluids, exposure to droplets from the nose or mouth, or hand-to-hand contact. Indirect: From an inanimate object, such as hard surfaces, tissues, or dishes. Routes of Exposure Inhalation: Airborne, such as from a sneeze or cough. Contact: Contact with body fluids through an opening in the skin, mucous membrane, sexual contact, or contaminated equipment. Ingestion: Swallowing. Intermediary: Vector-borne transmission, such as flea, mosquito, or rodent.
Contagious Period	Period of time that the infectious agent can be passed to another person.
Incubation	Period of time between exposure to an infectious agent and the onset of symptoms.
Diagnosis	Method by which the cause or nature of a disease or condition is determined.
Management of Case	Steps to be taken in diagnosis and treatment of the person with the condition, including any requirement for exclusion from school.
Management of Contacts	Steps to be taken in prevention of infection in persons who have been exposed to infection.
Immunization	Availability and recommended use of vaccines and their impact on disease control.
Public Health Action	Requirement for reporting to the NMDOH and the action to be taken by the NMDOH.
Prevention Education	Information on behaviors that individuals can adopt to reduce exposure to communicable diseases.
School Action	Summary of actions by schools to manage communicable diseases in the school community.

Animal or Human Bite Wound/Infection

Condition, Disease, Agent	Animal or Human Bite Wound/Infection The rate of infection after a bite varies but can be as high as 50% after a cat bite and 5% to 20% after a dog or human bite. The rate of postinjury infection can be minimized through early administration of proper wound care. Possible bacterial agents include Streptococcus, Staphylococcus, Pasteurella, and Bartonella; viral agents include herpes simplex, hepatitis B and C, and rabies.
Clinical Description	An infected bite wound may cause increasing pain and swelling, redness, warmth, and discharge of pus or bloody/serous fluid. Herpes simplex infections of these wounds show blisters and ulcers.
Transmission/Exposure	Bacteria or virus present in the mouth or throat of a person or animal inoculated into a bite or scratch contaminated with saliva.
Contagious Period	Bacteria, herpes simplex, and other viruses can be carried indefinitely by a healthy person or animal. Rabies virus is present in saliva for a few days before the onset of symptoms and may be present in recently deceased animals with active rabies.
Incubation	Depends on agent: 1–5 days for bacteria or herpes simplex virus, several weeks for cat scratch fever, weeks or months for hepatitis B, and 4–6 weeks for rabies, with a range of 5 days to one year.
Diagnosis	Cultures or serologic tests are required to determine the specific cause.
Management of Case	First aid for all bites using standard precautions is very important. Control bleeding with local pressure over a clean cloth or sterile gauze dressing. Cleanse the wound well with clean water or saline and soap. Cover the wound with a loose sterile dressing. Refer to a medical provider for further management. Report all animal bites to Animal Control and provide the name, age, home address, and phone number of the victim as well as a description and location of the animal. Do not touch or handle dead animals and contact Animal Control. The medical provider will assess for tetanus immunization status and the need for antibiotic prophylaxis or treatment. For human bites, assessment of the risk of exposure to hepatitis B virus and HIV is also standard.
Management of Contacts	For human bites, review the health and immunization records of the biter and the individual who was bitten/wounded. If the wounded person has been immunized against hepatitis B, it is very unlikely that they would be infected regardless of the infection status of the biter. Refer victim to provider for evaluation of bite for further screening and treatment of possible infection.
Public Health Action	Report animal bites to your local Animal Control Officer as described above. Report bat exposures, including potential bites or any handling, to Animal Control. Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or your regional Nurse Epidemiologist with questions or concerns. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 for questions or concerns regarding potential exposure to rabies, especially bat or wildlife exposures.
Prevention Education	Teach children to avoid unfamiliar domestic animals and all wild or stray animals. Children should not feed or handle wild animals. Ill or injured animals present special hazards.
School Action	Apply first aid for wounds and possible shock. Clean and bandage wound and refer individual to a medical provider or emergency department depending on level of care needed. Report animal bites and stray or injured animals to Animal Control. Offer prevention education.
Resources/References	Kimberlin, David W., et al. “Bite Wounds.” Red Book: 2018-2021 Report of the Committee on Infectious Diseases, 31st edition. American Academy of Pediatrics, Itasca, IL, 2018, pp. 189–199.

Bed Bugs

Disease/Condition	Bed bugs identified on personal belongings of a student or potential infestation within the school setting.
Pest	Bed bugs are present throughout the world. They have been found in 5-star hotels and resorts, single family homes, dormitories, nursing homes, schools, and daycare centers. Their presence is not determined by the cleanliness of the living conditions where they are found. Bed bugs are very small reddish-brown, wingless insects that feed on warm-blooded animals while they sleep. They typically feed on humans. However, they can feed on other mammals and birds if there is no human host. Infestations usually occur around or near where people sleep. These areas include apartments, shelters, hotels, cruise ships, buses, trains, and dorm rooms. They can cause rust-colored spots on bedding and blankets caused by blood-filled fecal matter excreted by bed bugs. Bed bugs or exoskeletons can be found on folds of mattress and sheets. A sweet-musty odor in bedding may also be present. When bed bugs bite, they inject an anesthetic and anticoagulant that prevents a person from realizing they are being bitten.
Clinical Description	Bites may be random or appear in a straight line. Bite marks are similar to that of a mosquito or a flea — a slightly swollen area that may itch and be irritating. Itching can lead to excessive scratching, which can increase the chance of secondary skin infection. Some people have no reaction to bites and others may be allergic and react adversely to the bites. These allergic symptoms can include enlarged bite marks, painful swellings at the bite site, and on rare occasion anaphylaxis.
Transmission/Exposure	Bed bugs are not known to transmit disease and students should not be excluded from school due to bed bugs. Bed bugs are usually spread by traveling in clothing, baggage, and other items from an infested area. They hide during the day in seams of mattresses, box springs, crevices of furniture and walls, and are usually found within 8 feet of where people sleep. Transmission and infestation are not related to personal hygiene or cleanliness of the infested site.
Contagious Period	Bed bugs are not known to transmit disease.
Incubation	Eggs hatch after 4–12 days and go through 5 nymphal stages before becoming an adult. They need to feed on blood at all stages after they hatch. Females lay about 5 eggs daily as adults. Adults live 6–12 months.
Diagnosis	Bed bug bite marks are non-specific. Identifying an infestation may be necessary to determine the cause of the bites. If bed bugs are suspected, collection of the insect using tissue or gauze for confirmation by a professional exterminator or pest management company is recommended.
Management of Case	Recommendations for infestation in the school setting: Identify the exact location and isolate the area. It may be necessary to temporarily remove students from the area. Contact a professional pest management company and/or notify your district’s facilities department for guidance. In most cases, pesticides alone will not eliminate bed bugs. An Integrated Pest Management program should be implemented to help achieve long-term and environmentally friendly pest control. Your school administration should be part of overseeing any pest management. If possible, collect a specimen for identification with tissue or gauze. Try not to crush the bug. Place insects in a sealed plastic bag. Remove any clutter and trash from the area. Vacuum all areas where any bed bugs were found, including carpeted areas, non-carpeted areas, and baseboards. Place vacuum bag contents in a tightly sealed garbage bag for disposal in an outdoor trash receptacle or dumpster. To minimize potential transfer of bed bugs or eggs, store each student’s items separately from other classmates when possible. Remember that a single bed bug is not an infestation. Integrated Pest Management is needed only if there is evidence of a bed bug infestation in the school setting. Bed Bugs and Schools \| US EPA CDC – Bed Bugs – Additional Resources
Management of Contacts	Staff may inspect the area discreetly for any signs of bed bugs transferred to belongings of other students.
Immunization	Not applicable.
Public Health Action	Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or your regional Nurse Epidemiologist with questions or concerns. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 if the number of cases of bed bugs suddenly increases above what is normally observed in the school’s population.
Prevention Education	See Management of Case and Transmission/Exposure sections above. The best way to prevent bed bugs is regular inspection for signs of an infestation.
School Action	See Management of Case above.
Resources/References	6.29.1.9 NMAC, retrieved on 01/23/2024. United States Environmental Protection Agency. Managing Pests in Schools. Bed Bugs and Schools. Centers for Disease Control and Prevention. Parasites. Bed Bugs. CDC – Bed Bugs – Additional Resources.

Chicken Pox (Varicella) [See Shingles for Herpes-Zoster]

Condition, Disease, Agent	Chicken Pox (Varicella) Varicella-zoster virus Chicken Pox Fact Sheet, English Chicken Pox Fact Sheet, Spanish
Clinical Description	Primary infection with VZV causes chickenpox, which is characterized by fever, malaise, and non-descript respiratory symptoms, usually including cough, followed by crops of skin lesions. Lesions appear first on the face and trunk, then spread to extremities. The rash is usually itchy. Severe or disseminated varicella is unusual in children with normal host defenses but may be serious in children with immune impairment.
Transmission/Exposure	Chickenpox is highly contagious and can be transmitted person-to-person by direct contact, inhalation of aerosols from vesicular fluid of skin lesions, and possibly through infected respiratory secretions.
Contagious Period	In children, typically 1–2 days before onset of rash and until all skin lesions have crusted over. Contagiousness may be prolonged in patients with altered immunity.
Incubation	It takes from 10 to 21 days, with an average of 14–16 days, after exposure to develop symptoms of chickenpox. The incubation period may be prolonged up to 28 days after administration of passive immune globulin.
Diagnosis	For both unvaccinated and vaccinated persons, PCR test on a swabbed lesion is preferred for laboratory confirmation of diagnosis and subsequent management of case and contacts. A single positive IgG antibody result should not be used for diagnosis, and IgM testing is not recommended for diagnosis due to false positive results and inadequate sensitivity and specificity. In vaccinated persons who develop varicella, the disease is almost always mild, with fewer than 50 lesions and shorter duration of illness.
Management of Case	Initial or sporadic cases of chickenpox should be confirmed by a physician. Children should be excluded from school until all lesions have crusted over, usually 5–7 days. Antiviral treatment may be used for adults and immunocompromised individuals, but it is not necessary for most children. Children should not be treated with aspirin because it may increase the risk of Reye syndrome. Contacting the NMDOH for specific recommendations is encouraged.
Management of Contacts	Refer immune-impaired susceptible contacts to their medical provider immediately for evaluation for passive immunization with varicella-zoster immune globulin after exposure. Post-exposure prophylaxis with vaccine administered within 5 days of exposure for nonimmune contacts, and catching up those overdue for their second vaccine dose, is generally recommended. Nonimmune contacts should quarantine at home from day 8 after first exposure through day 21 after last exposure. If post-exposure varicella-zoster immune globulin was administered, quarantine through 28 days. Contacting the NMDOH for specific recommendations is encouraged.
Immunization	Varicella vaccine is highly effective in prevention of chicken pox. All children who have not had chicken pox should receive a vaccine.
Public Health Action	Must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006. NMDOH will conduct a case investigation and coordinate follow-up actions as indicated.
School Action	Students with chicken pox should be excluded from school until all lesions have crusted over. Students who are immune-impaired may continue to develop new vesicles for a longer period and should be excluded until all lesions have become dry and crusted. Contact the NMDOH at (505) 827-0006 for specific recommendations when dealing with altered immunity. Identify all pregnant females and immunocompromised individuals who have been exposed to varicella and consult ERD for further recommendations. Exclude susceptible persons who are exposed from the 8th through the 21st day after exposure. Provide prevention education. Encourage vaccination for the unvaccinated or under-vaccinated.
Resources/References	Kimberlin, David W., et al. “Varicella-Zoster Virus Infections.” Red Book: 2018-2021 Report of the Committee on Infectious Diseases, 31st edition. American Academy of Pediatrics, Itasca, IL, 2018, pp. 869–883. New Mexico Department of Health. “Chickenpox Factsheet.” English and Spanish.

Clostridium Difficile/CDiff

Condition, Disease, Agent	Clostridium Difficile (CDiff) Clostridium Difficile Factsheet English Clostridium Factsheet Spanish
Clinical Description	C. difficile infection is a bacterial infection that causes mild to severe gastrointestinal illness characterized by watery diarrhea, nausea, fever, and abdominal pain. At-risk students include those with recent or prolonged antibiotic exposure, immunocompromised status, history of a long stay in a healthcare setting, or serious underlying chronic health conditions.
Transmission/Exposure	Person-to-person transmission occurs through direct contact when the bacterial spore is shed and spreads to surfaces, materials, or hands. Contact precautions are recommended until resolution of diarrhea.
Contagious Period	Most contagious until resolution of symptoms; however, asymptomatic transmission is possible.
Incubation	Unknown.
Diagnosis	Stool culture may be used to determine the etiology of diarrhea. Testing is typically via PCR for the C. difficile toxin gene or stool testing for C. difficile toxins. Consider symptoms and recent antibiotic therapy to guide testing.
Management of Case	Students and staff should be excluded from school/work until symptoms have resolved. Use isolation during diapering and proper PPE, including gown and gloves. Hand hygiene is vital. After contact, wash hands with soap and water, even if gloves/PPE were used. Hand sanitizer should not be used without first washing hands with soap and water. A thorough and complete cleaning of the entire area should be performed once the child has left the building. Do not use the same changing table until the contaminated area has been properly cleaned and sanitized.
Management of Contacts	Watch for signs of C. difficile. Incubation period is unknown.
Public Health Action	Reporting to NMDOH is required. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006. NMDOH will conduct a case investigation and coordinate follow-up actions as indicated. Contact your regional School Health Advocate and/or regional Nurse Epidemiologist with questions or concerns, as well as suggestions for control measures.
Prevention Education	Promote and teach proper hand hygiene techniques.
School Action	See Management of Case above. Provide prevention education.
Resources/References	Kimberlin, David W., et al. “Clostridium Difficile.” Red Book: 2021-2024 Report of the Committee on Infectious Diseases, American Academy of Pediatrics, Itasca, IL, 2018, pp. 288–292. Clostridioides Difficile Infection Summary, NMHealth.org. Accessed December 4, 2023. Shirley, Debbie-Ann, et al. “Clostridioides Difficile Infection in Children: Recent Updates on Epidemiology, Diagnosis, Therapy.” American Academy of Pediatrics, August 10, 2023.

Conjunctivitis (Pink-Eye)

Condition, Disease, Agent	Conjunctivitis (Pink-Eye) Adenovirus, enterovirus, other respiratory viruses; Haemophilus influenzae and other bacteria. Conjunctivitis Fact Sheet, English Conjunctivitis Fact Sheet, Spanish
Clinical Description	Infectious conjunctivitis produces a variably red eye with swelling and discharge, which may be watery or contain mucus or pus with crusting of the eyelids. Discomfort ranges from minimal itching or a grainy sensation to substantial pain, sometimes with mild light sensitivity or blurred vision. Allergic conjunctivitis is usually accompanied by other signs of allergy, such as swollen or itching eyelids, nasal congestion, watery eye and nasal discharge, or sneezing.
Transmission/Exposure	Person-to-person by contact with infected secretions from the eye or respiratory tract, either directly or through contact with contaminated objects such as shared towels or eye makeup. Viral conjunctivitis is highly contagious. Bacterial conjunctivitis is somewhat less contagious, and antibiotic treatment reduces the period of communicability.
Contagious Period	Bacterial: during the course of infection. Adenovirus: late in incubation period to 14 days after onset. Enterovirus: at least 4 days after onset.
Incubation	1–3 days for most bacterial infections; 4–5 days for adenovirus, with an average of 8 days; and 12 hours to 3 days for enterovirus.
Diagnosis	Diagnosis is usually by clinical evaluation. Definitive diagnosis usually requires culture of the eye drainage.
Management of Case	Refer students with conjunctivitis for medical evaluation and treatment. An outbreak of conjunctivitis requires determination of the cause. Specific antibiotic treatment is available for conjunctivitis due to bacterial infection; symptomatic treatment is used for viral disease. Exclusion from school is usually not necessary if a child can practice frequent hand-washing. In the case of outbreaks of bacterial conjunctivitis, a patient is considered non-contagious after 24 hours of antibiotic therapy.
Management of Contacts	During outbreaks, prevention depends on careful personal hygiene. Outbreaks of viral conjunctivitis will usually run their course in a relatively closed community such as a school. Bacterial conjunctivitis may require intensive surveillance to detect new cases as early as possible. Proper disinfection of medical and eye examining equipment is recommended. Ensure prompt hand-washing before and after eye treatment, administering eye drops, or cleansing.
Public Health Action	Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or your regional Nurse Epidemiologist with questions or concerns, as well as suggestions for control measures. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 if the number of cases of conjunctivitis suddenly increases above what is normally observed in the school’s population.
Prevention Education	Hand-washing and not touching one’s eyes are the most effective defenses against eye and respiratory infections. Avoid sharing towels, eye makeup, and other items that may be contaminated. Ensure proper disposal of contaminated materials, such as tissues.
School Action	Refer children with eye irritation or discharge for medical evaluation and treatment. School exclusion is usually not necessary for isolated cases but may be necessary for control of outbreaks. Recommended to exclude children from daycare while disease is active. Provide prevention education.
Resources/References	Kimberlin, David W., et al. “Conjunctivitis.” Red Book: 2018-2021 Report of the Committee on Infectious Diseases, 31st edition. American Academy of Pediatrics, Itasca, IL, 2018. New Mexico Department of Health. “Conjunctivitis Factsheet.” English and Spanish.

COVID-19 Updated March 2024

Condition, Disease, Agent	COVID-19 is caused by SARS-CoV-2, a virus that was discovered in December 2019. It is part of the coronavirus family, which includes common viruses that cause illnesses ranging from head or chest colds to more severe diseases.
Clinical Description	COVID-19 infection can cause a range of disease from mild symptoms to severe illness. Possible symptoms include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. Symptoms of COVID-19 \| CDC
Transmission/Exposure	The principal modes of infection with SARS-CoV-2 include inhalation of respiratory droplets and aerosol particles, deposition of respiratory droplets and particles on exposed mucous membranes, and touching mucous membranes with hands soiled by virus-containing respiratory fluids or contaminated surfaces. Anyone infected with SARS-CoV-2, with or without symptoms, can spread the disease.
Contagious Period	SARS-CoV-2 can be spread in the 48 hours prior to symptoms starting. Most individuals are no longer infectious after 8–10 days. The majority of people are most contagious within a few days before and after symptom onset.
Incubation	Symptoms may show up as early as 2 days after contact with an infected person to as long as 14 days after exposure. On average, symptoms show up within 3–5 days of infection.
Diagnosis	The diagnosis of COVID-19 is made by direct detection of SARS-CoV-2 RNA using a PCR test or by detection of viral protein using an antigen test. A positive PCR or antigen test is generally indicative of infection and does not need to be repeated.
Management of Case	People who have symptoms of respiratory or gastrointestinal infections should stay home until symptoms have improved and they are fever-free for 24 hours without the use of fever-reducing medications. A person with COVID-19 may return to school only when, for at least 24 hours, they remain fever-free without fever-reducing medication and their symptoms are improved. People recovering from COVID-19 should take added precautions over the next 5 days, such as hand hygiene, wearing a mask, physical distancing, and taking steps for cleaner air. Testing is recommended for people with symptoms of COVID-19 as soon as possible after symptoms begin. People at risk of getting very sick with COVID-19 should consult with a healthcare provider about antiviral treatment right away after testing positive, even if symptoms are mild. Thoroughly clean and disinfect contaminated areas and frequently touched surfaces.
Management of Contacts	COVID-19 is a highly contagious respiratory infection, and reasonable measures should be taken to limit spread within the school. It is recommended that those exposed to COVID-19 test on day 5 after exposure or at any time they begin to have symptoms. The exposed individual may test again during the 14-day incubation period or at any time symptoms appear.
Public Health Action	On March 1, 2024, the CDC incorporated COVID-19 guidance into coordinated Respiratory Virus Guidance that also includes flu, RSV, and other respiratory viruses. If the school nurse or school staff perform SARS-CoV-2 testing, they should report positive results to NMDOH via Simple Reports and follow New Mexico Administrative Code 7.4.3.1. Results do not need to be reported to NM PED. You may notify your regional School Health Advocate if you have questions about how to manage cases in your school.
Prevention Education	Teach and reinforce proper hand hygiene. Teach and reinforce covering coughs and sneezes. Encourage staying up to date with COVID-19 vaccines. Improve ventilation and choose outdoor activities when possible. Support anyone who chooses to wear a mask or respirator at school. Offer diagnostic testing for students and staff with symptoms or refer them to a community testing site, healthcare provider, or at-home test. Avoid contact with people who have suspected or confirmed COVID-19. CDC no longer recommends routine COVID screening testing in K-12 schools.
School Action	Any student or staff member with fever should be sent home to isolate per CDC guidance. Students or staff who come to school with fever or develop fever while at school should be asked to wear a well-fitting mask or respirator while in the building and be sent home. Symptomatic people who cannot wear a mask should be separated from others as much as possible. Clean high-touch surfaces regularly with appropriate cleaning products. Sanitizing and disinfecting can further lower the risk of spreading disease.
Mental Health Considerations	The SARS-CoV-2 pandemic had a significant impact on the mental health of students. Each school district should include emotional and behavioral health strategies for students and staff in response to COVID-19 or any other crisis within their Safe Schools Plan. If a student experiences adverse mental health symptoms, they should be referred to a mental health professional.
References & Resources	CDC Respiratory Virus Guidance Symptoms of COVID-19 \| CDC When and How to Wash Your Hands \| CDC Ventilation in Buildings \| CDC FDA At-Home COVID-19 Antigen Tests Safety Communication

Cytomegalovirus (CMV)

Condition, Disease, Agent	Cytomegalovirus Infection (CMV) Cytomegalovirus Cytomegalovirus (CMV) and Congenital CMV Infection \| CDC
Clinical Description	Mononucleosis-like syndrome with fever, malaise, and mild enlargement of lymph nodes is common in older children and adults. Infections range from subclinical to severe systemic infection in the fetus and immune-impaired patients. Manifestations may include hepatitis, pneumonia, encephalitis, and chorioretinitis. Complications for babies born after exposure from intrauterine infection may include growth retardation, failure to thrive, developmental delay, or visual and hearing deficits. Severe disease in immune-impaired individuals may result in blindness or respiratory failure.
Transmission/Exposure	Contact with infected secretions, including saliva, urine, and genital secretions, or by blood transfusion. Infected infants or children can infect mothers and other caregivers because of prolonged virus shedding in the urine. CMV infection can be sexually transmitted.
Contagious Period	Weeks to many months. The virus becomes latent and can reactivate with periodic viral shedding in saliva and urine.
Incubation	3–12 weeks.
Diagnosis	Confirmation of infection requires positive culture, such as urine culture, and/or serology, such as IgM antibody.
Management of Case	Most treatment is symptomatic. Treatment of life-threatening or sight-threatening infection with antiviral drugs is at least temporarily effective. Exclusion from school is not necessary.
Management of Contacts	Avoid contact with urine and saliva. Personnel who care for non-toilet-trained children, or who come in contact with saliva, body fluids, or secretions, should practice careful personal hygiene, especially hand-washing. Wash contaminated toys and other objects regularly. Women who are pregnant or trying to become pregnant may wish to consult their physician to determine whether they are susceptible.
Public Health Action	Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or regional Nurse Epidemiologist with questions or concerns. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 if the number of cases of CMV suddenly increases above what is normally observed in the school’s population.
Prevention Education	Hand-washing is the best defense, especially after using the toilet, changing diapers, assisting a student with toileting, and contact with saliva.
School Action	Emphasize personal and environmental hygiene and standard precautions. School exclusion is not needed. Provide prevention education.

Diarrhea (Acute)

Condition, Disease, Agent	Acute infectious diarrhea refers to the passage of loose or watery stools associated with an infectious agent and lasting less than 2 weeks. Diarrhea can also be caused by noninfectious conditions. In the United States, infectious diarrhea is caused mainly by viruses. However, bacteria can also cause infectious diarrhea, and parasites can rarely be the cause of infectious diarrhea. Foodborne Illnesses Chart
Clinical Description	Although enteric infections may be asymptomatic, many children present with diarrhea. In addition to diarrhea, the child may have vomiting, fever, abdominal cramping or pain, anorexia, myalgia, and headaches. Symptoms usually last less than 5 days.
Transmission/Exposure	Person-to-person by fecal/oral route and by contaminated food, water, or milk.
Contagious Period	The time one is contagious depends on the cause of the infectious diarrhea, but one is most infectious while having diarrhea, vomiting, or fever. The child should stay home if any of these conditions occur.
Incubation	Depends on infectious agent.
Diagnosis	Most cases of infectious diarrhea resolve on their own, and no diagnostic work-up is performed. Diagnosis requires culture for bacteria and microscopic exam or antigen testing for parasites.
Management of Case	The child should be kept hydrated. The child and contacts should wash hands frequently. If the child is ill-appearing, severely dehydrated, has bloody diarrhea or diarrhea with mucus, high cyclic fevers, recent travel history, recent camping trips, suspicious food exposure, or a known immunocompromised state, referral to a medical provider is warranted. If diarrhea does not resolve in 3–5 days, referral to a medical provider is recommended.
Management of Contacts	Contacts should practice good personal hygiene, especially hand-washing and careful food handling. Testing of contacts may be necessary depending on the organism causing the infection.
Public Health Action	Most pathogens that cause acute diarrhea must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006 if diagnostic testing is performed. See the list of Notifiable Diseases or Conditions in New Mexico. In cases involving a reportable pathogen, NMDOH will conduct a case investigation and coordinate follow-up actions as indicated. Contact your regional School Health Advocate and/or regional Nurse Epidemiologist with questions or concerns. Contact NMDOH at (505) 827-0006 if the number of cases of diarrhea suddenly increases above what is normally observed in the school’s population.
Prevention Education	Prevention requires good personal hygiene, such as frequent hand-washing, and access to a safe food and water supply.
School Action	With acute diarrhea of any cause, prevent dehydration by increasing fluid intake. Students with acute diarrhea, fever, or vomiting should be sent home. Refer for medical care if the student is ill-appearing, severely dehydrated, has bloody diarrhea or diarrhea with mucus, has high fevers, has recent travel or camping history, has suspicious food exposure, or is immunocompromised. If diarrhea does not resolve in 3–5 days, medical referral is needed. Contact NMDOH at (505) 827-0006 if cases suddenly increase or there is suspicion of food or water transmission. Report most diagnosed pathogens that cause acute diarrhea to NMDOH if diagnostic testing is performed.
References and Resources	Centers for Disease Control and Prevention. Cytomegalovirus (CMV) and Congenital CMV Infection. Cytomegalovirus (CMV) and Congenital CMV Infection \| CDC

Fifth Disease (Erythema Infectiosum)

Condition, Disease, Agent	Fifth Disease (Erythema Infectiosum) Human parvovirus B19 Fact Sheet: English https://www.nmhealth.org/publication/view/general/5044/ Fact Sheet: Spanish https://www.nmhealth.org/publication/view/general/5045/
Clinical Description	Symptoms are a mild fever in a minimally ill child with flushed cheeks or bright red and slightly swollen “slapped” cheeks. Later in the infection, a lace-like rash may appear on the trunk and extremities, accentuated by heat or sunlight. Older children and adults may have transient arthritis lasting a few days.
Transmission/Exposure	Person-to-person transmission by droplets or contact with respiratory secretions. Subclinical and atypical infections are very common and are contagious.
Contagious Period	Approximately one week before the rash appears; usually not contagious by the time the rash develops. Immune-impaired patients may be contagious for a prolonged period.
Incubation	4–20 days.
Diagnosis	Clinical diagnosis of typical disease occurring in outbreaks is reliable. The diagnosis can be confirmed by serology, such as IgM antibody, or PCR.
Management of Case	There is no specific treatment, but most cases in children resolve without intervention. School exclusion is not beneficial because transmission to susceptible individuals will have occurred before the infection is recognized.
Management of Contacts	Parents of children with chronic anemia or immune deficiency and pregnant women should be notified of possible exposure. Pregnant women should avoid exposure due to potential fetal risk.
Public Health Action	Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or regional Nurse Epidemiologist with questions or concerns. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 if the number of cases of Fifth Disease suddenly increases above what is normally observed in the school’s population.
Prevention Education	Frequent hand-washing will minimize the risk of exposure.
School Action	School exclusion is not helpful. Notify parents of children with chronic anemia or immune deficiency and pregnant women when outbreaks occur. Frequent hand-washing should be stressed for all students and school staff. Provide prevention education.

Giardiasis, Cryptosporidiosis

Condition, Disease, Agent	Giardiasis, Cryptosporidiosis Giardia lamblia, Cryptosporidium — protozoan parasites https://www.nmhealth.org/publication/view/general/5066/ Fact Sheet: English https://www.nmhealth.org/publication/view/general/5067/ Fact Sheet: Spanish https://www.nmhealth.org/publication/view/general/5068/
Clinical Description	Diarrhea with loss of appetite, nausea, abdominal discomfort, and flatulence. Patients may have an altered sense of taste or metallic taste and may report headache, malaise, and similar nonspecific symptoms. Diarrhea is often chronic or recurrent and may alternate with constipation. Symptoms may last for weeks or months. Individuals may carry the parasite without symptoms.
Transmission/Exposure	Contamination with animal and human feces has resulted in the presence of Giardia cysts in virtually all untreated surface water. Transmission can occur through untreated water, contaminated food, food prepared by infected individuals, diapering/caregiving contact, and person-to-person transmission in daycare or similar settings.
Contagious Period	Variable. An untreated case may continue to excrete Giardia cysts indefinitely.
Incubation	For giardiasis, 1–4 weeks. For cryptosporidiosis, incubation period is 7 days, with a range of 1–12 days.
Diagnosis	Identification of parasites by microscopic exam or antigen test in the stool. Repeated examinations may be necessary, especially if the infection is chronic.
Management of Case	Symptomatic patients should be treated. Repeat treatment using the same drug may be needed if initial therapy fails. Alcohol gels do not kill cryptosporidiosis. No water play or swimming for daycare cases. As long as sanitation is adequate, there is no reason to exclude a student with giardiasis or cryptosporidium after diarrhea stops.
Management of Contacts	Symptomatic contacts should have stool examined and should be excluded from handling food. Personal hygiene habits should be monitored for adequacy.
Public Health Action	These parasitic infections must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006. NMDOH will conduct a case investigation and coordinate follow-up actions as indicated.
Prevention Education	Avoid contact with animals with diarrhea. Animals in the school with diarrhea should be taken to the vet and isolated from children. Wash hands carefully after using the toilet or changing diapers and before preparing food and eating. Avoid ingesting untreated water. Separate diaper changing areas from play or food preparation areas.
School Action	Refer suspected cases for diagnosis and treatment. Report outbreaks to the NMDOH. School exclusion is usually not necessary unless the student is unable to maintain continence of stool. Exclude symptomatic contacts from handling food. Classroom animals with diarrhea should be isolated. Provide prevention education. For daycare settings, the center should notify parents in writing of a case in the daycare.

Haemophilus influenzae Invasive Disease

Condition, Disease, Agent	Haemophilus influenzae Invasive Disease https://www.nmhealth.org/publication/view/general/5069/ Fact Sheet: English https://www.nmhealth.org/publication/view/general/5070/ Fact Sheet: Spanish https://www.nmhealth.org/publication/view/general/5071/
Clinical Description	Haemophilus influenzae is classified into six capsular types and nonencapsulated strains. The organism can cause a broad range of infections and is transmitted person-to-person by respiratory droplets. Common manifestations of invasive disease include bacteremia, meningitis, pneumonia, epiglottitis, septic arthritis, or other musculoskeletal disease. Signs and symptoms may include fever, headache, meningismus, cough, respiratory distress, bone or joint pain, or general illness.
Transmission/Exposure	The organism resides in the human upper respiratory tract. Person-to-person transmission occurs through inhalation of respiratory droplets or direct contact with respiratory tract secretions. Pharyngeal colonization is common and can persist for months.
Contagious Period	The period of communicability is undefined because the organism can be transmitted as long as it is present in the nasopharynx. For patients with invasive Hib disease, the patient is considered noninfectious 24 hours after initiation of appropriate antimicrobial therapy.
Incubation	Incubation period is unknown.
Diagnosis	H. influenzae can be cultured from blood, cerebrospinal fluid, synovial fluid, sputum, and pleural fluid. Gram stain of infected body fluid can demonstrate the organism and allow a presumptive diagnosis. Rapid antigen detection testing may also be requested for Hib disease.
Management of Case	Patients with invasive H. influenzae must receive antimicrobial therapy. Treatment decisions are made by the patient’s health care provider, and consultation with infectious disease specialists can be beneficial in treating invasive infections.
Management of Contacts	For close contacts of patients with invasive Hib Type b disease, prophylaxis with rifampin is indicated. Consultation with the Epidemiology Response Division of the NMDOH is recommended for specifics on who needs prophylactic treatment.
Public Health Action	Must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006. NMDOH will conduct a case investigation and coordinate follow-up actions as indicated.
Prevention Education	Age-appropriate vaccination is the primary way to prevent invasive Hib disease. Infants routinely begin the primary immunization series at age 2 months, with subsequent vaccines at ages 4 and 6 months. A booster dose is given at ages 12–15 months. Hib vaccine is not typically given after age 6 years.
School Action	Refer suspected cases for diagnosis and treatment. Report suspected cases to the NMDOH. Ensure appropriate immunization of students, especially those in daycare or pre-kindergarten programs. Encourage good hand-washing in school. Encourage staff and students to cover their mouths and noses when coughing or sneezing and to wash their hands afterward.

Hand, Foot, and Mouth Syndrome

Condition, Disease, Agent	Hand, Foot, and Mouth Disease (HFMD) Groups A and B Coxsackieviruses, Enteroviruses HFMD Fact Sheet, English HFMD Fact Sheet, Spanish
Clinical Description	This illness is characterized by fever and flu-like illness, a nonspecific rash, and tiny blisters in the mouth and on fingers, palms of hands, buttocks, and soles of feet. The rash may be raised or flat red spots. Mouth discomfort may make it difficult to eat or drink.
Transmission/Exposure	Person-to-person contact, respiratory droplets, blister fluid contact with contaminated surfaces, and fecal-oral route.
Contagious Period	Respiratory route: less than a week after symptoms appear. Fecal-oral route: viral shedding in feces can occur for several weeks after symptoms appear.
Incubation	Typically 3–7 days.
Diagnosis	Usually clinical diagnosis is sufficient; however, coxsackievirus can be identified by culture and other enteroviruses by PCR.
Management of Case	Ill students who do not feel well enough to perform usual activities at school should stay home. Otherwise, children may continue to attend school unless they have fever or uncontrolled drooling/diarrhea. Hydration should be encouraged despite mouth discomfort. Hand-washing and appropriate disposal of contaminated articles are important in disease control. Refer suspected cases for diagnosis and supportive treatment as appropriate.
Management of Contacts	Encouraging good hygiene is the most effective management, along with prevention education. Symptomatic contacts should not handle food for consumption by others.
Public Health Action	Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or regional Nurse Epidemiologist with questions or concerns. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 if the number of cases of HFMD suddenly increases above what is normally observed in the school’s population.
Prevention Education	Prevention education should include covering the mouth when sneezing and coughing, proper disposal of contaminated articles, good hand-washing technique, adequate fluid intake, and good diapering technique. Limit activities involving shared equipment, shared toys, or pools during the infectious period.
School Action	Refer suspected cases for diagnosis and supportive treatment as appropriate. Reach out to your regional School Health Advocate with questions or concerns. For outbreak management questions, call the NMDOH Epidemiology and Response Department at (505) 827-0006. School exclusion is not necessary unless the student has fever, uncontrolled drooling with mouth sores, or is unable to maintain continence of stool. Exclude symptomatic contacts and cases from handling food. Encourage adequate hydration. Provide prevention education. Clean and disinfect frequently touched surfaces and shared items.

Hantavirus Pulmonary Syndrome (HPS)

Condition, Disease, Agent	Hantavirus Pulmonary Syndrome (HPS) RNA virus of Bunyaviridae family https://www.nmhealth.org/publication/view/general/5072/ Fact Sheet: English https://www.nmhealth.org/publication/view/general/5073/ Fact Sheet: Spanish https://www.nmhealth.org/publication/view/general/5074/
Clinical Description	The prodromal illness consists of fever and muscle aches with variable respiratory symptoms, abdominal pain, vomiting, or diarrhea, followed by progressive cough, shortness of breath, and dizziness that reflect cardiorespiratory insufficiency. HPS may progress to respiratory failure or shock.
Transmission/Exposure	Contact with aerosolized rodent feces, urine, or saliva, mainly from deer mice, is the presumed mode of transmission. Indoor exposures in closed, poorly ventilated homes, vehicles, and outbuildings with visible rodent infestations are especially suspect.
Contagious Period	No person-to-person infections have been documented in North America.
Incubation	Approximately 2 weeks, with a range of 1–6 weeks.
Diagnosis	Diagnosis is made by demonstration of specific IgM antibodies in specialized laboratory testing.
Management of Case	There is no specific treatment. Supportive care includes respiratory intensive management of pulmonary edema, severe hypoxemia, and hypotension that may occur within the first 48 hours. Patients should be rapidly transferred to a tertiary care facility. Bed rest and early diagnosis are critical to disease outcome. School exclusion is not a consideration.
Management of Contacts	None.
Public Health Action	Must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006. NMDOH will conduct a case investigation and coordinate follow-up actions as indicated.
Prevention Education	Exterminate rodents in the home and avoid contact with rodent feces and urine. Store human and animal food in rodent-proof containers. Disinfect rodent-contaminated areas by spraying a disinfectant such as 10% bleach solution before cleaning. Limit possible rodent nesting sites and seal holes or other possible rodent entrances. Do not use brooms or vacuums to clean rodent-infested areas. Avoid inhalation of dust in infested areas by wearing approved respirators when cleaning these areas.
School Action	School exclusion is not appropriate. Provide prevention education.

Hepatitis A

Condition, Disease, Agent	Hepatitis A virus https://www.nmhealth.org/publication/view/general/5075/ Fact Sheet: English Fact Sheet: Spanish
Clinical Description	Symptoms include fever, nausea, vomiting, loss of appetite, or distaste for certain foods, followed in 3–10 days by dark brown urine, pale feces, and jaundice. About 70% of hepatitis A infections in young children are without symptoms or are a gastroenteritis-like illness without jaundice, compared to 50% of infections in school-age children and 20% in adults.
Transmission/Exposure	Person-to-person by fecal-oral mechanism, both direct and indirect. Contaminated food or water may lead to outbreaks. Secondary cases occur in families and other close groups where people share food and drinks. Persons at high risk of transmission in schools include food handlers and staff who do diapering and toileting. Good hand-washing is key to preventing transmission.
Contagious Period	Latter half of incubation period through first week after onset of jaundice.
Incubation	Usually 5–50 days, with an average of 30 days.
Diagnosis	Exam shows jaundice with liver enlargement and tenderness as with other types of hepatitis. Laboratory testing results in elevated liver enzymes and elevated bilirubin. Hepatitis A IgM antibody is usually present at the onset of jaundice.
Management of Case	Refer students with jaundice for medical evaluation. Students in the active phase of illness may be too sick to attend school. Those with a clinical diagnosis of Hepatitis A should be excluded until one week after onset of jaundice or, in the absence of jaundice, for 14 days after appearance of symptoms.
Management of Contacts	Close contacts should be given immune globulin within two weeks after exposure. Older children are less likely to spread hepatitis A within the classroom. If Hepatitis A transmission occurs within a school, students and staff in the same classroom may be given prophylaxis. Hepatitis A vaccine may be used for post-exposure prevention for ages 12 months to 40 years; for older adults, immune globulin is favored.
Public Health Action	Must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006. NMDOH will conduct a case investigation and coordinate follow-up actions as indicated.
Immunization	One dose of Hepatitis A vaccine is required for childcare enrollment at 16 months and older in New Mexico and is recommended for all children in high-incidence communities. It can be given to children 12 months of age or older. Hepatitis A vaccine may also be recommended to school populations when one or more students have acute Hepatitis A disease.
Prevention Education	Hand-washing after using the toilet, changing diapers, assisting children with toileting, and before handling food and eating is the most important preventive measure. Keeping toilet and food preparation areas clean will minimize risk of disease transmission. Use standard precautions for bloodborne pathogens.
School Action	Refer jaundiced students for medical evaluation. Report suspected cases to the NMDOH at (505) 827-0006. Consider exclusion of confirmed Hepatitis A cases until one week after onset of jaundice. Encourage use of immune globulin and Hepatitis A vaccine as recommended by the NMDOH. Prophylaxis is not recommended after more than two weeks from exposure. Exclude confirmed cases from food handling. Provide prevention education. Use standard precautions for bloodborne pathogens.

Hepatitis B and C (Acute)

Condition, Disease, Agent	Hepatitis B and C (Acute) Hepatitis B virus (HBV) and hepatitis C virus (HCV) Hepatitis B Fact Sheet, English Hepatitis B Fact Sheet, Spanish Hepatitis C Fact Sheet, English Hepatitis C Fact Sheet, Spanish
Clinical Description	Symptoms may include anorexia, nausea, malaise, jaundice, arthritis, and skin rashes. Complications may include liver failure, chronic hepatitis, and eventual cirrhosis or liver cancer.
Transmission/Exposure	Usually by direct and indirect contact with infected blood, body fluids, or objects contaminated with blood or genital secretions. Contact may be parenteral, such as injection drug use, accidental needle stick, or transfusion, or by sexual contact. Hepatitis B can potentially be transmitted by close family contact, such as sharing toothbrushes, razors, tweezers, scissors, or nail clippers.
Contagious Period	Anytime virus is present in blood, secretions, body fluids containing blood, or genital secretions, and for many weeks before onset of symptoms. Chronic carrier states for both viruses are common.
Incubation	HBV averages 90 days, with a range of 45–160 days. HCV is usually 36–63 days, with a range of 14 days to 6 months.
Diagnosis	Serology for acute hepatitis B usually shows hepatitis B surface antigen and IgM antibody to core antigen. Serology for hepatitis C is a test for total antibody.
Management of Case	Refer students with suspicion of hepatitis for medical evaluation. School exclusion is unnecessary; however, the student may be too ill to participate in school activities.
Management of Contacts	Contacts of Hepatitis B and C should be evaluated for risk of infection. Needle sharing, sexual contact, or close family contact with an infected individual is indication for serologic testing and immunization for Hepatitis B.
Public Health Action	Must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006. NMDOH will conduct a case investigation and coordinate follow-up actions as indicated.
Immunization	Infants should receive hepatitis B vaccine along with other routine immunizations. As of 2002, Hepatitis B vaccine is required for school entry in New Mexico. Any unvaccinated person at increased risk of hepatitis B infection should receive vaccine.
Prevention Education	Avoid contact with blood and body fluids. Avoid injections, tattoos, or similar procedures with unsterile equipment. Practice safe sex, including use of latex condoms. Persons who inject illicit substances should be encouraged to stop or obtain sterile needles and equipment from a local public health office under the Harm Reduction Program. Use standard precautions for bloodborne pathogens.
School Action	Refer children with jaundice or other suspicion of hepatitis for medical evaluation. Monitor immunization status of students. Report confirmed cases to the NMDOH. School exclusion is not necessary. Observe standard precautions for bloodborne pathogens. Monitor students who are chronic carriers of HBV for behavior that may place others at risk, such as biting. School staff identified at high risk for exposure to HBV in the school district’s bloodborne pathogen exposure plan should receive Hepatitis B vaccine. Provide prevention education. Refer sexual contacts of an infected person to the NMDOH for testing and appropriate immunization. Respect the right to confidentiality of infected persons.

Herpes Simplex, Non-Genital Infections (“Cold Sores”)

Condition, Disease, Agent	Herpes Simplex, Non-Genital Infections (“Cold Sores”) Herpes simplex virus (HSV), type 1
Clinical Description	Symptoms include small blisters on the skin and/or mucous membranes that rupture quickly, leaving painful ulcers and dry crusts on the skin. Satellite blisters may form for several days with primary infection. Fever and malaise may last five or more days. Recurrent infections are common and usually occur in the same area as the primary lesion. HSV-1 may spread to the eye and cause inflammation and ulceration of the cornea. Patients with eczema may develop widespread herpetic infection of their skin lesions.
Transmission/Exposure	Contact with oral secretions of infected persons, with or without symptoms, or contact with open lesions from which eyes or genitals may become infected.
Contagious Period	7–50 days following onset of primary infection and typically 3–4 days after onset of a recurrent episode. Patients may have asymptomatic shedding of the virus and may be capable of spreading the infection when they have no symptoms.
Incubation	2–12 days for primary infection.
Diagnosis	Diagnosis is made on clinical evaluation of the lesions.
Management of Case	Refer for medical evaluation for apparent primary infection or for frequent or severe recurrences. Oral, or in severe cases intravenous, antiviral medication may shorten the duration of the primary episode and reduce viral shedding. Those with frequent recurrences may be able to suppress them with antiviral medication. Topical products may be used to relieve symptoms.
Management of Contacts	Protect students with eczema or severe immune deficiency, and newborns, from exposure to persons with active herpes infections. Covering lesions with clothing or a loose dressing will curtail most transmission. Avoid contact with lesions, such as kissing or sharing drinks and utensils.
Public Health Action	Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or regional Nurse Epidemiologist with questions or concerns. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 if the number of cases of herpes simplex virus infections suddenly increases above what is normally observed in the school’s population.
School Action	School exclusion is not necessary. Children with primary HSV gingivostomatitis who cannot control oral secretions should be excluded from daycare or school until symptoms resolve. Infected students should be taught to frequently disinfect surfaces and objects routinely contaminated with oral secretions. Persons in physical contact with students who have active lesions and cannot control their oral secretions should wash hands frequently and use standard precautions for bloodborne pathogens. Exclude athletes in contact sports from competition while they have open lesions that cannot be covered. Disinfect sports equipment, especially mats, after practice and competition. Provide prevention education.

Impetigo

Condition, Disease, Agent	Impetigo Group A Streptococci (GAS), Staphylococcus aureus Impetigo Fact Sheet, English Impetigo Fact Sheet, Spanish
Clinical Description	Flat yellow crusty or weeping lesions are commonly seen on the face and arms. Lesions are usually superficial at first, proceeding through vesicular, pustular, and encrusted stages. Impetigo can occur as a complication of abrasions, insect bites, and chicken pox. Outbreaks can occur in populations with frequent skin-to-skin contact and a high rate of GAS carriage.
Transmission/Exposure	Direct person-to-person contact of colonized skin or lesion-to-skin transmission is most common. Respiratory droplets from asymptomatic carriers may also contribute.
Contagious Period	Variable, at least while lesions are actively weeping and crusting and while a carrier state exists. Not contagious 24 hours after initiation of effective antibiotic treatment.
Incubation	Streptococcal: 7 to 10 days. Staphylococcal: 4 to 10 days.
Diagnosis	Usually clinical diagnosis. Culture and sensitivity of the lesion may be used if diagnosis is uncertain.
Management of Case	Local skin infection is managed by cleaning the area and applying appropriate prescription topical antimicrobial ointment. Systemic antimicrobial therapy is usually not indicated unless infection spreads significantly or there is impetigo in multiple family members or school attendees. A student should not return to school until 24 hours after antibiotic treatment has been started. Large weeping lesions should be covered by clothing or a loose dressing.
Management of Contacts	Use careful surveillance of contacts and persons living in close contact at home and school. Improved personal hygiene will minimize the risk of infection of minor wounds. Use standard precautions for bloodborne pathogens.
Public Health Action	Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or regional Nurse Epidemiologist with questions or concerns. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 if the number of cases of impetigo suddenly increases above what is normally observed in the school’s population.
School Action	Refer suspected cases for medical evaluation and treatment. Exclude infected students from school until after 24 hours of antibiotic treatment is completed. Stress good personal hygiene and avoidance of contact with lesions by unaffected individuals. Monitor students with lesions and cover with clothing or a loose dressing as appropriate. Provide prevention education. Use standard precautions for bloodborne pathogens. Properly dispose of wound dressings.

Influenza

Condition, Disease, Agent	Influenza Virus — Types A and B https://www.nmhealth.org/publication/view/general/5084/ Influenza Fact Sheet, English Influenza Fact Sheet, Spanish
Clinical Description	Acute respiratory infection, or flu, is characterized by sudden onset of fever, chills, headache, malaise, muscle aches, and respiratory symptoms including sore or scratchy throat, nasal congestion, and cough. Abdominal pain, vomiting, and diarrhea are not uncommon in children infected with influenza. Bacterial superinfections are relatively common, including bronchitis, pneumonia, otitis media, and sinusitis.
Transmission/Exposure	Direct and indirect contact with respiratory secretions, either by large droplets through sneezing and coughing or by contact with contaminated surfaces or objects through hand inoculation of the eyes and nose. Influenza may also be transmitted by the airborne route.
Contagious Period	One day before onset of symptoms and up to 5 days after onset. Young children can be contagious from several days before symptom onset and up to 10 days after.
Incubation	1–4 days.
Diagnosis	Clinical diagnosis is usually reliable when symptoms are typical and influenza is circulating in the community. Diagnosis can be confirmed by PCR tests or viral antigen point-of-care tests. Cultures take more time but can identify the influenza type, which is important for surveillance.
Management of Case	Children and adults with clinical influenza should be sent home until fever subsides. Fluids are important to maintain hydration. Bed rest and analgesics other than aspirin may help symptomatically. The influenza cough may persist for weeks and may limit activity, especially for those with asthma. Students should not return to school until they are afebrile for 24 hours without fever-reducing medications and systemic symptoms have subsided, usually 3–7 days.
Management of Contacts	All individuals 6 months of age and older should receive influenza vaccine annually. Encourage good hand hygiene and appropriate disposal of contaminated articles. Emphasis should be placed on obtaining flu vaccine for individuals at risk for influenza complications and those who come into contact with persons at increased risk.
Immunization	Influenza vaccine changes each year, so it should be repeated annually.
Public Health Action	Must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006 for: A laboratory-confirmed hospitalized case. Human infection with novel influenza strains confirmed by laboratory testing. A pediatric influenza-related death. Influenza-like illness involving a large number of people in the same geographic area. NMDOH will conduct a case investigation and coordinate follow-up actions as indicated. Annually updated guidelines for the management of influenza in childcare, school, outpatient, acute care, and long-term care settings can be accessed at the NMDOH Influenza webpage.
School Action	Exclude students and staff with clinical influenza until afebrile, less than 100.4°F, for 24 hours without fever-reducing medications and symptoms have subsided. Report suspected outbreaks of respiratory disease to the NMDOH. Emphasize hand-washing and respiratory droplet precautions in prevention education. Offer influenza vaccination to students and staff through school health programs. Consider student absenteeism and staff availability when making decisions regarding school closure when outbreaks occur. Provide prevention education. In the case of a novel influenza virus with pandemic activity, updated guidance will be provided by the NMDOH.

Meningitis (Bacterial)

Condition, Disease, Agent	Meningitis (Bacterial) Neisseria meningitidis (meningococcus), Streptococcus pneumoniae https://www.nmhealth.org/publication/view/general/5096/ Meningococcal Fact Sheet, English Meningococcal Fact Sheet, Spanish
Clinical Description	Invasive bacterial disease is manifested by fever, chills, malaise, rash that may be macular, maculopapular, or petechial, stiff neck, headache, vomiting, and possibly stupor or loss of consciousness. Potential complications include shock, respiratory failure, seizures, coma, and death. Neurologic complications may include deafness, seizure disorders, acquired learning disabilities or developmental delay, and paralysis.
Transmission/Exposure	Direct person-to-person transmission through droplet spread or contact with respiratory secretions. The organism may be carried in the throat or nasopharynx by asymptomatic individuals.
Contagious Period	Healthy carriers are potentially infectious. Patients with bacterial meningitis, once started on appropriate antibiotic therapy, are generally non-contagious within 24 hours.
Incubation	Usually 3–4 days, with a range of 2–10 days.
Diagnosis	Examination of spinal fluid and culture of blood and spinal fluid are required to confirm the clinical diagnosis and guide therapy.
Management of Case	Bacterial meningitis is a life-threatening illness requiring immediate hospitalization, antibiotic treatment, and respiratory isolation for 24 hours after initiating therapy. The infected student may return to school at the advice of a medical provider with any limitations specified by the provider.
Management of Contacts	Review needed: The source text appears to contain copied Influenza guidance in this row. Confirm correct bacterial meningitis contact-management guidance with NMDOH before publishing.
Immunization	Review needed: The source text appears to contain copied Influenza guidance in this row. Confirm correct bacterial meningitis immunization guidance with NMDOH before publishing.
Public Health Action	Must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006. NMDOH will conduct a case investigation and coordinate follow-up actions as indicated.
School Action	Review needed: The source text appears to contain copied Influenza school-action guidance in this row. Confirm correct bacterial meningitis school actions with NMDOH before publishing.

Meningitis (Viral or Aseptic)

Condition, Disease, Agent	Meningitis (Viral or Aseptic) Enteroviruses, including ECHO and Coxsackie viruses, and other viruses CDC information: https://www.cdc.gov/meningitis/viral.html
Clinical Description	Symptoms include fever, headache, stiff neck, back pain, vomiting, malaise, drowsiness, altered consciousness, prostration, and possibly rash. Although enteroviral infections can occur year-round, they are most common in summer and early fall. Seizures, coma, and neurologic complications can occur. Children with suspected meningitis represent a medical emergency and should be immediately evaluated by a healthcare provider and excluded from childcare until the cause of meningitis is identified.
Transmission/Exposure	Direct person-to-person contact with infected secretions from the throat or nose. Fecal-oral contamination can occur for many enteroviruses.
Contagious Period	Weeks to months depending on causative agent; most infectious during the stage of illness.
Incubation	Variable depending on the virus; 3–6 days for enteroviruses.
Diagnosis	Examination of spinal fluid and spinal fluid culture can help confirm the clinical diagnosis.
Management of Case	There is no specific treatment. Supportive treatment is provided as indicated by the specific clinical signs. When the infected student has recovered, they may return to school with limitations according to a medical provider’s recommendations.
Management of Contacts	Other cases of enteroviral infection are likely to occur in the same school or group setting, but it is not likely that there will be other cases of meningitis or other serious illness. Contacts with symptoms suggestive of meningitis should be referred for medical evaluation immediately. Good hand-washing practices should be enforced at school.
Immunization	None available.
Public Health Action	Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or regional Nurse Epidemiologist with questions or concerns. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 if the number of cases of viral meningitis suddenly increases above what is normally observed in the school’s population.
School Action	Refer suspected students for medical evaluation. School exclusion is not necessary unless prescribed by a medical provider. Provide prevention education, including good hand-washing practices.

MRSA (Methicillin-Resistant Staphylococcus Aureus)

Condition, Disease, Agent	MRSA (Methicillin-Resistant Staphylococcus Aureus) Staphylococcus aureus bacteria MRSA Fact Sheet, English MRSA Fact Sheet, Spanish
Clinical Description	MRSA is a type of Staphylococcus aureus that is resistant to some antibiotics, including methicillin. Staph bacteria are found on the skin of many people but do not cause infection or illness until they enter a cut, scrape, or other break in the skin. Infections can look like a pimple, rash, boil, or open wound.
Transmission/Exposure	Direct skin-to-skin contact, such as holding hands or contact sports, is the most common route of transmission. Indirect transmission can occur through contact with items touched or used by an infected person or staph carrier, such as razors, towels, athletic equipment, or clothing.
Contagious Period	As long as bacteria are carried on the skin.
Incubation	Variable and indefinite.
Diagnosis	Isolation of S. aureus from culture is definitive.
Management of Case	Early treatment can help prevent MRSA infection from worsening. All skin lesions should be covered with clean, dry pads. The infected student may need to avoid certain activities, such as contact sports or gym activities, so the dressing remains intact and the body can heal. Gloves, hand-washing, and proper disposal of contaminated materials are essential in care delivery. Prescribed antibiotics should be taken as directed. Students or staff with suspected or confirmed infection do not need to be excluded from school.
Management of Contacts	Good hand-washing practices and observation are important for known contacts. There is no vaccine or preventive medication available for MRSA exposure.
Immunization	None available.
Public Health Action	Contact NMDOH at (505) 827-0006 if more than one case of MRSA is diagnosed or suspected in the same school.
Prevention Education	Wash hands frequently with soap and water. Keep cuts and scrapes clean with soap and water and covered with dry pads. Do not pick, touch, or scratch skin lesions or touch another person’s sores or lesions. Avoid skin contact and sharing personal items with anyone suspected of having MRSA. To help prevent antibiotic resistance, do not request antibiotics for colds or other viruses and take all antibiotics as prescribed.
School Action	Do not exclude students or staff with MRSA infections. Alert parents of school cases only after collaboration with the NMDOH. Encourage frequent hand-washing and proper coverage of all skin wounds. Ensure access to sinks, soap, clean towels, and/or alcohol-based sanitizers. Infected students may need to avoid gym activities and contact sports to prevent wound dressings from coming off. Clean athletic equipment daily if used by more than one individual. Follow standard precautions when providing care for an infected student. Report more than one case to NMDOH at (505) 827-0006.

Molluscum Contagiosum

Condition, Disease, Agent	Molluscum Contagiosum Molluscum Contagiosum \| CDC
Clinical Description	Molluscum contagiosum is a benign, mild superficial skin infection. It typically resolves on its own within 6–12 months but may be present as long as 4 years. It is characterized by flesh-colored to translucent dome-shaped bumps, often with an indented center. Lesions commonly occur on the trunk, face, and extremities in clusters. They can be itchy and are most common in children 1–10 years of age.
Transmission/Exposure	Person-to-person by direct contact with skin lesions and contaminated objects. The virus may spread through contact with towels, clothes, and surfaces. Scratching lesions may spread the rash to other parts of the body. It does not spread through coughing or sneezing.
Contagious Period	When lesions are present, the virus can spread to others. Once the lesions are gone, the virus is gone. Contacting NMDOH for specific recommendations is encouraged.
Incubation	Typically 2–7 weeks or as long as 6 months.
Diagnosis	Clinical diagnosis is reliable when the presentation includes typical dome-shaped indented lesions. Serologic testing is not available.
Management of Case	In most cases, no treatment is needed. Management of itching helps prevent spread and secondary infection due to open skin. Children with genital lesions should be seen by a provider and screened for sexually transmitted infections. No quarantine or isolation is necessary. Under direction of a clinician, topical treatments or physical destruction of lesions can be performed. Refer immune-impaired susceptible contacts to their provider immediately for management.
Management of Contacts	No quarantine or isolation is necessary.
Immunization/Prevention	Good hygiene habits help prevent spread. Hand-washing is the best prevention strategy. Touching and scratching lesions can spread the virus and should be avoided. Cover lesions when possible and avoid sharing gear if lesions cannot be covered.
Public Health Action	No control measures are recommended for isolated cases. Contact NMDOH School Health Advocates with questions.
School Action	A student with Molluscum Contagiosum can attend school or daycare without limitations. Maintain confidentiality and consider mental health implications of long-term skin abnormalities. Provide prevention education. Contact the NMDOH at (505) 827-0006 for specific recommendations when dealing with altered immunity.
Writers / Editors / Reviewers	Vicki Casias, BSN, RN School Health Advocate, NW Region; Kathryn Willits, RN Epidemiology Nurse, NW Region; Maricelda Pisana; Kate LaRose; Crista Pierce; Dr. Marciniak; Dr. Bustos; Dr. Ross; Dr. Novak; Jim Farmer.

Mononucleosis (Infectious Mononucleosis, Mono)

Condition, Disease, Agent	Mononucleosis (Infectious Mononucleosis, Mono) Most common virus is Epstein-Barr virus (EBV). CDC information: https://www.cdc.gov/epstein-barr/about-mono.html
Clinical Description	Persons with mono usually have fever, sore throat, cervical adenopathy, and fatigue. Less commonly, patients have splenomegaly, or an enlarged spleen. Fatigue may be severe and prolonged. Symptoms may return after a period of convalescence. Adolescents and young adults tend to have more typical disease.
Transmission/Exposure	EBV is the most common cause of infectious mononucleosis, but other viruses can cause this disease. These viruses spread most commonly through bodily fluids, especially saliva, such as kissing or sharing drinks or toothbrushes. They can also spread through blood and semen during sexual contact, blood transfusions, and organ transplantations.
Contagious Period	Viral shedding begins before onset of symptoms. Periodic shedding occurs even after complete recovery for as long as a year or more and is probably the source of most new infections.
Incubation	4–6 weeks.
Diagnosis	Healthcare providers typically diagnose infectious mononucleosis based on symptoms. Lab tests may show an increase in lymphocytes with many atypical lymphocytes. Serologic tests are usually positive by the second week of illness.
Management of Case	Because of a small risk of rupture of the enlarged spleen, infected students should be excluded from contact sports until the spleen has returned to normal size. There is no specific treatment for mono. Infected students who are well enough to attend school should not be excluded.
Management of Contacts	Because the virus is present in saliva, hand-washing and washing objects contaminated with saliva should reduce transmission from person to person. Discourage activities involving exchange of saliva with infected individuals.
Immunization	None available.
Public Health Action	EBV infections are not reportable.
School Action	Refer children with suspected infectious mononucleosis for medical evaluation. Infected students who are well enough to attend school should not be excluded. Students with enlarged spleen should avoid contact sports until medical clearance is received. Students typically can return to contact sports four weeks from the start of symptoms but may need to stay out longer if fatigue persists. Provide prevention education.

Mumps

Condition, Disease, Agent	Mumps Mumps virus, RNA virus https://www.nmhealth.org/publication/view/general/5108/ Mumps Fact Sheet, English Mumps Fact Sheet, Spanish
Clinical Description	Mumps is an acute viral infection characterized by fever and enlargement of the salivary glands. Pancreatitis, orchitis in males, oophoritis in females, and encephalitis may occur but are rare. Complications are more common in adults.
Transmission/Exposure	Direct airborne transmission, respiratory droplets, or direct contact with saliva of an infected person.
Contagious Period	6–7 days before until 9 days after swelling begins.
Incubation	16–18 days after exposure, with a range of 12–26 days.
Diagnosis	Clinical diagnosis of symptomatic mumps is reliable in outbreaks. Isolated cases of salivary gland swelling may be caused by other viruses, blockage of a salivary duct, or bacterial infection. Virus isolation and serology, including detection of IgM antibodies, are recommended. Confirmation is important before extensive surveillance or immunization is undertaken.
Management of Case	Refer students with suspected mumps for medical evaluation. There is no specific treatment, and most school-age children are only mildly ill. School exclusion should be for 5 days after onset of swelling.
Management of Contacts	Contacts of mumps cases who have not had two doses of mumps vaccine should be immunized, preferably with MMR vaccine. Contacts with no prior history of mumps illness or immunization should be excluded from school from the 12th through 25th day after exposure and should be considered for mumps vaccine. Testing adults to determine susceptibility should be considered before vaccination with MMR, since a majority of adults without a history of mumps will be immune because of subclinical or unrecognized infection.
Immunization	All students are required to have two doses of MMR vaccine before school entry.
Public Health Action	Report cases and suspected cases to the NMDOH at (505) 827-0006.
School Action	Refer students with enlarged salivary glands for medical evaluation. Exclude students with confirmed mumps for 5 days following onset of swelling. Exclude susceptible contacts from day 12 through day 25 after exposure. Excluded students can be readmitted immediately after immunization. Exclude students who are exempted from mumps immunization until at least 26 days after onset of swelling in the last contact case of exposure. Provide prevention education.

Norovirus

Condition, Disease, Agent	Norovirus Norovirus, RNA virus https://www.nmhealth.org/publication/view/general/5112/ Norovirus Fact Sheet, English Norovirus Fact Sheet, Spanish
Clinical Description	Noroviruses are the leading cause of acute gastroenteritis, sometimes referred to as “stomach flu” or “winter vomiting disease.” Illness is generally short-lived and self-limiting. It is characterized by acute onset of vomiting, watery non-bloody diarrhea with abdominal cramps, and nausea. Some people may experience only vomiting or diarrhea. Muscle aches, malaise, headache, and low-grade fever may also occur. Symptoms usually last 24 to 60 hours. Dehydration is the most common complication. Up to 30% of infections may be asymptomatic.
Transmission/Exposure	Noroviruses are highly contagious and can remain viable and infective on surfaces for up to two weeks. Outbreaks are most commonly spread person-to-person. Humans are the only known reservoir. Noroviruses are found in the stool or vomit of infected people or on contaminated surfaces that are not properly cleaned and disinfected.
Contagious Period	Ill persons are most contagious during illness and for 72 hours after symptoms end.
Incubation	Generally 24 to 48 hours after ingestion of the virus; however, symptoms can appear as early as 12 hours after exposure.
Diagnosis	Diagnosis relies on detection of viral RNA in stool or vomit using reverse transcription polymerase chain reaction testing.
Management of Case	Treatment is supportive, with an emphasis on maintaining hydration. Most people recover completely within 1 to 2 days with no long-term complications.
Management of Contacts	Persons with suspected norovirus infection should be managed with standard precautions, with careful attention to hand hygiene. Contact precautions should be implemented when caring for diapered or incontinent persons.
Public Health Action	Individual cases are not reportable, but outbreaks should be reported to the NMDOH at (505) 827-0006.
Prevention Education	Prevention requires good personal hygiene, including hand-washing after using the toilet, after changing diapers, and before preparing food and eating.
School Action	With acute diarrhea of any cause, prevent dehydration by increasing fluid intake. Students with fever, vomiting, or diarrhea that interferes with school activity should be sent home and excluded from school until afebrile and diarrhea no longer interferes with normal activities. Report outbreaks of diarrhea to the NMDOH immediately, especially if there is suspicion of food or water transmission. Frequent hand-washing should be stressed by all school staff. Provide prevention education.

Pediculosis (Head Lice)

Condition, Disease, Agent	Pediculosis (Head Lice) Pediculus humanus capitis, parasitic arthropod Lice Fact Sheet, English Lice Fact Sheet, Spanish
Clinical Description	Head lice are parasitic insects with six legs and no wings. They hold onto head hair with specially adapted claws and move swiftly on dry hair. Head lice feed by biting and sucking blood through the scalp. They often cause itching, but this is not always the case, particularly when newly arrived to the head. Most cases are light, with about 10 lice on the head. Lice will not leave the scalp unless they are dead or dying.
Transmission	Lice are spread by close head-to-head contact with someone who has head lice. Lice cannot jump, fly, or swim, but spread by climbing rapidly from head to head. Anyone with hair on the head can get lice. Head lice do not survive off the scalp for more than 48 hours. Head lice infestations have low contagion in classrooms.
Contagious Period	Full-grown lice move between heads when they have the opportunity. Lice mature to the adult stage approximately 9–12 days after hatching. Nits remain on the head where they hatch for a minimum of 6 days.
Incubation	Eggs hatch in 7–10 days and reach maturity in 6–14 days. At maturity they are capable of reproduction.
Diagnosis	Inspect for live crawling lice. Proper diagnosis of head lice is the most important step in controlling infestation. Most persons with head lice infestation will have between 10 and 20 lice.
Management of Contacts	School-wide head checks are no longer recommended. Educating parents and teachers on head lice is essential.
Public Health Action	Pediculosis is not a reportable condition.
School Action	At the end of the school day, send students who have lice home. They may return to school after the first treatment is completed. Provide educational material, including treatment recommendations, to parents. Maintain confidentiality of the affected student and family. Mass screening of children for head lice has been shown to be ineffective. According to the American Academy of Pediatrics, “no-nit policies” in schools are detrimental because they cause lost classroom time, inappropriate allocation of school nurse time, and a response that is out of proportion to the medical significance.

Pertussis (Whooping Cough)

Condition, Disease, Agent	Pertussis (Whooping Cough) Bordetella pertussis, Bordetella parapertussis Pertussis Pertussis Fact Sheet, English Pertussis Fact Sheet, Spanish
Clinical Description	Pertussis has three stages: catarrhal, paroxysmal, and convalescent. Symptoms may include sore throat, runny nose, mild cough, low-grade or no fever, severe spasms of cough with post-tussive whoop or vomiting, and gradual lessening of coughing spasms. Infants under six months may have apnea without whoop. Complications may include pneumonia, seizures, encephalopathy, and death.
Transmission/Exposure	Direct person-to-person spread by respiratory droplets or direct contact with respiratory secretions from an infected person.
Contagious Period	From onset of symptoms until three weeks of coughing; most contagious during the first two weeks of cough.
Incubation	7–10 days, with a range of 4–21 days.
Diagnosis	Laboratory diagnosis is by PCR swabbing. Mild cases may be difficult to recognize unless they occur in contacts of typical disease.
Management of Case	Refer persons with severe or persistent cough for medical evaluation. Even though coughing may continue, people are no longer considered infectious after 5 days of antibiotics. Exclude suspected or confirmed cases until after 5 days of antibiotic treatment.
Management of Contacts	Identify close contacts and refer them for preventive treatment. High-risk contacts include infants, pregnant women, immunocompromised individuals, and vaccine exemptors. Conduct surveillance for additional cases for three weeks from the first date of exclusion of the case. NMDOH will evaluate high-risk contacts before advising prophylaxis for classmates.
Immunization	Students are required to have completed at least four doses of pertussis-containing vaccine, with one dose received on or after the fourth birthday. Tdap is required for 7th and 8th grade entry and recommended for higher grades and adults as appropriate.
Public Health Action	Report suspected and confirmed cases to NMDOH. The Epidemiology and Response Division will coordinate testing, contact identification, and treatment.
School Action	Exclude cases and symptomatic contacts until completion of 5 days of antibiotic treatment or until three weeks after onset of cough if not treated. Refer suspected cases for medical evaluation and treatment immediately. Monitor school for additional cases for 21 days after last contact with known cases. Report confirmed and suspected cases to NMDOH at (505) 827-0006. Review immunization status of students and staff to identify susceptible contacts. Provide access to immunization and prevention education.

Plague

Condition, Disease, Agent	Plague Yersinia pestis bacteria Plague Plague Fact Sheet, English Plague Fact Sheet, Spanish
Clinical Description	Plague is a flea-transmitted bacterial infection. The most common form is bubonic plague; less common forms are septicemic, pneumonic, and pharyngeal plague. Bubonic plague may cause tender enlarged lymph nodes, fever, and flu-like symptoms. Pneumonic plague may cause cough with bloody sputum and can spread person-to-person. Plague is treatable but has a high fatality rate with inadequate or delayed treatment.
Transmission/Exposure	Humans may be infected by the bite of an infected flea, contact with respiratory secretions from an infected person or animal, contact with tissues from an infected animal, or ingestion of raw or undercooked meat from an infected animal.
Contagious Period	Pneumonic plague: from onset of cough until completion of several days of antibiotic therapy. Bubonic and septicemic plague are usually not contagious.
Incubation	2–8 days for bubonic plague; 1–6 days for human-to-human transmission of pneumonic plague.
Diagnosis	Plague may resemble wound infections with secondary lymphadenitis. Cultures should be obtained from blood and apparent sites of infection, such as the affected lymph node.
Management of Case	All suspected plague cases should be treated immediately with appropriate antibiotics. Pneumonic cases and contacts should be treated and kept under surveillance. Pneumonic cases should be excluded from school until completion of 48 hours of antibiotics and favorable clinical response. School exclusion of bubonic and septicemic plague cases is not appropriate unless ill.
Management of Contacts	Any suspected plague case should be referred immediately for medical evaluation. Contacts of pneumonic plague cases should be given antibiotic prophylaxis immediately and kept under surveillance.
Prevention Education	Reduce rodent activity near homes and schools; control fleas on domestic animals; avoid contact with dead or ill animals; rodent-proof houses and outbuildings; and use precautions when handling wild game.
Public Health Action	Report cases or suspected cases immediately to NMDOH at (505) 827-0006.
School Action	Refer possible cases immediately for medical evaluation. Exclude pneumonic cases until completion of 48 hours of antibiotics. Do not exclude septicemic or bubonic cases unless ill. Assist in identifying close contacts. Report rodent activity or unusual numbers of dead rodents on or near school grounds to NMDOH.

Rubella

Condition, Disease, Agent	Rubella (German Measles, Three-Day Measles) Rubivirus Rubella Rubella Fact Sheet, English Rubella Fact Sheet, Spanish
Clinical Description	A diffuse maculopapular rash is often the first sign. Mild prodromal illness with low-grade fever, malaise, coryza, conjunctivitis, and headache may occur before rash. Rash usually begins on the face and spreads rapidly. Adolescents and adults may have arthritis. Congenital rubella can cause serious fetal effects.
Transmission/Exposure	Droplet or contact transmission by nasopharyngeal secretions or urine from congenital rubella cases. Rubella can cross the placenta and infect the fetus in pregnant women.
Contagious Period	A few days before rash develops to 5–7 days after rash begins; congenital rubella cases may shed virus in urine for one year or longer.
Incubation	Usually 16–18 days, with a range of 14–23 days.
Diagnosis	Confirmation by serology is essential. Rubella IgM antibody is usually present during acute illness.
Management of Case	There is no specific treatment. School exclusion is appropriate for 7 days after onset of rash.
Management of Contacts	Susceptible contacts should be immunized immediately. Pregnant women should contact their medical provider immediately. Exclusion from school is not appropriate unless symptomatic.
Immunization	Two doses of rubella/MMR vaccine are required for school entry. Pregnant females should not be vaccinated.
Public Health Action	All suspected and confirmed cases should be reported immediately to NMDOH at (505) 827-0006.
School Action	Refer all suspected cases for medical evaluation. Exclude infected students until 7 days after onset of rash. Do not exclude contacts unless symptomatic. Enforce the 2-dose MMR requirement for school entry. Notify NMDOH immediately of suspected and confirmed cases. Provide prevention education, including concerns for pregnancy and pregnant contacts.

Rubeola (Measles)

Condition, Disease, Agent	Rubeola (Measles) Rubeola virus https://www.nmhealth.org/publication/view/general/5093 Measles Fact Sheet, English Measles Fact Sheet, Spanish
Clinical Description	Measles is characterized by acute onset of fever, coryza, non-exudative conjunctivitis, cough, and rash. Rash begins on the face or neck and progresses to the trunk and extremities. Complications may include otitis media, pneumonia, croup, diarrhea, and encephalitis.
Transmission/Exposure	Droplet and airborne transmission of respiratory secretions that may circulate in the air up to 4 hours after an infected person leaves a room. Measles is highly contagious.
Contagious Period	1–2 days before onset of initial symptoms; 3–5 days before rash onset until 4 days after rash appears.
Incubation	Average of 10 days from exposure to onset of rash, with a range of 7–18 days. Rash usually appears about 14 days after exposure.
Diagnosis	Clinical evaluation with history of symptoms is useful, with confirmation by laboratory testing of respiratory secretions.
Management of Case	Refer suspected cases immediately for medical evaluation. There is no specific treatment. School exclusion is appropriate until 4 days after rash onset.
Management of Contacts	Review immunization records to identify susceptible contacts. Provide access to immunization within 72 hours of exposure. Susceptible contacts may need exclusion until 21 days after rash onset in the last case.
Immunization	Two doses of measles/MMR vaccine are required for school entry.
Public Health Action	All suspected and confirmed cases should be reported immediately to NMDOH at (505) 827-0006.
School Action	Refer suspected cases immediately for medical evaluation. Report confirmed and suspected cases immediately to NMDOH. Exclude cases from school until 4 days after rash onset. Review immunization records to identify susceptible individuals. Exclude susceptible individuals until 21 days after rash onset in the last case. Provide prevention education, including risks in pregnancy.

Scabies

Condition, Disease, Agent	Scabies Sarcoptes scabiei Scabies Fact Sheet, English Scabies Fact Sheet, Spanish
Clinical Description	Scabies causes an intensely itchy, red, vesiculopapular eruption caused by mites burrowing under the skin. Lesions are commonly found on finger webs, wrists, elbows, axillary folds, belt line, thighs, external genitalia, nipples, abdomen, and buttocks.
Transmission/Exposure	Direct, prolonged contact with infected skin, including sexual contact.
Contagious Period	Until mites and eggs are destroyed by treatment.
Incubation	Four to six weeks in people without previous exposure. Previously infested people may develop symptoms 1–4 days after re-exposure.
Diagnosis	Exam shows typical excoriated papules and burrows. Microscopic exam of skin scrapings may show mites, eggs, or fecal deposits.
Management of Case	Infested students should be excluded from school until initial treatment is completed. Clothing and bed linens used in the three days before treatment should be laundered in hot water. Items that cannot be washed should be isolated in plastic bags for 10–14 days. Environmental disinfection is unnecessary.
Management of Contacts	Close contacts should be examined. Household contacts are usually also infested and should be treated concurrently to prevent reinfestation.
Public Health Action	Not a reportable condition; assistance with treatment is available at public health offices.
School Action	Exclude infested students at the end of the school day until initial treatment is completed. Examine close contacts for infestation. Provide prevention education, including treatment recommendations.

Shingles (Herpes-Zoster/Varicella Virus)

Condition, Disease, Agent	Shingles Herpes-Zoster Virus / Varicella Zoster Virus (VZV)
Clinical Description	Shingles represents reactivation of latent varicella zoster virus. It is typically a painful rash formed by blisters, usually in a single stripe or dermatome around one side of the face or body. Before the rash, people may have pain, itching, or tingling. Other symptoms may include fever, fatigue, headache, chills, and upset stomach.
Transmission/Exposure	People who have not had chickenpox or varicella vaccine can get the virus from contact with shingles blisters. A person with shingles is contagious until blisters scab over.
Contagious Period	Shingles blisters usually scab over in 7–10 days and disappear completely in 2–4 weeks. People with shingles cannot spread the virus before blisters appear or after the rash has crusted.
Incubation	If an individual had chickenpox previously, they may develop shingles years or decades later.
Diagnosis	PCR testing on a swabbed lesion is preferred for laboratory confirmation.
Management of Case	If the individual with active shingles can keep the rash covered, maintain hygiene, and avoid people with weakened immune systems, pregnant women, and newborns, they may attend work or school. Children whose lesions cannot be covered should be excluded until lesions have crusted.
Management of Contacts	Refer immune-impaired susceptible contacts to their provider immediately. Post-exposure vaccination within 5 days and catching up overdue second doses are generally recommended for nonimmune contacts. Nonimmune contacts may need quarantine from day 8 after first exposure through day 21 after last exposure, or through day 28 if immune globulin was administered.
Immunization	The shingles vaccine is available to adults over 50 years of age.
Public Health Action	Shingles must be reported to NMDOH Epidemiology and Response Division at (505) 827-0006.
School Action	Contact NMDOH at (505) 827-0006 for specific recommendations when altered immunity is involved. Identify pregnant females and immunocompromised individuals who have been exposed and consult ERD. Exclude susceptible exposed persons as recommended. Report to NMDOH Epidemiology and Response Division at (505) 827-0006. Provide prevention education. Encourage vaccination for the unvaccinated or under-vaccinated.

Streptococcal Infections (Strep Throat)/Scarlet Fever

Condition, Disease, Agent	Streptococcal Infections (Strep Throat)/Scarlet Fever Streptococcus pyogenes Group A https://www.nmhealth.org/publication/view/general/5136 Fact Sheet: English Fact Sheet: Spanish
Clinical Description	Classic strep throat is characterized by severe sore throat, malaise, toxicity, fever, tender lymph nodes in the neck, and a purulent exudate on the tonsils. Untreated strep throat may develop complications including otitis media, sinusitis, and abscesses on the tonsils and pharynx. Scarlet fever is strep throat plus a characteristic fine, sandpaper-like rash. Invasive streptococcal infections may follow wound infections, including infected varicella lesions, or respiratory infections.
Transmission/Exposure	Transmitted person-to-person mainly through respiratory secretions. Recurrent disease may occur from ongoing contact with carriers.
Contagious Period	Weeks to months; 10–21 days after acute illness or until 24 hours after treatment.
Incubation	2 to 5 days for pharyngitis.
Diagnosis	Rapid strep test from throat swab or throat culture supports clinical evaluation.
Management of Case	Suspected cases should be referred for medical evaluation. Referral is urgent if high fever, marked toxicity, or respiratory distress is present. School exclusion is recommended until at least 24 hours after antibiotic treatment is initiated.
Management of Contacts	For sporadic cases of uncomplicated streptococcal infection, surveillance for additional cases is adequate.
Public Health Action	Report cases of scarlet fever, streptococcal toxic shock syndrome, invasive streptococcal disease, and outbreaks of streptococcal disease within schools to the NMDOH at (505) 827-0006.
School Action	Refer suspected cases for medical evaluation and treatment. Exclude cases until the infected individual has been on antibiotic treatment for at least 24 hours. Report complicated cases and outbreaks of streptococcal infection to the NMDOH. Provide prevention education.

Tetanus

Condition, Disease, Agent	Tetanus Clostridium tetani https://www.nmhealth.org/publication/view/general/5137/ Tetanus Fact Sheet, English Tetanus Fact Sheet, Spanish
Clinical Description	Tetanus, or “lockjaw,” is caused by a neurotoxin produced by Clostridium tetani. Although tetanus occurs worldwide, it is rare in the United States due to immunization. Tetanus infection usually occurs from a skin wound. Localized tetanus consists of painful tonic muscle spasms in the area of a wound and can precede generalized tetanus, which presents with muscle spasms. Muscle spasms often produce trismus, or inability to open the mouth fully or at all.
Transmission/Exposure	Contact of a wound in the skin with material containing tetanus spores. Contaminated wounds, deep wounds, or wounds with devitalized tissue are at greatest risk. Tetanus spores are everywhere in the environment.
Contagious Period	Not communicable from person to person.
Incubation	Most cases occur within 8–10 days of exposure, with a range of 3 to 21 days.
Diagnosis	The diagnosis should be made based on clinical presentation and exclusion of other possibilities. Culturing of wounds is low yield; treatment should not be based on laboratory evidence.
Management of Case	Tetanus is a medical emergency requiring hospitalization. All wounds should be properly cleaned and debrided. Tetanus immune globulin is recommended for treatment, and tetanus booster vaccination may be needed. Antibiotic treatment and supportive care to control spasms may also be necessary.
Management of Contacts	Not indicated, since tetanus is not spread person-to-person.
Public Health Action	Report suspected cases to the NMDOH at (505) 827-0006.
School Action	Refer suspected cases for medical evaluation and treatment. Assure appropriate immunization status for all students. For wounds, make sure appropriate treatment is given. Provide prevention education.

Ticks

Condition, Disease, Agent	Ticks
Clinical Description	Tick bites are generally painless. Symptoms of infection from a tick bite depend on the specific condition. Simple local bacterial infection can occur, including redness, pain, swelling, or pus. Symptoms from other pathogens may include fever, chills, aches, rash, headache, weakness, fatigue, and muscle aches.
Transmission/Exposure	Depending on the tick species and stage of life, preparing to feed can take from 10 minutes to 2 hours. When the tick finds a feeding spot, it grasps the skin and cuts into the surface. The tick inserts its feeding tube and may secrete substances that keep it attached. If the tick contains a pathogen, the organism may be transmitted to the host through saliva during feeding.
Contagious Period	Ticks are not seasonal; cold weather does not mean a person cannot be bitten by a tick.
Incubation	Ticks may take up to 3 years to complete their life span. Conditions caused by pathogens contracted from ticks may have incubation periods that vary by disease, from days to months.
Diagnosis	Visual inspection and identification. Conditions caused by tick bites can have characteristic signs and symptoms. Lab testing of a symptomatic person may be available.
Management of Case	Use clean, fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. Pull upward with steady, even pressure. Do not twist or jerk the tick. After removing the tick, clean the bite area and hands with rubbing alcohol or soap and water. Never crush a tick with fingers. Dispose of a live tick by putting it in alcohol, sealing it in a bag or container, wrapping it tightly in tape, or flushing it down a toilet. If a rash or fever develops within several weeks after a bite, see a primary care provider and mention the recent tick bite.
Management of Contacts	Not applicable.
Public Health Action	Reporting to NMDOH is not required. Contact your regional School Health Advocate and/or regional Nurse Epidemiologist with questions or concerns. Contact the NMDOH Epidemiology and Response Division at (505) 827-0006 for questions or concerns.
Prevention Education	Use products that contain permethrin to treat clothing and gear, such as boots, pants, and socks. Treat dogs for ticks. Bathe or shower as soon as possible after coming indoors to wash off and more easily find crawling ticks before they bite. Put dry clothes in a dryer on high heat for 10 minutes to kill ticks after coming indoors. Conduct a full-body tick check after returning from tick-infested areas.
School Action	School exclusion is not helpful. Tickborne diseases are not transmitted person-to-person. Frequent hand-washing should be stressed for all students and school staff. Provide prevention education.
Resources	Tick Removal \| CDC Tickborne Disease Continuing Education \| CDC

Tinea Capitis, Corporis, Cruris, and Pedis

Condition, Disease, Agent	Tinea Capitis, Corporis, Cruris, and Pedis Ringworm fungal infection of scalp, body, groin, and feet Microsporum and Trichophyton Fact Sheet, English Fact Sheet, Spanish
Clinical Description	Tinea lesions are generally circular, reddish, crusty, and scaly, with a vesiculopapular border. They occur on the face, scalp, and body. Lesions are often itchy. Tinea capitis may present with dandruff-like scaling and hair loss, discrete areas of hair loss with stubs of broken hair, numerous scaly pustules, or a kerion.
Transmission/Exposure	Direct or indirect contact with skin or scalp lesions of infected persons or animals; potentially any surface, especially moist surfaces.
Contagious Period	As long as lesions are present. Viable fungus may persist on contaminated materials for long periods.
Incubation	Unknown; estimated to be 10–14 days.
Diagnosis	Fungal culture and potassium hydroxide wet mount of scrapings from skin lesions.
Management of Case	Refer suspected cases for medical evaluation and treatment. Scalp lesions require oral therapy for at least four weeks. Other varieties require topical or oral antifungal therapy. Students should avoid public areas conducive to transmission, such as gyms and swimming pools. School exclusion is not necessary, especially if skin lesions can be covered until treatment has been initiated.
Management of Contacts	Examine close contacts, including household pets, by visual examination of the skin and scalp. Monitor contacts as long as potential for exposure continues.
Public Health Action	Not a reportable condition.
School Action	Refer suspected cases for medical evaluation and treatment. School exclusion is not necessary. Observe contacts for development of lesions. Decontaminate sports equipment or wading pools where fungus may grow. Encourage covering of lesions. Discourage sharing personal items with infected cases. Provide prevention education.

Tuberculosis (TB)

Condition, Disease, Agent	Tuberculosis (TB) Mycobacterium tuberculosis CDC Fact Sheets: https://www.cdc.gov/tb/topic/basics/default.htm
Clinical Description	Primary infection in children may produce nonspecific symptoms of fever, weight loss, and cough. Reactivation in adolescents or adults may produce an enlarging cavity in the lung containing large numbers of bacteria. Active pulmonary tuberculosis causes chronic cough with purulent, often blood-tinged sputum. Chest pain, fatigue, weight loss, night sweats, and fever may occur.
Transmission/Exposure	Mycobacterium tuberculosis is transmitted in airborne particles called droplet nuclei that are expelled when persons with pulmonary or laryngeal TB cough, sneeze, shout, or sing. Transmission usually occurs with close contact to the active case over time.
Incubation	2–12 weeks from exposure to development of a positive tuberculin test. Clinical disease is most likely within the first 2–3 years after infection but may occur decades later.
Contagious Period	Throughout the period of active infection until 1–3 weeks after initiation of effective treatment.
Diagnosis	Physical examination may be suggestive of tuberculosis, especially if the individual is known to have been exposed. A positive TB test means infection with M. tuberculosis or prior BCG vaccine but does not indicate whether infection is active. Active TB is diagnosed by sputum culture or other specimens and chest imaging.
Management of Case	For active TB disease, completion of treatment is critical. Active disease cases should be excluded from school until released by the NMDOH Tuberculosis Prevention Program, usually after two weeks of completed therapy and coughing has subsided.
Management of Contacts	The NMDOH TB Prevention Program will coordinate testing and determine the need for chest x-ray, physician evaluation, and preventive treatment of contacts.
Vaccine	BCG vaccine is administered in parts of the world where there is a high risk of childhood TB, but it is not used in the United States.
Public Health Action	All active cases of tuberculosis should be reported to NMDOH. Children who are positive tuberculin reactors should also be referred, since infection in a child indicates recent exposure to an active case. The Tuberculosis Prevention Program will coordinate contact evaluation.
School Action	Refer students and staff with chronic cough lasting longer than three weeks for medical evaluation. Report suspected or confirmed cases to NMDOH. Exclude students and staff with active tuberculosis from school until determined non-contagious by the NMDOH TB Prevention Program. Provide prevention education.

Tularemia

Condition, Disease, Agent	Tularemia Francisella tularensis https://www.nmhealth.org/publication/view/general/5140 Fact Sheet, English Fact Sheet, Spanish
Clinical Description	Tularemia is also known as rabbit fever. People usually become infected through tick or deer fly bites or by handling infected animals. Symptoms may include sudden onset of high fever, chills, fatigue, body aches, headache, nausea, and a skin ulcer at the site of entry.
Transmission/Exposure	Most humans acquire tularemia through handling infected rabbits or rodents, or from deer fly or tick bites.
Contagious Period	Not communicable from person to person.
Incubation	Usually 3–5 days, with a range of 1–21 days.
Diagnosis	Diagnosis is done with a positive serologic test and confirmed by a four-fold rise in antibody titer with a second specimen. Diagnosis is usually confirmed by culture of F. tularensis.
Management of Case	Tularemia is treatable with antibiotics. Prompt diagnosis and treatment are critical. When human tularemia is suspected, appropriate specimens should be obtained immediately and the patient should be started on specific antimicrobial therapy pending laboratory confirmation.
Management of Contacts	Not indicated, since tularemia is not spread person-to-person.
Public Health Action	Report suspected cases to NMDOH at (505) 827-0006.
School Action	Preventive measures include avoidance of tick and deer fly bites. Provide prevention education. Avoid contact with dead and sick animals.

Upper Respiratory Tract Infection, Acute Viral

Condition, Disease, Agent	Upper Respiratory Tract Infection, Acute Viral Numerous viruses, including adenoviruses, coronaviruses, enteroviruses, and rhinoviruses Fact Sheet, English Fact Sheet, Spanish
Clinical Description	Rhinoviruses are the most frequent cause of the common cold. Signs and symptoms of upper respiratory tract infections include nasal discharge, nasal congestion, sneezing, cough, and low-grade fever. Otitis media and pharyngitis can also occur, depending on the causative agent.
Transmission/Exposure	Occurs primarily through person-to-person contact, self-inoculation by contaminated secretions on hands, and aerosol spread. Some viruses can also spread by aerosol and indirect contact.
Contagious Period	Most communicable during the first few days of acute illness.
Incubation	Depends on the causative virus; varies from 2–14 days.
Diagnosis	Usually clinical. Testing is available for some viruses, although testing is not widely used for typical upper respiratory infections.
Management of Case	Children and adults with clinical illness should be sent home until fever greater than 100.4°F subsides. Fluids are important to maintain hydration. Bed rest and analgesics or antipyretics other than aspirin may help symptomatically.
Management of Contacts	No specific recommendations other than using good techniques to avoid spreading illness. Encourage good hand hygiene and appropriate disposal of contaminated articles.
Public Health Action	Notify NMDOH at (505) 827-0006 when outbreaks of respiratory disease appear in a school.
School Action	Exclude students and staff with respiratory illness until afebrile and symptoms do not affect participation in routine school activities. Report suspected outbreaks of respiratory disease to NMDOH. Emphasize hand-washing and respiratory droplet precautions in prevention education. Provide prevention education.

West Nile Disease

Condition, Disease, Agent	West Nile Disease Flavivirus https://www.nmhealth.org/publication/view/general/5103/ Fact Sheet, English Fact Sheet, Spanish
Clinical Description	Inapparent disease and mild infection are common. Signs and symptoms vary in severity from mild fever to aseptic meningitis, encephalitis with coma, paralysis, and death. The elderly are at greatest risk of severe illness. Disease in humans is most common in summer and early fall.
Transmission/Exposure	Transmission is by the bite of infected mosquitoes that have acquired the virus from feeding on infected birds. Birds have the virus for only a few days, but mosquitoes remain infected for life.
Contagious Period	Not transmitted human-to-human.
Incubation	Usually 2–14 days, up to 21 days in immunocompromised people.
Diagnosis	Refer suspected cases for medical evaluation and diagnosis as appropriate.
Management of Case	No antiviral medication is available. Supportive therapy is indicated.
Management of Contacts	None indicated.

Sexually Transmitted Diseases (STDs)

Introduction

STDs are common infections in the United States and in New Mexico. New Mexico currently has one of the highest rates of chlamydia in the nation. Rates of gonorrhea and chlamydia are highest in people 15 to 24 years of age. Other sexually transmitted infections, such as syphilis, occur in the teenage population but are less common.

Teenagers often practice “serial monogamy” and therefore may have several sex partners in a given year. Many teenagers do not use contraception and many are not using condoms to protect themselves from infections. These factors help explain the high STD rates among the teenage population. School nurses can be a valuable resource for information about sexuality, contraception, and STDs.

Information on specific STDs can be found at: CDC STD Fact Sheets.

School Nurse Education

School nurses can help address concerns by conveying simple and nonjudgmental messages to students:

Delay having sexual intercourse until ready.
Use condoms to prevent STDs.
Use reliable contraception such as birth control pills or a long-acting progesterone injection or implant.
Limit the number of sexual partners.
Encourage students to talk to parents or trusted adults about sexual feelings, intimate relationships, sexual activity, birth control, and STDs.
Refer students to proper medical or counseling interventions when they are fearful of parental reactions or need additional support.

School nurses can also help students by letting them know they are legally entitled to receive confidential medical services for family planning and STDs. School-Based Health Centers and local Public Health Offices provide free and confidential STD services, prevention services, and family planning services.

Students who present to the school nurse with possible symptoms of an STD should be asked about their risks for STDs and referred to a medical facility for diagnosis and treatment.

STD Signs and Symptoms

STD signs and symptoms may occur in areas other than the genitals, depending on the type of sexual exposure. Many STDs have no symptoms or may have vague and nonspecific symptoms, especially in girls.

Male

Penile discharge.
Any sore, growth, or ulcer on the penis or groin area.

Female

An abnormal vaginal discharge.
A sore, growth, or ulcer on the external or internal genitalia.
Pain with intercourse.
Abnormal vaginal bleeding.
Lower abdominal pains with or without vomiting, nausea, or fever.

Either Gender

Unusual rashes, especially on the palms or soles, which may be concerning for syphilis.
Sore throat in the case of receptive oral intercourse.
Burning with urination.
Rectal discharge and/or discomfort.
Sores, growths, or ulcers in the rectal area.
Sore and swollen cervical

Public Health Services

Every county in New Mexico has at least one public health office where people with STDs may be evaluated. Disease Intervention Specialists provide STD outreach and follow-up services through public health offices across the state. Public Health Offices provide free and confidential STD and family planning services for teens. Minors do not need parental consent for family planning services or STD evaluation and treatment, including HPV vaccine.

Reporting Suspected Abuse

If sexual abuse or inappropriate sexual contact is suspected, report it to Children, Youth, and Families Department (CYFD) or other appropriate authority. Every person who knows or has reasonable suspicion that a child is being abused or neglected in New Mexico must report the matter immediately to CYFD’s Statewide Central Intake child abuse hotline at 1-855-333-SAFE (7233), #SAFE from a cell phone, law enforcement, or the appropriate tribal authority.

Chlamydia, Gonorrhea

Condition, Disease, Agent	Chlamydia, Gonorrhea Chlamydia trachomatis (CT); Neisseria gonorrhoeae (GC) CDC Chlamydia Fact Sheet, English CDC Chlamydia Fact Sheet, Spanish CDC Gonorrhea Fact Sheet, English CDC Gonorrhea Fact Sheet, Spanish
Clinical Description	These infections are described together because there is overlap in the clinical presentation, and dual infections are common. CT and GC infect mucous membranes, resulting in inflammation with burning on urination and urethral or vaginal discharge. Infections of other sites may cause sore throat, conjunctivitis, rectal pain, and discharge. Complications include pelvic inflammatory disease in women and epididymitis in men.
Transmission/Exposure	Both are readily transmitted by intimate mucosal contact with infectious secretions. CT conjunctivitis can be caused by self-inoculation of the eye by a person with genital infection. Sexual contact with an infected individual may result in genital, throat, and rectal infections.
Contagious Period	If untreated, the infected individual may remain contagious indefinitely. After treatment, the contagious period is one to several days.
Incubation	GC is 2–5 days after exposure; CT is 7–14 days.
Diagnosis	Examination may reveal inflammation, tenderness, swelling, or discharge of the infected genitals or eyes. Laboratory testing by DNA probes is highly sensitive and specific. Bacterial culture for GC is recommended.
Management of Case	Suspected cases should be referred for medical evaluation and treatment. Minors may seek care for sexually transmitted disease without parental knowledge or consent. In addition to GC and chlamydia, at-risk individuals should be evaluated for other sexually transmitted diseases. Gonococcal and chlamydial infections in young children may indicate inappropriate sexual contact. Refer children under the age of consent and older children who give a history of sexual assault to CYFD and/or another appropriate authority.
Management of Contacts	Intimate sexual contacts of infected individuals should be evaluated for infection and treated.
Preventive Education	Postpone sexual activity, limit partners, and use condoms.
Public Health Action	Report gonorrhea and chlamydial infections to the NMDOH STD Program via morbidity fax at (505) 476-3638.
School Action	Support school-based clinics, peer counseling, and education to increase health care services for adolescents. Refer students to a physician, NMDOH, or school-based clinic for diagnosis and treatment. School exclusion is not necessary. Consider the possibility of child or sexual abuse and refer to CYFD as appropriate. Provide prevention education, including safer sex practices.

Herpes Simplex Genital Infection

Condition, Disease, Agent	Herpes Simplex Genital Infection Herpes simplex virus (HSV), type 2 CDC Genital Herpes Fact Sheet, English CDC Genital Herpes Fact Sheet, Spanish
Clinical Description	Symptoms include vesicles, or small blisters, on the skin and/or mucous membranes that rupture quickly, leaving painful ulcers and dry crusts. Satellite vesicles may form for several days with primary infection. Fever and malaise may occur. Recurrent infections are common and usually occur in the same area as the primary lesion.
Transmission/Exposure	Direct contact with genital secretions or lesions. Indirect contact is highly unlikely, although the virus may remain viable on contaminated objects for several hours.
Contagious Period	7–50 days following onset of primary infection and typically 3–4 days after onset of a recurrent episode; also during asymptomatic shedding of the virus.
Incubation	2–12 days for primary infection.
Diagnosis	Diagnosis is made on clinical evaluation of lesions that are initially thin-walled vesicles and/or blisters that ulcerate on moist surfaces or crust on dry skin. Laboratory testing may include cultures.
Management of Cases	Refer for medical evaluation for apparent primary infection or frequent or severe recurrences. Genital herpes in a student may be indicative of sexual abuse. Specific antiviral treatment may shorten the duration of primary and recurrent episodes and reduce viral shedding. Those with frequent recurrences may be able to suppress them with continuous oral antiviral medication.
Management of Contacts	Refer contacts for medical evaluation and provide prevention education.
Public Health Action	Not a reportable condition.
School Action	Support school-based clinics, peer counseling, education, and other measures to increase availability and acceptability of health care services to adolescents. Affected students should not be excluded from school. If sexual abuse or inappropriate sexual contact is suspected, report to Child Protective Services or another appropriate authority. Provide prevention education, including safer sex practices.

HIV Infection/AIDS (Acquired Immunodeficiency Syndrome)

Condition, Disease, Agent	HIV Infection/AIDS (Acquired Immunodeficiency Syndrome) Human immunodeficiency virus (HIV) CDC information: https://www.cdc.gov/hiv/basics/index.html
Clinical Description	Initial infection with HIV may be subclinical or may cause an acute mononucleosis-like illness with fever, malaise, sore throat, lymph node enlargement, and skin rash. HIV infects cells of the immune system and causes progressive impairment of immune function. Antiretroviral treatment has prolonged the symptom-free period, delayed the onset of AIDS, and prolonged the lives of people with HIV.
Transmission/Exposure	HIV can transmit through contact with blood, sexual contact, or sharing injection equipment with an infected person. HIV can be transmitted from a mother to her baby during pregnancy, birth, or breastfeeding. HIV is not transmitted through casual household, school, or social contact or through contact with tears, sweat, or saliva.
Contagious Period	Early in infection to indefinitely, since infection is chronic. People on antiretroviral treatment who have an undetectable viral load will no longer transmit the virus through sex.
Incubation	1–3 months to seroconversion for HIV infection. One to many years for the development of AIDS.
Diagnosis	HIV infection can be suspected clinically, but diagnosis requires laboratory confirmation. There are three types of HIV tests: antibody tests, antigen/antibody tests, and nucleic acid tests.
Management of Case	Students with HIV infection may be absent from school frequently and may need medication regularly at school. They may be more susceptible to some infections and may not be completely protected by immunizations. Standard precautions are especially important.
Management of Contacts	Post-exposure preventive treatment is recommended for any percutaneous exposure to blood from a person with known HIV infection. Treatment must be started within 72 hours of exposure to be optimally effective. Contacts should be referred for medical evaluation immediately. Any person at risk of HIV infection should be tested to facilitate early treatment.
Public Health Action	Report cases of HIV infection or AIDS to NMDOH. Refer uninsured exposures to the DOH/STD Program at (505) 476-3136 immediately for post-exposure preventive treatment and testing.
Prevention Education	Avoid contact with blood and body fluids; avoid injections, tattoos, or similar procedures with unsterile equipment; practice safer sex; encourage sterile needles and equipment through harm reduction resources; and practice standard precautions.
School Action	School exclusion is not appropriate, though exceptions may occur with opportunistic infections such as TB. Practice standard precautions and conform to OSHA regulations. Monitor students for behavior that may place others at risk, such as biting. Provide prevention education. Protect confidentiality of infected persons and provide as normal a school environment as possible.

Human Papillomavirus (Genital HPV)

Condition, Disease, Agent	Human Papillomavirus (Genital HPV) Human Papillomavirus (HPV) CDC Genital HPV Fact Sheet, English CDC Genital HPV Fact Sheet, Spanish
Clinical Description	Single or massed warty or cauliflower-like growths may be found on external genitals, urethral opening, anus, and inside the vagina. They may cause irritation. Some strains cause neoplasia of the cervix and other genital structures.
Transmission/Exposure	Person-to-person genital contact and possibly contaminated articles.
Contagious Period	May be indefinite but probably at least as long as lesions exist.
Incubation	2–3 months, with a range of 1–20 months.
Diagnosis	Typical lesions usually confirm diagnosis but may be excised and examined histologically. Microscopic examination of cells is an effective method for detecting cellular abnormalities associated with malignancy in women.
Management of Case	Treatment may be chemical or physical destruction and can decrease the amount of wart virus available for transmission. Warts may regress spontaneously within months to years. Avoidance of direct contact with lesions prevents transmission. School exclusion is not appropriate.
Management of Contacts	Sexual contacts of patients with venereal warts should be examined and treated if indicated.
Prevention Education	Avoidance of contact with lesions prevents infection. HPV vaccine is effective if initiated before sexual debut.
Public Health Action	Not reportable to NMDOH.
School Action	School exclusion is not appropriate. Provide prevention education as part of sex education curriculum.

Trichomoniasis

Condition, Disease, Agent	Trichomoniasis Trichomonas vaginalis CDC Trichomonas Fact Sheet, English CDC Trichomonas Fact Sheet, Spanish
Clinical Description	Malodorous gray vaginal discharge, often with external irritation that usually includes itching or painful urination.
Transmission/Exposure	Person-to-person genital contact.
Incubation	Indeterminate.
Contagious Period	Indefinite in untreated persons.
Diagnosis	Usually made by noting the organism on microscopic examination of vaginal discharge.
Management of Case	Suspected cases should be referred for medical evaluation and treatment. Minors may seek care for sexually transmitted disease without parental knowledge or consent. Sexual contact should be avoided during the period of infection and during treatment of the patient and partner(s).
Management of Contacts	Sexual partners are usually asymptomatic but should be evaluated and treated for case treatment to be effective long-term.
Public Health Action	Promotion of safer sex behavior, including condom use, is indicated.
School Action	Provide prevention education with sex education curriculum. Refer suspected cases for evaluation and appropriate treatment. School exclusion is not appropriate. Provide prevention education, including safer sex education.

Tuberculosis (TB) Screening Guidelines

As of July 30, 2004, transmission-free certification for tuberculosis (TB) is no longer a state-mandated requirement for employment in schools and daycare centers; therefore, TB testing is no longer required for new employees in schools and preschools.

New Mexico has been a low-incidence state for TB since 2000, which means that there are fewer than 3.5 TB cases per 100,000 persons. Testing low-risk individuals often results in false positive tests and unnecessary treatment, diverting financial and human resources from other priorities.

Guidelines

Tuberculin testing for employment in schools and daycare centers of low-risk individuals is not required in New Mexico.
NMDOH will offer testing/screening for close contacts to someone with active TB disease. Recent contacts within the last two years have increased risk for progression to active TB.
For a full list of those qualifying for TB screening, contact your local public health office.

Primary Editors: Miranda Durham, MD, New Mexico Department of Health & Karen Edge, MPH, New Mexico Department of Health

Vicki Casias, BSN, RN School Health Advocate, NW Region & Kathryn Willits, RN Epidemiology Nurse, NW Region (on Molluscum)

Secondary Editors: Rhonda Miranda, BS, RN, School Health Advocate, NW Region, New Mexico Department of Health & Jim Farmer, Director, Office of School and Adolescent Health, New Mexico Department of Health; Crista Pierce, BA, RN, CLNC, SW Regional School Health Advocate; Kate LaRose, BSN, RN, NE Regional School Health Advocate; Maricelda Pisana, BSN, RN, SE Regional School Health Advocate; Dr. Eugene Marciniak, MD, SW Regional Health Officer; Dr. Savanna Bustos, MD, NW Regional Health Officer; Dr. Christine Ross, MD, NE Regional Health Officer; Dr. Christopher Novak, MD, MPH, Medical Director

Resources and References

NMDOH Communicable Disease Manual for Childcare Settings
Lice Removal Instructions Flyer
Lice Removal Instructions Flyer in Spanish
NMDOH TB Information Line: 505-827-2471
CDC Tuberculosis Basics. https://www.cdc.gov/tb/topic/basics/default.htm
NM Register Reference: New Mexico Register, Volume XV, Number 14, July 30, 2004. This part 7 NMAC 4.4, Control of Communicable Disease in Health Facility Personnel, filed October 18, 1996, is repealed effective July 30, 2004.
Molluscum Contagiosum | Poxvirus | CDC. https://www.cdc.gov/poxvirus/molluscum-contagiosum
Kimberlin, D. W. (2024). Red Book: 2021–2024 Report of the Committee on Infectious Diseases. Molluscum Contagiosum. https://www.cabdirect.org/cabdirect/abstract/20183376718

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New Mexico Student Health

Communicable Disease Control

Reporting and Disease Outbreak Support

Notifiable Conditions in New Mexico

Reportable Communicable Disease Algorithm and NMDOH Contact List

Procedures for Control of Communicable Diseases

Classroom Cleanliness

Classroom Cooking

Diapering

Hand-washing

Bloodborne Pathogens Exposure Risk

Toileting

Communicable Diseases Information Sheets

Introduction

Animal or Human Bite Wound/Infection

Bed Bugs

Chicken Pox (Varicella) [See Shingles for Herpes-Zoster]

Clostridium Difficile/CDiff

Conjunctivitis (Pink-Eye)

COVID-19 Updated March 2024

Cytomegalovirus (CMV)

Diarrhea (Acute)

Fifth Disease (Erythema Infectiosum)

Giardiasis, Cryptosporidiosis

Haemophilus influenzae Invasive Disease

Hand, Foot, and Mouth Syndrome

Hantavirus Pulmonary Syndrome (HPS)

Hepatitis A

Hepatitis B and C (Acute)

Herpes Simplex, Non-Genital Infections (“Cold Sores”)

Impetigo

Influenza

Meningitis (Bacterial)

Meningitis (Viral or Aseptic)

MRSA (Methicillin-Resistant Staphylococcus Aureus)

Molluscum Contagiosum

Mononucleosis (Infectious Mononucleosis, Mono)

Mumps

Norovirus

Pediculosis (Head Lice)

Pertussis (Whooping Cough)

Plague

Rubella

Rubeola (Measles)

Scabies

Shingles (Herpes-Zoster/Varicella Virus)

Streptococcal Infections (Strep Throat)/Scarlet Fever

Tetanus

Ticks

Tinea Capitis, Corporis, Cruris, and Pedis

Tuberculosis (TB)

Tularemia

Upper Respiratory Tract Infection, Acute Viral

West Nile Disease

Sexually Transmitted Diseases (STDs)

Introduction

School Nurse Education

STD Signs and Symptoms

Male

Female

Either Gender

Public Health Services

Reporting Suspected Abuse

Chlamydia, Gonorrhea

Herpes Simplex Genital Infection

HIV Infection/AIDS (Acquired Immunodeficiency Syndrome)

Human Papillomavirus (Genital HPV)

Trichomoniasis

Tuberculosis (TB) Screening Guidelines

Guidelines

Resources and References