Outbreak Control Measures in Childcare

Daily surveillance of children and daily recording of any enteric and/or respiratory symptoms will give a clear picture of the baseline incidence in the childcare centre. An outbreak may be occurring when there are clusters of cases, characterized by common symptoms, above the normal or baseline levels for the centre in a short period of time. 

Early reporting of the suspect outbreak, along with implementation of infection control measures, will decrease the number of children and staff who could be affected and will also reduce the duration of the outbreak. 

Be aware of any children in the childcare centre with cancer, including leukemia or other immune deficiency illnesses. These children may need special attention due to increased risk of illness. 

Signs and symptoms of enteric illnesses include: 

• More than one episode of diarrhea or vomiting, which may be accompanied by: 
  • Abdominal cramps/stomach aches 
  • Fever 
  • Nausea 
  • Loss of appetite 
  • Bloody and/or mucous stools 

It is important to determine whether the diarrhea may be a reaction to medication, change in diet or other reasons that may not be linked to an enteric illness. 

A respiratory infection usually starts with: 

• Onset of a fever and may be accompanied with one or more of the following: 
  • Runny nose 
  • Cough 
  • Nasal congestion 
  • Sore throat 
  • Chills 
  • Muscle aches 
  • Fatigue 
  • Poor appetite 
  • Young children may also have diarrhea 

A suspect outbreak exists when there is an increase in the baseline incidence indicating there are a higher than expected number of children or staff who are experiencing similar symptoms of illness. 

To determine whether a suspect outbreak exists: 

• Review illness surveillance recording forms, communication books or daily log 
• Identify similar symptoms of illness among the symptomatic children/staff 
• Check recent child/staff absenteeism records 

Contact the health unit (1-888-221-2133) to discuss unusual clustering of symptoms. 

When several children and/or staff become ill on the same day, notify the health unit (1-888-221-2133) IMMEDIATELY. 

Health unit staff will provide information to assist in bringing outbreaks under control and in communicating with parents if necessary. You will be provided a line list, outbreak number, and outbreak control measures. 

For quick reference, a copy of the Diseases of Public Health Significance for Schools and Childcare [PDF] is available. 

The health unit has three major roles related to the investigation of an enteric or respiratory outbreak in childcare centres. 

Legislated Role 

In order to protect the public’s health, the health unit’s Medical Officer of Health and public health staff have the authority to require: 

• The exclusion of ill children/staff from the centre 
• Children/staff to submit samples 
• The centre to follow specific outbreak control measures. 

Consulting Role 

The health unit will provide advice to the childcare centres regarding: 

• Signs and symptoms of enteric and respiratory illnesses including case definitions 
• Information about infectious diseases capable of causing illness in a centre
  • See listing of Diseases of Public Health Significance [PDF]
• How to reduce the spread of infectious microorganisms in a centre
• How to obtain and store specimen samples
• Policies to support outbreak reporting and management 

Co-ordinating Role 

The health unit will help to co-ordinate the necessary steps to bring the outbreak under control by: 

• Identifying the type and number of specimen samples needed 
• Delivering enteric outbreak kits to the centre and possibly to pick-up/drop-off sites in the community 
• Ensuring specimen samples collected are appropriately transported to the Public Health Laboratory in a timely manner 
• Conducting a kitchen inspection at the centre if an outbreak of foodborne illness is suspected 

All childcare centres are legally responsible for reporting enteric and/or respiratory outbreaks to the local public health unit. Once the outbreak has been reported, the centre is required to: 

• Follow all health unit recommendations and requirements 
• Assist the investigating public health staff by facilitating the collection of requested specimen samples and providing the necessary information about children and staff.
• Provide parents who are providing specimen samples for their child the How to Collect Stool Sample Instructions [PDF] and the HPPH PHO General Test Requisition (Gastro). 
  • Inform parents that all highlighted fields on the form must be completed.
• Immediately report changes associated with the outbreak and provide updated information about the outbreak on a daily basis 
• Communicate necessary information to the parents of children attending the centre.