Lewisburg Area School District Policies	Printable version
414.1 Communicable Disease and Immunization 414.1. COMMUNICABLE DISEASE The Board recognizes its responsibility for protecting the health of the students served and the personnel employed by the District. To prevent the spread of communicable diseases within the school environment, the Board adopts the following guidelines to deal with "infected" individuals, immunizations, and student health records as they pertain to communicable diseases. Furthermore, the intent of these guidelines is to deal with students and/or school employees with a communicable disease on a case-by-case basis. "Infected" Individuals Students and/or employees who have been diagnosed by a physician or who are suspected by the school nurse of having one of the communicable diseases listed in Section 27.71(Exclusion for Specified Diseases and Infectious Conditions) of the Public Health Code shall be excluded from school for a time period specified by the health code for the specific communicable disease and/or recommended by the school physician. Current Recommendations Include 1. Diptheria Two (2) weeks from the onset or until appropriate negative culture tests. Reference should be made to #27.108 of the Public Health Code (relating to diptheria). 2. Measles Four (4) days from the onset of rash. Reference should be made to #27.121 of the Public Health Code (relating to measles). 3. Mumps Nine (9) days from the onset or until subsidence of swelling. Reference should be made to #27.124 of the Public Health Code (relating to mumps). 4. Pertussis Four (4) weeks from the onset or seven (7) days from institution of appropriate antimicrobial therapy. Reference should be made to #27.126 of the Public Health Code (relating to Pertussis {whooping cough}). 5. Rubella Four (4) days from the onset of rash. Reference should be made to #27.134 of the Public Health Code (relating to Rubella {German Measles} and Congenital Rubella Syndrome). 6. Chickenpox Six (6) days from the last crop of vesicles. 7. Respiratory Streptococcal Infections including Scarlet Fever Not less than seven (7) days from the onset if no physician is in attendance or twenty-four (24) hours from institution of appropriate antimicrobial therapy. 8. Acute Contagious Conjunctivitis (pink eye) Twenty-four(24) hours from institution of appropriate therapy. 9. Ringworm (All Types) Until judged noninfective by the school nurse or by the child's physician. 10. Impetigo Contagiosa Until judged non-infective by the school nurse or by the child's physician. 11. Pediculosis Capitis Until judged noninfective by the school nurse or by the child's physician. 12. Pediculosis Corpora Until judged noninfective by the school nurse or by the child's physician. 13. Scabies Until judged noninfective by the school nurse or by the child's physician. 14. Tonsillitis Twenty-four (24) hours from institution of appropriate therapy. 15. Trachoma Twenty-four (24) hours from institution of appropriate therapy. Students and/or employees who are showing symptoms of an unusual skin eruption, soreness of the throat, symptoms of whooping cough, and/or diseases of the eyes shall be excluded from school (PHC Section 27.72). They may return to school when a school nurse is satisfied that the above condition for which the student and/or employee was excluded is not communicable or when the student and/or employee presents a certificate of noninfectiousness from a physician. Exclusion Students and/or employees who have a disease requiring isolation or who have been exposed to an individual who has such a disease shall be excluded from school until the local health authorities grant the student and/or employee permission to return to school (PHC Section 27.74). The school nurse must review the written grant of permission. Measles Students and/or employees who are presumed susceptible to measles (rubeola) may be excluded from school during an outbreak of this communicable disease (PHC Section27.75). The procedure for excluding such susceptible individuals is outlined in Section 27.121 of the Public Health Code. Students and/or employees who have been diagnosed by a physician as having a communicable disease not specifically listed by the Department of Health as an excludable condition(Public Health Code Section 27.71), who have been diagnosed as a carrier of such a disease, and/or who have one of the reportable communicable diseases identified by the Department of Health in Section 27.2 of the Public Health Code may be excluded from school if the "infected" individuals are at risk of transmitting the communicable disease to others in the school environment. 1. The current list of reportable diseases includes: AIDS (Acquired Immune Deficiency Syndrome) Amebiasis Animal bite Anthrax Botulism Brucellosis Campylobacteriosis Cancer Cholera Diptheria Encephalitis Food poisoning Giardiasis Gonococcal infections Gullain-Barre Syndrome Hemophilus influenza type B disease Hepatitis non-A non-B Hepatitis, viral, including Type A and Type B Histoplasmosis Kawasaki's disease Legionnaires' disease Leptospirosis Lyme disease Lymphogranuloma venereum Malaria Measles Meningitis all types Meningococcal disease Mumps Pertussis (whooping cough) Plague Poliomyelitis Psittacosis (Ornithosis) Rabies Reye's syndrome Rickettsial diseases including Rocky Mountain Spotted Fever Rubella (German Measles) and congenital rubella syndrome Salmonellosis Shigellosis Syphilis all stages Tetanus Toxic shock syndrome Toxoplasmosis Trichinosis Tuberculosis all forms Tularemia Typhoid Yellow Fever 2. The procedure for excluding such students and/or employees is as follows: Procedures Students 1. The school physician shall make a preliminary recommendation to the district as to the health risks associated with the diagnosed disease. 2. If in the opinion of the school physician, the admission or continuous attendance of the student in question poses a potential health risk to others, a panel (see item 5 below) shall be convened to review the medical history and assess the specific health risks of the identified student to the school community. 3. Prior to the panel's assessment and recommendation as to the health risks, the Superintendent may temporarily exclude the student from school or a specific school program after receiving the school physician's recommendation and consulting with the student's or guardian(s) and personal physician. Homebound instruction may be provided as per policy provisions. 4. The Superintendent will determine which school staff, if any, will share information about the "infected" individual and be involved on a needto-know basis. These persons will be required to preserve the confidentiality of information regarding the patient. Records must be kept confidential. The number of people informed of the"infected" individual's status will be kept to the minimum required to assure proper care and supervision of the individual and other members of the school community. 5. The Superintendent shall name an administrator to coordinate the district's response to the issue. The administrator shall convene the panel. The panel shall consist of the coordinating administrator, school physician, school nurse, the student's family physician, parent(s) or guardian(s), and appropriate health officials with access to experts in communicable diseases. 6. The panel shall assess the potential for transmission of the disease of the school community and the risks associated with potential infection. 7. Within ten (10) school days, the panel shall make a recommendation to the Superintendent regarding the attendance of the student. 8. The Superintendent shall, after review of the facts of the case with the school solicitor, promptly make a final decision on attendance or alternate placement of the student. 9. The panel, at the request of the coordinating administrator, shall meet periodically to assess the recommendations as to the student's attendance at and participation in school and/or school activities. Employees According to district practices and regulations, all employees so excluded shall be entitled to pay benefits and other compensation during the period of their exclusion up until the time step "8" of the following procedure is completed. 1. The school physician shall make a preliminary recommendation to the district as to the health risks associated with the diagnosed disease. 2. If, in the opinion of the school physician, the continued employment of the employee in question poses a potential health risk to others, a panel (see item 5 below) shall be convened to review the medical history and assess the specific health risks of the identified employee to the school community.3. Prior to the panel's assessment and recommendation as to health risks, and after any appropriate releases have been signed, the Superintendent may temporarily exclude the employee from the school work place after receiving the school physician's recommendation and consulting with the employee's personal physician. 4. The Superintendent will determine which school staff, if any, will share information about the "infected" individual and be involved on a needto-know basis. These persons will be required to preserve the confidentiality of information regarding the patient. Records must be kept confidential. The number of people informed of the "infected" individual's status will be kept to the minimum required to assure proper care and supervision of the individual and other members of the school community. 5. The Superintendent shall name an administrator to coordinate the district's response to the issue. The administrator shall convene the panel. The panel shall consist of the coordinating administrator, school physician, school nurse, the employee's family physician, and appropriate health officials with access to experts in the area of communicable diseases. 6. The panel shall assess the potential for transmission of the disease to the school community and the risks associated with potential infection. 7. Within ten (10) school days the panel shall make a recommendation to the Superintendent regarding the employment of the employee. 8. The Superintendent shall, after review of the facts of the case with the school solicitor, promptly make a final decision on reassignment or reinstatement of the employee. 9. The panel, at the request of the coordinating administrator, shall meet periodically to assess the recommendations as to the employee's status. Immunizations Beginning in the 1997-98 school year no student shall be admitted to school for the first time (i.e. kindergarten or first grade) who has not been immunized against certain diseases. Currently, the following immunizations are required as a condition of attendance at school and of homeschooled children: 1. Diphtheria Four (4) properly spaced doses of diphtheria toxoid which may be administered separately, in combination with tetanus toxoid, or in combination with tetanus toxoid and pertussis vaccine. The fourth dose of tetanus and diphtheria (Td) administered on or after the fourth birthday. 2. Tetanus Four properly spaced doses of tetanus toxoid, which may be administered separately, in combination with diphteria toxoid or in combination with diphtheria toxoid and pertussis vaccine. The fourth dose of tetanus and diphtheria (Td) administered on or after the fourth birthday. 3. Poliomelitis Three or more properly spaced doses of oral polio vaccine or at least four properly spaced doses of inactivated polio vaccine if inactivated vaccine is recommended as an appropriate immunizing agent by a physician. 4. Measles (Rubeola) One dose of live attenuated measles vaccine administered at 12 months of age or older or by a history of measles immunity proved by serological evidence showing antibody to measles determined by the hemagglutination inhibition test or any comparable test. A second dose of measles vaccine, preferably given as measles, mumps, rubella vaccine (MMR) must be administered before entering kindergarten or first grade. 5. German Measles (Rubella) One dose of live attenuated rubella vaccine administered at 12 months of age or older or a history of rubella immunity proved by serological evidence showing antibody to rubella determined by the hemagglutination inhibition test or any comparable test. A second dose of measles vaccine, preferably given as measles, mumps, rubella vaccine, must be administered before entering kindergarten or first grade. 6. Mumps One dose of attenuated mumps vaccine administered at 12 months of age or older or a physicians' diagnosis of mumps disease indicated by a written record signed by the physician/designee. A second dose of measles, mumps, rubella vaccine (MMR) must be administered before entering kindergarten or first grade. 7. Hepatitis B Three (3) doses of hepatitis B vaccine. Medical tests documenting serological immunity to Hepatitis B will be accepted in lieu of the vaccination. Beginning in the school year 2000-2001 two (2) doses of measles vaccine will be required for all school children. A student may be PROVISIONALLY admitted to school if evidence of administration of at least one (1) dose of each required immunization is provided and the parent's/guardian's plan for completion of the required immunizations is made part of the student's health record. All immunization requirements shall be completed within eight (8) months of the date of the provisional admission to school. If the requirements are not met, the student shall not be permitted to continue to attend school. Parents/guardians may object, in writing, to such immunization. Acceptable objections include religious grounds or certification by the student's personal physician that the child's medical condition contraindicates immunization. All students transferring into the District from another school district must present evidence that all required immunizations have been completed prior to admission to school. The school physician and school nurses shall annually review the State standards for immunization of students and make recommendations to the Superintendent regarding these standards. The Superintendent shall: 1. Inform parents and guardians of children prior to their entry to a district school of the requirements for immunization, the requisite proof of immunization, the exemptions available for religious or medical reasons, and the means by which such exemptions may be granted. 2. Review the evidence that all required immunizations have been completed prior to admission to school and report them to the Board. There may be a need for immunization programs or other public health measures to insure the health of the school community. Such programs are subject to Board approval and should be conducted in cooperation with local health agencies. Health Records Prior to a student's first admission to a district school, a medical history report form including information regarding known communicable diseases shall be completed for each student. The nurse or school physician may use such reports to advise the parent of the need for further medical care or the need for other special arrangements. All health records shall be confidential. With appropriate signed release forms, these records may be divulged to a physician only when necessary for the health of the child or at the request of the parent or guardian except in the event of a medical emergency. (See also Education Records Policy V.B.10) As part of the health record, a certificate of immunization for each child enrolled shall be maintained as established by the Pennsylvania Department of Health. The information previously recorded and stored by school on the paper"Certificate of Immunization" may be recorded and maintained in a computer data base. The Board shall require that the medical history information, submitted with health and dental examinations, be revised annually to include recent communicable diseases. School Nurse In addition to the responsibilities outlined in the above guidelines, a school nurse is required by the Public Health Code Section 27.23 to do the following: 1. A school nurse shall report the presence of suspected reportable disease to the local health authority in accordance with existing requirements of the local health authority. A copy of this report shall be sent to the school principals and Superintendent. 2. A school nurse shall report an unusual increase in the number of absentees among school children to the local health authority. Educational Programs All students will receive age-appropriate instruction in communicable disease prevention. This instruction will be part of the district health curriculum. As the need arises, all district personnel will be able to participate in general and job specific in-service programs related to communicable disease prevention. Other On occasion there may be the need to address specific communicable diseases because of the unique characteristics of the disease (i.e., lack of specific therapy, contagiousness, lethality, etc.), social implications, or specific disease prevention practices. These items will be dealt with in the form of supplements to this policy. SUPPLEMENT 1 Spills of Body Fluids and Excrement Individuals cleaning up spills of body fluids and excrements should adhere to the following practices: 1. Assume all such spills contain potentially infectious agents (viruses, bacteria, etc.). 2. Wear protective disposable gloves. 3. Avoid contaminating themselves (skin, clothing, etc.) with the fluid or excrement. 4. Avoid "painting" (i.e., use blotting technique) the fluid or excrement when removing it. 5. Clean the "contaminated" surfaces with a cleaning agent known to be viralcidal, bacteriocidal, and fungicidal. 6. Dispose of contaminated gloves, cleaning cloths, etc., according to current Department of Environmental Resources (DER) regulations of municipal waste. Note: Plastic bags, disposable gloves, absorbent towels, should be available in each classroom and each school bus. The custodial staff should provide and use chemical cleaning agents(see 5 above). SUPPLEMENT 2 Acquired Immunodeficiency Syndrome (AIDS) The following administrative guidelines are to be used to deal with known or suspected cases of Human Immunodeficiency Virus (HIV) infection--the cause of the Acquired Immunodeficiency Syndrome (AIDS). "Infected" Individuals Students 1. The provisions outlined in the communicable disease policy shall be used to determine a student's attendance at and participation in school and/or school activities. 2. In addition to the provisions outlined in the Communicable Disease Policy, the following provisions shall apply: a. There is no medical evidence to indicate that HIV infection or AIDS is spread through casual contact including non-intimate or home-living situations. Therefore, any school-related activity which includes casual contact will be available for students identified as having HIV infection or AIDS unless one or more of the following factors exist: (1) The student who has HIV infection or AIDS exhibits behaviors (e.g., biting, spitting, etc.), which may cause others to be infected with HIV. (2) The student who has HIV infection or AIDS has open wounds or sores which may cause others to be infected with the virus through contact with secretions from these wounds or sores. (3) The student who has HIV infection or AIDS is unable to control gastrointestinal or urinary function thus possibly infecting those responsible for treating the child or cleaning the area. (4) The student who has HIV infection or AIDS is ordered by his/her attending physician not to attend school. b. Any student identified as having HIV infection or AIDS will be excluded from participating in any activity for which his/her attending physician writes a letter of excusal for the patient. c. Before a student with HIV infection or AIDS participates in an activity which might put him/her or another at risk, the parent of the infected student will be responsible for obtaining written medical approval from the infected student's physician and submitting a copy of that approval to the school principal. d. Students identified as having HIV infection or AIDS will be exempt from compulsory vaccinations if the patient's physician so advises. Employees 1. The provisions outlined in the Communicable Disease Policy shall be used to determine an employee's employment status. 2. In addition to the employee provisions outlined in the Communicable Disease Policy, the following provisions shall apply: a. Unless required by State or federal law, there will be no mandated HIV testing of employees or prospective employees. b. The Superintendent of schools may exercise the right to transfer an employee who has HIV infection or AIDS from a position currently held to another position without the loss of seniority or any other current benefits and without a reduction in salary. The employee may request a transfer at any time; however, such requests, if approved, may result in a demotion in rank, benefits or salary. c. In the event that the employee who has HIV infection or AIDS is unable to perform the duties required, the employee has the right to utilize any contractual benefits to which the employee is eligible. There will be no special provisions or employment benefits given to the employee who is identified as having HIV infection or AIDS. d. The employee's attending physician, with the patient's written consent, and the district's physician may be called upon to advise the Superintendent concerning the employee's health status as it relates to the tasks required and/or, after a prolonged absence from work, whether or not the employee may return to work. Educational Programs All personnel will participate in an AIDS in-service program which addresses problems related to AIDS education. New personnel shall receive such instruction as a regular part of their induction. Counselors and nurses shall attend at least one workshop every three (3) years which addresses the problems related to the special needs of AIDS patients. New pertinent information will be disseminated to all personnel. The elementary, middle school and high school health programs will be amended to insure that health classes provide AIDS information at least once at each of these levels. 1. The topic of AIDS will be presented in a variety of subject areas beginning with the third grade level. 2. A grade specific AIDS curriculum shall address such topics as drug abuse including intravenous abuse, homosexuality, and abstinence from sexual activity in addition to other related sex education topics. The school district will not be a dispensary of condoms unless required to do so by State or federal law. If necessary, sources of counseling from outside agencies will be provided to students and staff. Requests for sources of counseling and/or information will be held in strictest confidence in keeping with State and federal laws. Parents shall be advised, prior to the presentation, that an AIDS curriculum will be taught at the school. This curriculum will be available for review at the child's school. A student will be exempted from study of the AIDS curriculum upon written parental request.