Chicken Pox protocol

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					                                 Health Services Department
                                 Northampton Public Schools
                                         380 Elm St.
                                  Northampton, MA 01060

Protocol for Exclusion of Susceptible Students and Staff after Exposure to Varicella

Goals:           To limit the spread of chickenpox (varicella) in the schools.
                 To increase immunity to the varicella virus through vaccination.

Objectives:      Exclude any susceptible students or staff after exposure to varicella
                 Inform staff and parents when a case of varicella is reported
                 Provide information to staff and parents about the exclusion regulation,
                 proof of immunity, the risks of varicella, and the availability of the varicella
                 vaccine.

Prior to the first case being reported the school nurse should do the following.
• Identify the students and staff who are susceptible. For students, immunization record
   review, for staff use letter to school staff and substitutes (Varicella exclusion regs, memo to staff)
   Susceptible means;
   Ø Has never had varicella
   Ø Has never received the varicella vaccine
   Ø Has never had an antibody test that indicates they have had the varicella virus or
       have had the test and it shows they are not protected.
       (To document having had the disease; for students, written documentation from an
       MD is required, for staff a verbal history of having had the disease is sufficient).
• Encourage these susceptibles to either have the vaccine or an antibody titer to
   determine if they actually are already immune. The school physician is willing to
   administer the vaccine to staff members who are not able to see their own health care
   provider. Remember that to avoid exclusion this vaccine must be administered within
   five days of the last exposure.
• The school nurse will send a letter to the parent/guardian of each student with a
   medical or religious exemption at the beginning of every year stating that they will be
   excluded if there is a case of chickenpox (Varicella, letter to exempted students’ parents)
• When there is no documentation the school nurse will send a letter requesting this
   documentation and explaining the exclusion regulation. (Varicella, no documentation)

When a case of varicella is reported the school nurse will do the following
• Determine if there was any contact among the infected student and the susceptibles
  during the contagious period (@ 2days before the rash appears and 5 days after).
  Contact means;
  Ø Sharing airspace with the infected person (same room, car, hallway, cafeteria, bus,
      etc.).
  Ø Contact with the varicella lesions.
• Inform all staff in the building that a case of varicella has been reported.     (over)
•    Inform all susceptibles who were determined to have contact that they will be excluded
     from day 10 through day 21 following the last exposure. (Varicella exclusion document, parents
     and staff)
•    Inform all susceptibles who did not have contact that there has been a case in school.
     (Varicella, one case, letter to exempted students’ parents)
•    Inform all susceptibles who may be pregnant or immunocompromised that they should
     contact their health care provider immediately.
•    Staff who must be excluded may use sick time, personal time, or vacation time.
•    Inform all susceptibles that they can avoid exclusion by taking the following measures.
     Ø Receive the varicella vaccine within five days of their last exposure to the virus.
     Ø Have an antibody test to determine if they actually have immunity to the varicella
          virus. (Written proof of this test to be submitted to the school nurse. If the test is
          positive they are not susceptible).
•    Provide information to parents and staff regarding the risk of complications from the
     varicella virus and the rationale for immunization. While the most important rationale
     for receiving the vaccine is to provide immunity against the wild virus and thus avoid
     the potentially serious consequences, research has also shown a 3 to 4 fold lower
     incidence of shingles in people who were vaccinated compared to those having the
     natural disease. Immunization also prevents the spread of the disease and protects those
     who cannot get vaccinated or those who are vaccine failures. (Varicella, CDC, FAQs)
•    If parents or staff ask about intentional exposure to someone with chickenpox the
     school nurse will explain that the potential for serious consequences of the disease is
     the reason for the varicella vaccine requirement for school entry and the exclusion
     regulation.
•    Notify the Northampton Board of Health and the Director of Health Services.
•    In addition, the DPH Division of Epidemiology recommends that any cases with
     unusual presentations or severe complications also be reported directly to the DPH at
     617-983-6800. Examples of such cases are, immunocompromised cases, outbreaks
     involving adolescents and adults, outbreaks among vaccinated populations, outbreaks
     in childcare centers with infants, outbreaks in other high-risk institutional settings.

Varicella protocol, 12/03