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
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)
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).
Ø Sharing airspace with the infected person (same room, car, hallway, cafeteria, bus,
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
• 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
• 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