Pediatr Infect Dis J 2001 Apr;20(4):380-91 Evidence base
of incubation periods, periods of infectiousness and exclusion policies for the
control of communicable diseases in schools and preschools.
Richardson M, Elliman D, Maguire H, Simpson J, Nicoll A.
Paediatric Infectious Diseases Unit, St George’s Hospital, St George’s Hospital Medical School, London, UK. martin.richardson@pbh-tr.anglox.nhs.uk
BACKGROUND: The optimal control of communicable diseases
requires accurate information on incubation periods, periods of infectiousness
and the effectiveness of exclusion. We collected the available evidence for a
wide range of infections and infestations and produced evidence-based
guidelines for their control in schools and preschools. METHODS: A thorough MEDLINE literature search
was conducted on the incubation period, period of infectiousness and
effectiveness of exclusion for 41 infections. The quality of the information
obtained was indicated by levels of evidence. The information was used to
produce guidelines on exclusion, and the recommendations were graded according
to the levels of evidence available. Grades A, B and C represented strongly,
reasonably and poorly evidence-based recommendations, respectively.
RESULTS: The quality of data obtained was highly variable.
Information on incubation periods was obtained for all 41 infections and was
generally of good quality. Information on periods of infectiousness and
effectiveness of exclusion was of a lesser quality and was found for only 11
and 4 conditions, respectively. There were 3 Grade A, 17 Grade B and 21 Grade C
recommendations on exclusion. Examples of exclusion periods include: 5 days for
chickenpox, measles, mumps, rubella, pertussis and scarlet fever; and 24 h from
the cessation of diarrhea for most gastrointestinal diseases In contrast to
existing guidelines exclusion was not recommended for school age children with
hepatitis A.
CONCLUSIONS: We have been able to present the best available
data on the incubation periods and periods of infectiousness of 41 childhood
infections. It was possible to produce strongly or reasonably evidence-based
guidelines on exclusion periods for approximately one-half of the infections.
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