school absence (guidance re: common infections)

Last edited 03/2020 and last reviewed 02/2023

Exclusion for five days (1,2):

• from rash onset - chickenpox*, measles
• from starting antibiotics - whooping cough (pertussis)
• from onset of swollen glands - mumps

German measles (rubella) (3)

• six days from onset of rash

Scarlet fever (3)

• child can return 24 hours after commencing appropriate antibiotic treatment
  • antibiotic treatment recommended for the affected child

Exclusion until condition has settled

• giardiasis - see linked item
• salmonella -see linked item
• shigella - see linked item

Exclusion until lesions crusted or healed

• impetigo
  • until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment (3)

Shingles (3)

• exclude only if rash is weeping and cannot be covered

Exclusion from school until treated

• scabies

With respect to hepatitis A:

• see linked item

With respect to gastroenteritis:

• NICE have stated that (4):
  • children should not attend any school or other childcare facility while they have diarrhoea or vomiting caused by gastroenteritis
    • children should not go back to their school or other childcare facility until at least 48 hours after the last episode of diarrhoea or vomiting
    • children should not swim in swimming pools for 2 weeks after the last episode of diarrhoea.

With respect to tinea capitis (fungal scalp infection):

• although the potential risk of transmission of infection to unaffected classmates has led some authorities to recommend exclusion from school - however mmost experts consider this impractical and suggest that children receiving appropriate systemic and adjunctive topical therapy should be allowed to attend school or nursery (5)

Conditions where there is no recommended period to be kept away from school (once the child is well):

• influenza; cold sores (HSV); molluscum contagiosum; ringworm (tinea); athlete's foot; roseola; slapped cheek disease (parvovirus); warts and verrucae; conjunctivitis; glandular fever; head lice; non-meningiococcal meningitis; thread worm; tonsillitis
• hand, foot and mouth disease

  • infected children should be kept away from school while they are unwell. The child should not be kept away from school till the last blister disappears, providing the child is well (6).

* note that guidance from Great Ormand Street Hospital suggests that chickenpox is infectious from a few days before the onset of the rash and not more than six days after first lesions appear (7)

• this guidance implies that school exclusion should be for six days from the onset of the rash and not five days as per DOH guidance

Reference:

• 1) Pulse (17/7/99), 15.
• 2) Department of Health (2005). Guidance on infection control in schools and nurseries
• 3) Health Protection Agency (April 2010). Guidance on infection control in schools and other childcare settings
• 4) NICE (April 2009). Diarrhoea and vomiting in children.
• 5) ) Fuller LC et al. British Association of Dermatologists' guidelines for the management of tinea capitis 2014. Br J Dermatol. 2014;171(3):454-63.
• 6) Health Protection Agency. Essex Health Protection Unit 2009. Factsheet on hand, foot and mouth disease
• 7) Institute for Child Health, Great Ormond Street Hospital for Children NHS Trust.