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School Exclusion Times

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Doctors are often asked about incubation times for the common childhood infections, so that they can advise about attendance at school etc. Incubation times and infectivity (time when infectious) are variable so the following is only a guide. For a slightly more comprehensive list - see the HPA site referenced below the table.

Note: * = a notifiable disease (required by law to be reported to government authorities).

Disease	Incubation	Infectivity	Exclude Until	Comments
Adenovirus gastroenteritis	8-10 days	6-16 days	24 hours from last episode of diarrhoea or vomiting.	Exclude for 48 hours longer in children who are unable to maintain good personal hygiene.
Chickenpox	11-20 days	Up to 4 days before (usually only 1 day) to 5 days after. Cases often transmit before appearance of rash.	5 days from start of skin eruption.	Traditionally excluded until all lesions are crusted but no transmission recorded after day 5. Contacts with a weak immune system need prevention.
Campylobacter	1-10 days	Patients probably not infectious if treated and diarrhoea has resolved.	24 hours from last episode of diarrhoea.	Exclude for 48 hours longer in children who are unable to maintain good personal hygiene.
Conjunctivitis	3-29 days Mean = 8	While active (direct contact). Infective up to 2 weeks.	None.	Transmission more likely in young children by direct contact - very little data.
Fifth disease (slapped cheek)	13-18 days	30% in families. 10-60% in schools.	None - only likely to be infective before symptoms appear.	Avoid infection in pregnant women and people with a weak immune system.
Glandular fever	33-49 days	At least 2 months.	Person is well.	None.
Hand, foot and mouth disease	3-5 days	Up to 50% in homes and nurseries.	None - good hygiene helps.	Stool excretion continues for some weeks. Avoid infection in pregnant women.
Head lice	n/a	While harbouring lice.	No exclusions. (No evidence that exclusion of affected children has any effect on the spread.) Education is important.	Note need for treatment of cases and contacts shown to have head lice.
Hepatitis A	15-50 days	From 2 weeks before to 1-2 weeks after jaundice onset.	Children <5 yrs: 5 days from start of illness. Children >5 yrs: none.	Good hygiene needs emphasising.
Herpes simplex virus (cold sores)	1-6 days	While lesions are moist.	None.	Highly infectious, especially amongst young children. Avoid kissing.
Impetigo	Skin carriage 2-33 days before development of impetigo(strep).	High (strep). Low (staph). (Variable infectivity depending on causative bacteria.)	Until lesions healed or crusted (little firm evidence).	None.
Measles*	6-19 days	Highly contagious in non-immune population. A few days before to 6-18 days after onset of rash.	5 days from onset of rash.	Check immunisation. Risk of serious infection in people with a weak immune system (give preventative treatment).
Mumps*	15-24 days	10-29 days. Moderately infective in non-immunised population.	5 days from onset of swelling. Often not effective as transmission occurs before symptoms.	Outbreaks reported in vaccinated secondary school children.
Ringworm	Varies	Until lesions resolve.	None. Low infectiousness.	Good hygiene helps.
Rubella*	13-20 days	1 week before to approx. 4 days after onset of rash.	5 days from onset of rash.	Check all female contacts are immune.
Scabies	Varies	Until mites and eggs are dead.	24 hours of treatment.	Risk of transmission is low in schools but outbreaks do occur. Close contacts should also be treated.
Scarlet fever*	1-3 days	Moderate within families. Low elsewhere. Infective first 3 days of treatment.	Suggest 5 days if treated (little evidence - epidemics used to occur).	Moderate within families. Low elsewhere.
Threadworms	n/a	Until all worms are dead.	None.	Good hygiene helps. Case and family contacts should be treated.
Tuberculosis*	n/a	Until 14th day of treatment.	Variable.	See 2nd Reference below.
Verrucas	n/a	None	Continue all activities. Query cover with a dressing.	Care needed with verrucas in swimming pools, gymnasiums and changing rooms.
Whooping cough*	7-10 days	Mainly early catarrhal stage, but until 4 weeks after onset of cough paroxysms. Shorten to 7 days if given antibiotics.	5 days if given erythromycin or azithromycins, otherwise >3 weeks.	Check immunisation of contacts. Highly infectious in non-immune populations.

References

Guidelines on control of communicable diseases in schools and nurseries, Health Protection agency (2006)
BTS Guidelines; Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000. Joint Tuberculosis Committee of the British Thoracic Society. Thorax 2000;55:887-901.

Comprehensive patient resources are available at www.patient.co.uk

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
© EMIS 2009 Reviewed: 25 Sep 2009 DocID: 653 Version: 2

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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