Communicable Disease Policies

Standards of Practice for Exclusion from School - Signs & Symptoms

The primary role and consideration for the School Nurse in excluding a child from attendance is the probability of spreading disease among the school students and personnel.

Students with the following signs and symptoms are to be excluded from school attendance until they are symptom-free for 24 hours or they are seen by a physician with written information that the condition is, is currently under treatment, or is no longer contagious and able to return to school.

fever with oral equivalent of 100.0
persistent vomiting (at least two episodes)
diarrhea – 2 or more watery or loose stools, with or without fever
skin rashes that are associated with fever or any drainage (with or without being postulant)
red eyes that include red conjunctiva with crusting purulent discharge
persistent productive cough that produces bloody sputum
any open draining lesion
jaundice

Other signs and symptoms will be assessed individually by the school nurse and may result in exclusion from attending class.

nasal discharge that is green or yellow
incontinence of feces or urine
skin rashes of undetermined origin

The school nurse will make the decision to exclude a student based on the risk of disease spread, risk to the student themselves, medical history of student, or if it is determined the student is too ill to remain at school.

EXCLUSIONS FROM SCHOOL

A student may return to school after being excluded for communicable disease by submitting a physician’s note stating the student does not currently have signs and symptoms of a communicable disease or that the disease in not communicable in a school setting (25 Texas Administrative Code §97>7(d) or by readmission criteria established by the commissioner of health (spelled out below). The criteria for exclusion and re-admission for communicable conditions are listed below and can be found at 25 Texas Administrative Code §97.7(b).

Amebiasis: Exclude until treatment is initiated.
Campylobacteriosis: Exclude until after diarrhea-free for 24 hours without the use of diarrhea-suppressing medications and fever-free for 24 hours without the use of fever-suppressing medications.
Chickenpox: Exclude until the lesions become dry or if lesions are not vesicular until 24 hours have passed with no new lesions occurring.
Common cold: Exclude until fever-free for 24 hours without the use of fever-suppressing medications.
Conjunctivitis, bacterial and/or viral: Exclude until permission and/or permit is issued by a physician or local health authority or until symptom-free.
Coronavirus disease 2019: Exclude and readmit based upon guidance from the Department of State Health Services on its website at https://dshs.texas.gov/covid19readmission.
Fever: Exclude until fever-free for 24 hours without use of fever-suppressing medications.
Fifth disease (erythema infectiosum): Exclude until fever-free for 24 hours without the use of fever-suppressing medications.
Gastroenteritis: Exclude until diarrhea-free for 24 hours without the use of diarrhea-suppressing medications.
Giardiasis: Exclude until diarrhea-free for 24 hours without the use of diarrhea-suppressing medications.
Hepatitis A: Exclude until one week after onset of illness.
Infections (wounds, skin, and soft tissue): Exclude until drainage from wounds or skin and soft tissue infections is contained and maintained in a clean dry bandage; restrict from situations that could result in the infected area becoming exposed, wet, soiled, or otherwise compromised.
Infectious mononucleosis: Exclude until a physician decides or fever-free for 24 hours without the use of fever-suppressing medications.
Influenza: Exclude until fever-free for 24 hours without the use of fever-suppressing medications.
Measles (rubeola): Exclude until four days after rash onset or in the case of an outbreak, exclude an unimmunized child for at least 21 days after the last date the unimmunized child was exposed.
Meningitis, bacterial: Exclude until 24 hours after the start of effective treatment and approval by a health care provider.
Meningitis, viral: Exclude until fever-free for 24 hours without the use of fever-suppressing medications.
Meningococcal infections (invasive disease): Exclude until 24 hours after the start of effective treatment and approval by a health care provider.
Mumps: Exclude until five days after the onset of swelling.
Pertussis (whooping cough): Exclude until completion of five days of appropriate antibiotic therapy, or until 21 days have passed since cough onset, whichever is earlier.
Ringworm: None, if the infected area can be completely covered by clothing or a bandage, otherwise exclude until treatment has begun.
Rubella (German measles): Exclude until seven days after rash onset or in the case of an outbreak, unimmunized children should be excluded until at least three weeks after the onset of the last rash.
Salmonellosis: Exclude until diarrhea-free for 24 hours without the use of diarrhea-suppressing medications and fever-free for 24 hours without the use of fever-suppressing medications.
Scabies: Exclude until treatment has begun.
Shigellosis: Exclude until diarrhea-free for 24 hours without the use of diarrhea-suppressing medications and fever-free for 24 hours without the use of fever-suppressing medications.
Streptococcal sore throat and scarlet fever: Exclude until 24 hours from the time antibiotic treatment was begun and fever-free for 24 hours without the use of fever-suppressing medications.
Tuberculosis disease (suspected or confirmed), pulmonary or laryngeal: Exclude until antibiotic treatment has begun and a physician's certificate or health permit is obtained.
Typhoid fever: Exclude until diarrhea-free for 24 hours without the use of diarrhea-suppressing medications and fever-free for 24 hours without the use of fever-suppressing medications; and 3 consecutive stool specimens have tested negative for Salmonella Typhi.

Additionally:

The school administrator shall exclude any child having or suspected of having a communicable disease designated by the Commissioner of the Department of State Health Services as cause for exclusion until specific criteria are fulfilled. Any child excluded for reason of communicable disease may be readmitted by submitting a certificate of the attending physician, advanced practice nurse, or physician assistant; submitting a permit for readmission issued by a local health authority; or meeting readmission criteria as established by the commissioner.