Ministry of Health

Clinical and epidemiological features, and prevention and control of selected infectious diseases of importance in child care centres/kindergarten/pre-schools/ student care centres

Infectious disease
Signs and symptoms
Incubation period*
Mode of
transmission
Infectious period
Prevention and control
Authority to be notified+
Remarks
Poliomyelitis Fever, muscle pain, headache, nausea, vomiting, stiff neck/back, flaccid limb paralysis. In severe cases: difficulty in swallowing, speech and breathing, confusion, fits and death. 7-14 days,
range
5-35 days.

 Faecal-oral, respiratory. A few days before and after onset of illness. 3 doses of trivalent polio vaccine at 3, 4, 5 months of age; booster dose at 18 months of age.
Yes
-
Chickenpox Fever 1-2 days, followed by skin eruption. Successive crops appear on the body (scalp, face, limbs, trunk, conjunctiva, mouth, seldom involving the palms and soles) in all stages – macules, papules, vesicles, pustules and scabs. 10-21 days. Respiratory, direct contact. 1-2 days before onset of rash and not more than 6 days after appearance of the first crop of vesicles.

Chickenpox vaccine is available for children >1 year of age.

Isolate all contacts with fever and rash at home.
Yes
Immune after one attack.
Rubella
(German measles)		 Fever, headache, malaise, cough, sorethroat, enlarged and tender glands at back of neck and behind ears for 1-5 days, followed by a fine maculopapular rash that starts on face and lasting for 3 days. Symptoms subside rapidly with onset of rash. 2-3 weeks, usually
16-18 days.		 Respiratory, direct contact. 1 week before to 4 days after onset of rash. Vaccination given together with measles and mumps (MMR) at 1 year of age. Second dose at 11+ years.

Isolate all contacts with fever and rash at home, and advise them to stay away from pregnant women.
Yes
Immune after one attack. A history of measles does not protect against rubella.
Diphtheria

Sore throat, fever, nasal discharge, hoarseness of voice, malaise. Greyish membrane forms in the throat and may lead to difficulty in breathing and swallowing. Enlarged lymph nodes in the neck.

 2-5 days. Direct contact. 2-4 weeks after onset of illness.

Vaccination with 3 doses of DPT (diphtheria, pertussis, tetanus) at 3,4, and 5 months of age. Booster dose at 18 months of age.
Immediately isolate suspected case(s) and seek medical attention.
Yes
Serious disease. Diphtheria vaccination is compulsory.
Meningitis May be preceded by a cold, headache, stiff neck, vomiting, high temperature with convulsions or drowsy stupor. Bulging fontanelle most significant sign up to age of 2 years. 2-10 days. Respiratory, direct contact. Until recovery.

Vaccination against the disease caused by some bacteria available.
Immediately isolate suspected case(s) and seek medical treatment.
Yes
Serious disease.
Hepatitis A Fever, headache, abdominal pain, nausea, diarrhoea, general weakness. Later, yellow discolouration of skin and white of eyes (jaundice), dark coloured urine dark and pale stools. Many cases may have very mild symptoms. 15-50 days. Faecal-oral. 2-3weeks before to 1 week after onset of jaundice. Practise good personal hygiene, avoid eating raw or partially-cooked shellfish e.g. cockles, clams, oysters. Hepatitis A vaccine not routinely given.
Yes
-
Hepatitis B Tiredness, mild fever, nausea, jaundice, dark coloured urine. Many cases have no or very mild symptoms. 30-180 days, usually
60-90 days.		 Parenteral, perinatal and sexual (contact with blood and body fluid). Many weeks before onset of symptoms to years after jaundice in chronic carriers. Vaccination with 3 doses at birth, 1 month and 5 months.
Yes
Serious disease as it can lead to liver failure and liver cancer.
Roseola High fever 3-5days, followed by rash or large pink blotches (which fades rapidly) covering whole body. Child may not seem ill despite the high fever (40°C) but he may have convulsion. Fever rapidly subsides with onset of rash. Uncertain. ?2 weeks. Unknown. ?Direct contact. Unknown.

No vaccine.

No special measures.
Yes
Common amongchildren aged 3 months-3 years. Immune after one attack. Disease may be mistaken for measles.
Whooping cough (Pertussis) Fever and cough which becomes paroxysmal within 1-2 weeks. Paroxysms characterised by repeated violent coughs, followed by high-pitched “whoop”. Vomiting often follows the attack. 6-20 days, usually
7-14 days.		 Nasopharyngeal secretion, direct contact, respiratory. 7 days after exposure to three weeks after onset. Vaccination in the form of DPT (diphtheria, pertussis, tetanus) is recommended. Booster dose at 18 months of age.
Yes
Disease occursmainly in preschool children; especially dangerous for children <1year.
Measles High fever, cough, running nose and conjunctivitis 3-4 days before onset of rash. Rash starts at hair line and spreads down in blotches, fades after 5 days, leaving a stain on the skin for days-weeks. Small red spots with white centre (Koplik’s spots) appear in mouth before the rash. With onset of rash, fever becomes higher and child appears more ill. 8-14 days. Respiratory, direct contact with secretions. From just before onset of symptoms to 4 days after onset of rash. Vaccination using the trivalent MMR (measles, mumps and rubella) vaccine recommended at one year of age. Second dose at 11+ years.
Yes

Can be a serious disease because of its complications.

Measles vaccination is compulsory.
Mumps Fever, malaise, headache for 2-3 days, followed by painful swelling of salivary glands behind the ears glands for 1 week. 12-25 days, usually
18 days.		 Respiratory. 1 week before to 10 days after onset of swelling. Vaccination using the trivalent MMR (measles, mumps and rubella) vaccine recommended at 1 year of age. Isolate every contact with fever at home.
Yes
-
Hand, foot and mouth disease Fever, painful, small ulcers in the mouth,, reddish pimple-like rash or small blisters on the hands and feet. Other symptoms include fever, running nose, cough, sorethroat, refusal to eat, increased salivation, vomiting and diarrhoea. 2-5 days. Direct contact, indirectly by articles contaminated by secretions. Throughout duration of illness. Isolate every child with symptoms at home. Practise good personal hygiene, disinfect contaminated toys, feeding bottles, teats and other personal items handled by an infected child.
Yes
 Seriouscomplications of heart and brain are rare.
Dengue fever Acute onset of fever (high and continuous) 2-7 days, headache, backache, muscle ache, generalised rash, bleeding manifestation (easy bruising, bleeding gums, nose, skin etc.). 3-10 days, usually
4-6 days.		 Bite of an infected Aedes mosquito. Within 5 days after onset of fever. Prevent mosquitoes from breeding by removing stagnant water.

Every other day:
• Change water in vase.
• Remove water in plant pot plates.
• Check premises for containers where rainwater can collect.
• Get rid of containers or store them upside down under shelter.
• Clear leaves and stagnant water in drains, roof gutters and garden.
Yes
 May be difficult to diagnose unless a blood test is done.

• Incubation period is the interval between exposure to the disease and onset of the first symptoms. For example, if a child has come into contact with someone with chickenpox, he does not develop any symptoms until 10-21 days later. The child should be closely observed during this period and isolated as soon as symptoms develop.


+ Director of Medical Services, c/o Communicable Diseases Surveillance, Ministry of Health (Tel: 1800-3258451; Fax: 62215528 or 62215538). As all notifiable diseases have to be diagnosed and confirmed by registered medical practitioners or scientists, it is their responsibility to inform the relevant authorities. Childcare centres are advised to notify Ministry of Community Development, Youth and Sports of outbreaks so that other centres may be alerted to watch out for similar symptoms.