Outbreaks (Child Care Manual)

Children and staff at your child care centre will experience some infectious diseases no matter how careful you are. It’s important that your staff and parents know in advance of an outbreak what these illnesses could be and what to do.

Awareness and identification
Roles and responsibilities
Gastroenteritis outbreak
Enteric outbreak kit
Respiratory outbreak

Awareness and Identification

Early awareness and action is critical in managing an outbreak at your child care centre:

Keep a daily log book to know if there's an increase in illness at the centre
Call Public Health when several children and / or staff become ill on the same day or successive days. Any delay can have an impact on managing the outbreak and collecting specimens.
Refer to your centre's written policies and procedures
Follow proper infection prevention and control measures
Active screening is not required, unless specified in your centre's policy. Children and staff should self-screen each day before attending the child care centre.

Identify a potential outbreak

Consider any of the following as a potential outbreak:

Significantly more cases of the same or similar illness among children and staff than normally expected
For gastroenteritis cases: two or more children and / or staff are suffering from vomiting and / or diarrhea, within a 48 hour period and within the same area of the child care centre (such as three cases within the toddler room)
For respiratory cases: three or more children and / or staff are suffering from respiratory signs / symptoms, within a 48 hour period and within the same area of the child care centre (such as three cases within the toddler room)
A diagnosed Disease of Public Health Significance in a child or staff member

Roles and Responsibilities

Public Health

Recommend measures for outbreak infection prevention and control
Conduct on-site inspections when an outbreak is declared
Inform staff about the specific illness or disease of public health significance
Collected stool specimens may be submitted to Public Health for laboratory testing to identify a possible cause for the illness
Help to identify children and staff considered susceptible to infection, such as those unimmunized for certain diseases
Provide information for parent(s) / caregiver(s)
Provide information on medications and / or immunization for contacts when appropriate

Child Care Centre

Follow recommendations provided by Public Health
Report changes or provide updated information about the outbreak on a daily basis, such as line list
Provide information to the families of children attending the centre

Gastroenteritis Outbreak

A gastroenteritis outbreak may be in effect when there are two or more children and / or staff suffering from vomiting and / or diarrhea, within a 48 hour period and within the same area of the child care centre (such as three cases within the toddler room)

Typical symptoms of gastroenteritis:

Diarrhea
Bloody diarrhea
Vomiting
Nausea
Stomach cramps
Fever (above 37.8 Celsius)
General irritability
Headache

Managing a gastroenteritis outbreak

Step 1: Call Public Health at 905-688-8248 or 1-888-505-6074 ext. 7590

Step 2: A Public Health nurse will review general outbreak infection prevention and control measures and work with you to develop a case definition. A case definition identifies who is added to the line list. Public Health will assign an outbreak number.

Step 3. Create a line list. A line list identifies the number of new cases each day, including children and staff.

List all ill persons who meet case definition chronologically in order of when the illness started
Complete all information required on the line list. You may have to contact the parent(s) / caregiver(s) to obtain accurate information.
Record those that may have been part of the outbreak and are not present at the centre and those that are admitted to hospital
Do not record the same ill person more than once
Update the line list daily and report new information to Public Health
Do not remove names of resolved cases from the line list; simply add each new case to the existing line list
Email an updated line list daily to Public Health at outbreak@niagararegion.ca

Step 4: Review and implement outbreak infection prevention and control measures in your facility

Post outbreak signs at entrances and in the affected area. Signs are provided by Public Health.
Provide communication to parent(s) / caregiver(s), such as email, letters and communication board
Inform outside agencies that use the child care centre of the outbreak
Separate ill children from well children and arrange for prompt pick up
Minimize the movement of children and staff between age groups and rooms where possible
Reinforce the importance of hand hygiene with staff and children
Review the importance of proper glove use when toileting and diapering children with staff. Glove use should not be used as a substitute for proper handwashing.
Initiate enhanced environmental cleaning and disinfection. Procedures will be reviewed by Public Health during the site visit:

All toys and high contact surfaces should be cleaned and disinfected daily
Use of a broad spectrum virucide is recommended for the disinfection of toys, change tables and high contact surfaces. Examples of high contact surfaces include counters, doorknobs, light switches, toilet handles, sink tap handles, hand rails, electronics (cell phones, tablets, iPads, head sets, gaming devices, remotes), tables, chairs, etc.
Inform outside cleaning companies about the outbreak and review cleaning / disinfecting products and practices
Soiled diapers and clothing must not be rinsed or washed at the centre. Soiled diapers and clothing should be emptied into the toilet, placed in a securely tied plastic bag and sent home with parent(s) / caregiver(s).

Exclude symptomatic children and staff until they are symptom-free for 48 hours (exclusion period may vary based on cause of illness); this includes being fever-free without the use of fever reducing medicine for 24 hours before returning to child care.
Suspension of activities:

Activities between children should be limited to the same age group / room (i.e. cohorting)
Visitation from outside people / groups should not be permitted
Discontinue group outings, including field trips
Suspend sensory play, such as wet / dry sensory tables, sand boxes and play dough

Inform parent(s) / caregiver(s) with new child enrolments of the outbreak
Staff should only work at the outbreak centre, not other child care centres. If asymptomatic and they choose to work at another centre, they must wait 48 hours after working at the outbreak child care centre.

Step 5: A Public Health inspector will visit your facility for an inspection

Step 6: Collect specimen(s)

In order to identify the source of a gastroenteritis outbreak, it's important to collect stool, water and / or food specimens
Encourage parents to speak with their child's doctor about collection of stool specimens
If requested, Niagara Region Public Health will deliver (and pickup) stool specimen kits to the individuals home (child or staff). If a parent or staff is requesting a stool specimen kit, notify your public health nurse.

Food samples

Food samples should be kept on hold and accumulated for the duration of the outbreak. If there's a suspected link between the outbreak and the food, food samples will be submitted to the Public Health laboratory for analysis.

Declaring a gastroenteritis outbreak over

Public Health shall declare whether an outbreak is over in consultation with the child care centre. The Medical Officer of Health retains the final authority to determine if an outbreak is over.

The outbreak may be declared over when certain criteria are met. The end of an outbreak is determined on a case-by-case basis and varies by micro-organism, but is often set at 48 hours after the last symptomatic child or staff (from the affected area) last attended the child care centre.

Respiratory Outbreak

A respiratory outbreak may be in effect when there are three or more children and / or staff suffering from respiratory signs / symptoms, within a 48 hour period and within the same area of the child care centre (such as three cases within the toddler room)

Typical symptoms of respiratory illness are:

Fever (above 37.8 Celsius)
Cough
Shortness of breath
Runny nose
Sore throat
Congestion (nasal and / or chest)
Generally unwell / fatigue
Gastrointestinal symptoms (nausea / vomiting / diarrhea / abdominal pain)
Headache
Pink eye
Decreased or lack of appetite
Decreased sense of smell or taste
Joint or muscle pain

Managing a respiratory outbreak

Step 1: Call Public Health at 905-688-8248 or 1-888-505-6074 ext. 7590

Step 2: A Public Health Nurse will review general outbreak infection prevention and control measures and will follow-up with an email summarizing the recommendations

Step 3. A Public Health inspector will visit your facility for an inspection

Step 4: Review and implement outbreak infection prevention and control measures in your facility

Post outbreak signs at entrances and affected area. Signs are provided by Public Health.
Provide communication to parent(s) / caregiver(s), such as email, letters and communication board
Inform outside agencies that use the child care centre of the outbreak
Separate ill children from well children and arrange for prompt pick up
Minimize the movement of children and staff between age groups and rooms where possible
Encourage respiratory etiquette, such as covering coughs and sneezes, and use of tissue
Reinforce the importance of hand hygiene with staff and children
Initiate enhanced environmental cleaning and disinfection. Procedures will be reviewed by a Public Health inspector during the site visit:

All toys and high contact surfaces should be cleaned and disinfected daily
Use of a broad spectrum virucide is recommended for the disinfection of toys, change tables and high contact surfaces. Examples of high contact surfaces include counters, doorknobs, light switches, toilet handles, sink tap handles, hand rails, electronics (cell phones, tablets, iPads, head sets, gaming devices, remotes), tables, chairs, etc.
Inform outside cleaning companies about the outbreak and review cleaning / disinfecting products and practices

Exclude symptomatic children and staff until:

They have no fever (without the use of fever reducing medications) for 24 hours before returning to the child care facility and
Their other symptoms are improving for 24 hours (48 hours if they have gastrointestinal symptoms like nausea, vomiting or diarrhea)

Visit Community Guidance on Self-Isolation for the most up-to-date recommendations on who needs to isolate and for how long as well as information for close contacts of an individual who has COVID-19 symptoms or tests positive for COVID-19
Suspension of activities:

Activities between children should be limited to the same age group / room (i.e. cohorting)
Visitation from outside people / groups should not be permitted
Discontinue group outings, including field trips
Suspend sensory play, such as wet / dry sensory tables, sand boxes and play dough

Inform parent(s) / caregiver(s) with new child enrolments of the outbreak
Staff should only work at the outbreak centre, not other child care centres. If asymptomatic and they choose to work at another centre, they should wait three days after working at outbreak child care centre.

Step 5: Public Health will not be actively managing the outbreak but is still available for support. If there are any questions about the outbreak, call Environmental Health at 905-688-8248 or 1-888-505-6074 ext. 7590 or connect with your area Public Health inspector.

Declaring respiratory outbreak over

The child care centre is responsible for declaring the respiratory outbreak over. The outbreak may be declared over after five days from the last day a symptomatic child or staff (from the same area of the child care centre) attended the centre.

Last updated: October 2023