One of the things that the coronavirus pandemic has achieved is that parents understand that in the event of a certain illness their children must stay at home to avoid contagion from their peers , which in the case of the coronavirus is ten days from the onset of symptoms or from the test that diagnoses the infection (antigen test or PCR).
However, these quarantines that have been imposed on these children and adults during the last year and a half are not something strange or unknown to pediatricians, since there have always been a series of diseases for which children must stay at home in a attempt to reduce the possibility of contagion to their classmates: this is what is known as school exclusion diseases.
Now that a new course begins, it is worth reviewing this topic so that in the following months you have no doubts as to why with some diseases your children should not go to school or nursery school, while with others, to Although they can infect, it is not necessary to serve a period of school exclusion beyond the time during which they are with fever or malaise.
The periods of contagion of a disease
One of the great advances in medicine, specifically in microbiology and infectious diseases, is to know for how long a patient can infect other people when they have an infection , and that is known as the period of transmissibility of the infection. For some diseases, this period begins even before symptoms appear, in other cases it can last for months even though the patient is already recovered, although in most diseases it is usually a period of a few days after the onset of symptoms.
Knowing the time in which a disease can be transmitted from a sick person to a healthy one is very important, because when we recognize a disease and we know for how long it is contagious, it is very easy to tell the child or adult to stay home during those days .
The problem arises when after the acute period of the disease, that is, when they no longer have symptoms, the patient can continue to infect for weeks or months. In these cases, it is not very logical to say to parents’ look, since your child can spend five or six months excreting the virus in feces that has given him fever and spots on the skin, it is better that you take him out of school this the next course ‘, even knowing that it is possible that when joining one of his colleagues.
In the same way, as we will see later, there are infections that are only spread during the incubation period and that when the child begins with symptoms they will no longer be able to spread. In these cases, as you will also understand, the child can continue with his school activity if he is well even if he has any symptoms.
Unfortunately, there is no official document of the periods of school exclusion by the Ministry of Health or the various health ministries of the Autonomous Communities. What does exist are lists in which pediatricians have turned our knowledge to have a reference of whether a child should stay at home when they are infected with a disease and for how long .
The one we like the most to consult is the ABE Guide , belonging to the Infectious Pathology Group of the Spanish Association of Primary Care Pediatrics. If you enter it, you will see that it is a very long and cumbersome list to understand, so if you agree, we will comment on some of the most frequent diseases that do require school exclusion and which ones do not.
Diseases that ARE school exclusion
Chickenpox: although in Spain it is already very difficult for us to see cases of chickenpox thanks to vaccination, this disease is the paradigm of infection that requires school exclusion . We know that it is contagious from a few days before the symptoms begin (and therefore it is easy that if the child goes to school there are several children who become infected) until all the spots on the skin are crusted, which is usually occur around 7-10 days after the onset of the rash. That is why in these cases we tell the child to stay home until he sees that all the skin lesions are dry , because we know that even if there is still some mark left, it is no longer contagious.
Scarlet fever (or streptococcal angina, which is the same in the case): this disease is caused by a bacterium, its treatment consists of 10 days of penicillin, but we know that once the antibiotic treatment has been started, at 24 hours the child no longer contagious . So if you feel good and that period of time has passed, you could go back to school even if you are still taking antibiotics.
Acute gastroenteritis: there are many gastroenteritis since there are many viruses and bacteria that can cause them. Their period of contagion varies greatly from one to another, but most are transmitted very easily while the child has diarrhea. Therefore, in case of gastroenteritis, it is recommended that they do not go to school until after 24-48 hours without symptoms .
Impetigo : this skin disease is caused by bacteria and is contagious, so it is recommended that the child does not go to school until the lesions heal or after 48 hours with antibiotic treatment .
Whooping cough : this disease occurs with a cough in attacks that end in rooster and sometimes a low-grade fever. His treatment is an antibiotic for 5 days, the time it takes for the disease to stop being contagious . In this case, after completing the antibiotic regimen, they could return to school even if they continued to cough, since the cough can last for several weeks, although the child is no longer contagious.
Diseases that are NOT school exclusion
The rest of common illnesses that you can imagine are not of school exclusion, that is to say the majority. I know this will shock many of you who read us, but let me explain them with some examples.
Foot-hand-mouth : this disease causes spots on the skin and sometimes fever and is very typical of nursery schools. When a child is infected, it is very likely that all his companions will end up infected. Its form of contagion is by contact with the secretions and feces of the patient because in these fluids it is where the virus that causes it floats , a coxsackie of the enterovirus family.
After overcoming the disease, the patient can spend several weeks excreting this virus in feces, which makes it impossible to know when it stops spreading . For this reason, this disease is not considered school exclusion, as long as the child is well and does not have a fever, since it is impossible to know when it is safe to go back to school and not infect.
Kissing disease or mononucleosis : this disease is caused mainly by two viruses, the Epstein-Barr virus and the Cytomegalovirus. The first of them is transmitted by respiratory secretions and saliva and the second, also, by urine. Again, as in the hand-foot-mouth, the period of transmission of these viruses can last several months after the acute period of the disease, so we cannot know how long we should separate a child from school to that when we return we would know with exact science that it is no longer contagious .
Molluscum contagiosum : many of you will know that this is a skin disease that gives rise to a kind of warts caused by a virus and that is transmitted by direct contact with the lesions. It is not known for how long these injuries can spread, so it does not seem reasonable to prohibit the child from going to school indefinitely .
Slap disease (or fifth disease or infectious erythema) : caused by Parvovirus B19. This disease is only contagious during the incubation period of it, so when the child gets the spots that resemble a couple of slaps on both cheeks, which is the moment in which we can diagnose the disease, there is no longer Danger of contagion, so the child does not have to go through a period of exclusion from school.
And what do we do with a child who only has a fever or snot?
Perhaps the most difficult thing is to understand what we should do with a child who is sick, with fever, cough, snot …, come on, what has been a typical childhood respiratory infection and how frequently it occurs when they go to nursery school.
Most of these diseases are caused by respiratory viruses, such as rhinovirus, adenovirus or RSV, and in most cases the symptoms they cause are mild: some cough and mucus and a couple of days of fever. The period of transmission of these diseases is highly variable, but above all it is grouped around the days when children have more symptoms .
Therefore, it seems reasonable for children to stay home while they have symptoms that interfere with their daily school activity (if they have a fever or have a lot of cough and a lot of mucus), but not only to avoid contagion, but because a child who is unwell You should not go to school where it is difficult to monitor if among 20-25 other children your general condition worsens or ask you to act normally while you have a fever.
We know that during the first years of schooling, children spend almost more time with fever or colds than without symptoms, and that if we leave them without going to class during those periods, they will stay at home longer than at school. . And we also know that this collides with the family and work conciliation, but from the medical point of view we cannot recommend that a child who is in full effervescence of symptoms attend class .
In summary, some contagious diseases do not have a period of school exclusion beyond the time that the symptoms of the same last, while in other cases a specific time is imposed in which children should not go to school or school. In any case, if you have doubts, we are convinced that your pediatrician will be happy to tell you how long your child should stay at home.