Management and control of communicable diseases in schools and other child care settings: systematic review on the incubation period and period of infectiousness

Abstract

Background: Information on the incubation period and period of infectiousness or shedding of infectious pathogens is critical for management and control of communicable diseases in schools and other childcare settings.

Methods: We performed a systematic literature review (Pubmed and Embase) to identify and critically appraise all relevant published articles using incubation, infectiousness or shedding, and exclusion period as parameters for the search. No language, time, geographical or study design restrictions were applied.

Results: A total of 112 articles met the eligibility criteria. A relatively large number were retrieved for gastrointestinal diseases and influenza or respiratory syncytial virus, but there were few or no studies for other diseases. Although a considerable number of publications reported the incubation and shedding periods, there was less evidence concerning the period of infectiousness. On average, five days of exclusion is considered for measles, mumps, rubella, varicella and pertussis. For other diseases, such as most cases of meningococcal disease, hepatitis A and influenza exclusion is considered as long as severe symptoms persist. However, these results are based on a diverse range of study characteristics, including age, treatment, vaccination, underlying diseases, diagnostic tools, viral load, study design and definitions, making statistical analysis difficult.

Conclusions: Despite inconsistent definitions for key variables and the diversity of studies reviewed, published data provide sufficient quantitative estimates to inform decision making in schools and other childcare settings. The results can be used as a reference when deciding about the exclusion of a child with a communicable disease that both prevents exposure and avoids unnecessary absenteeism.

Keywords: Infectious diseases; Measles; Mumps; Pertussis; Rubella; Varicella.

Fig. 1

Flow diagram of the article selection process

Fig. 2

Summary measures for the incubation period, infectiousness and shedding period for measles by source. Legend: ▲: mean, ●: median, : minimum and maximum range, RB: Red Book, R2001: Richardson et al. (2001)

Fig. 3

Summary measures for the incubation period, infectiousness and shedding period for mumps by source. Legend: ▲: mean, ●: median, ▬ interval [quantitative measure around the central tendency (mean or medium) or qualitative (usually) measure as provided by the authors], : minimum and maximum range, RB: Red Book, R2001: Richardson et al. (2001), RG: The 2009 ‘Managing infectious diseases in child care and school. A quick reference guide’

Fig. 4

Summary measures for the incubation period, infectiousness and shedding period for rubella by source. Legend: ●: median, ▬ interval [quantitative measure around the central tendency (mean or medium) or qualitative (usually) measure as provided by the authors], : minimum and maximum range, RB: Red Book, R2001: Richardson et al. (2001)

Fig. 5

Summary measures for the incubation period, infectiousness and shedding period for varicella by source. Legend: ▲: mean, ▬ interval [quantitative measure around the central tendency (mean or medium) or qualitative (usually) measure as provided by the authors], : minimum and maximum range, RB: Red Book, R2001: Richardson et al. (2001)

Fig. 6

Summary measures for the incubation period, infectiousness and shedding period for meningitis by source. Legend: ▲: mean, ●: median, ▬ interval [quantitative measure around the central tendency (mean or medium) or qualitative (usually) measure as provided by the authors], minimum and maximum range, RB: Red Book, R2001: Richardson et al. (2001), RG: The 2009 ‘Managing infectious diseases in childcare and school. A quick reference guide’

Fig. 7

Summary measures for the incubation period, infectiousness and shedding period for pertussis by source. Legend: ●: median, ▬ interval [quantitative measure around the central tendency (mean or medium) or qualitative (usually) measure as provided by the authors], minimum and maximum range, RB: Red Book, R2001: Richardson et al. (2001)

Fig. 8

Summary measures for the incubation period, infectiousness and shedding period for hepatitis A by source. Legend: ▲: mean, ●: median, minimum and maximum range, RB: Red Book, R2001: Richardson et al. (2001), RG: The 2009 ‘Managing infectious diseases in child care and school. A quick reference guide’

Fig. 9

Summary measures for the incubation period, infectiousness and shedding period for influenza by source. Legend: ▲: mean, ●: median, ▬ interval [quantitative measure around the central tendency (mean or medium) or qualitative (usually) measure as provided by the authors], minimum and maximum range, RB: Red Book, R2001: Richardson et al. (2001), RG: The 2009 ‘Managing infectious diseases in child care and school. A quick reference guide’