Public Health and Education Data Analytics Online Course

Part 1I: Prevention of Infectious Diseases

Module 5: Management of Infectious Diseases

Module 5: Management of Infectious

Diseases
Objectives:
1. The learner should be able to recognize some of the common infectious diseases
that may present in the school setting
2. The learner should be familiarized with the early detection and community/school
management of students the aforementioned infectious diseases
3. The learner should be able to recognize urgent signs for immediate referral/red flags
for students with infectious diseases seen in the school setting.

5.1 Review: What are some of the common infectious

diseases that affect Filipino children?
The previous module discussed some of the common infectious diseases that affect
Filipino children. It is important to remember that children may fall sick in one setting,
be it the school or the community, but management of their illnesses requires
coordination in all the settings a child may be moving in. Thus, it is important for
school health providers to communicate with parents and caregivers regarding the
health of students seen at the school clinic.
Some of these infectious diseases are:
1. Acute diarrhea: Diarrhea lasting less than 7 days, may be bloody or watery in
character. May be caused by viruses, parasites or bacteria, priority is to
prevent dehydration
2. Acute respiratory tract infections: Present as fever, cough, runny nose, difficulty
of breathing, may require emergency care for very young or very ill patients
especially if pneumonia is considered
3. Tuberculosis: Bacterial infection that can cause cough, fever, weight loss, and
night sweats, usually affects the lungs but can spread to other parts of the
body. Not all children present with TB symptoms, even if they will have a Commented [BA1]: We can also mention that not all
positive result on diagnostics such as the TB skin test. Therefore, it is always children present with symptoms. In the absence of
important that children with family members or close contacts who have TB symptoms, usually the only sign of TB infection is a positive
reaction to the TB skin test which is considered safe in
should be screened. children. Hence, a history of TB in the family/household and
TB skin testing could be ways children can be screened.

Module 5: Management of Infectious Diseases 43

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School Reopening
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development through
All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001
Public Health and Education Data Analytics Online Course
Part 1I: Prevention of Infectious Diseases

Module 5: Management of Infectious Diseases

Figure 1: Positive TB Skin Test Result

Source: [Link]

4. Measles, Rubella, Mumps, and Chickenpox: Viral diseases that present with fever
and rashes. All of these are vaccine preventable. Measles has the potential to
cause epidemics and is considered a disease of concern from a surveillance
standpoint. Rubella may cause congenital anomalies in children born to
mothers who had rubella in pregnancy. Mumps presents with a characteristic
swelling of the cheeks and the salivary glands. Chickenpox has a vesicular rash
that causes intense itching.

Figure 2: Chickenpox rash

Source: [Link]

5. Dengue: Mosquito-borne disease that causes fever, headache, and joint pain,
may cause shock or hemorrhage in complicated cases.
6. Skin Infections: Caused by bacteria, viruses, or fungi, and may show up as
rashes, redness, swelling and crusting wounds such as in the case of impetigo.

Module 5: Management of Infectious Diseases 44

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School Reopening
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development through
All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001
Public Health and Education Data Analytics Online Course
Part 1I: Prevention of Infectious Diseases

Module 5: Management of Infectious Diseases

Many mild skin infections may be managed with creams/ointment. More

severe cases may require oral antibiotics or hospitalization.
Figure III: Skin infection known as impetigo on the face of a child

Source: [Link]
7. Conjunctivitis: Caused by bacteria, viruses, or allergies. Children may present
with painful, red eyes, sometimes with thick or watery discharge. Infectious
conjunctivitis can easily be spread among children in a crowded area,
especially when hygiene practices are not followed.
8. Soil-Transmitted Helminthiasis: Caused by several specific types of intestinal
worms, may cause malnutrition, anemia, and intestinal obstruction. Children
may have distended bellies, loss of appetite and abdominal pain, and may also
present with signs of malnutrition.

These diseases, as well as other infectious illnesses, can cause serious problems in the
school setting. Crowding, poor hygiene practices, and the tendency to still send
children to classes despite the child being sick can also contribute to the spread of
contagious diseases in a school.

Check-in Question: Of these diseases, which of these is most notable for

causing epidemics, and thus is a cause of concern for surveillance?
a. Conjunctivitis
b. Mumps
c. Measles
d. Acute diarrhea

Module 5: Management of Infectious Diseases 45

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School Reopening
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development through
All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001
Public Health and Education Data Analytics Online Course
Part 1I: Prevention of Infectious Diseases

Module 5: Management of Infectious Diseases

5.2 How are infectious diseases detected in the school

setting?
Most contagious illnesses present with non-specific signs and symptoms such as fevers
and body malaise/discomfort. It is important for teachers and staff to be observant and
responsive so that they can quickly pinpoint learners who should be urgently referred
to the school clinic for evaluation and management.
Some early signs and symptoms of infectious diseases in children include:
• Fever. This is defined as having a body temperature above 38°C in most
healthy individuals, although normal temperature may vary depending on the
child
• Cough and colds, with or without phlegm
• Sore throat, with or without accompanying hoarseness or painful swallowing
• Red eyes with or without discharge
• Nausea and vomiting
• Diarrhea
• Rashes
• Ear pain, with or without discharge
• Headache
• Abdominal pain
• Sudden loss of appetite
• Unusual lethargy. The child may be quieter than usual in the classroom or
refuse to join in activities or play
Some of these are also signs and symptoms of non-infectious diseases. However, since
these ailments can point to any number of causes, it is important to refer all children
who fall ill in school to the school clinic or health services.

5.3 What can the school clinic do to manage students,

teachers, and staff with these infectious diseases?
There are several important steps to consider when managing persons within the
learning community who fall ill on school premises or during school activities.
These include:

1. ISOLATION: Students, teachers, and staff members who feel ill should
immediately be pulled out of regular class/school activities for the day.
They should isolate, rest, and be monitored in the school clinic or in a
designated well-ventilated area until they can either go home or be
referred to another health facility for definitive care. Older children with
respiratory symptoms should be given a fresh face mask to wear while in

Module 5: Management of Infectious Diseases 46

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School Reopening
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development through
All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001
Public Health and Education Data Analytics Online Course
Part 1I: Prevention of Infectious Diseases

Module 5: Management of Infectious Diseases

isolation. Children and adolescents should only be released to their

parents/guardians/designated caregivers to ensure their safety as well as
ensure that they will head straight home after school. It is important that
students, teachers, and staff members should stay home for the
duration of their illness, to avoid further spread of any contagious
diseases.

2. SYMPTOMATIC MANAGEMENT/PRIMARY CARE: School clinic staff such

as physicians and nurses are equipped to provide remedies to help ease
symptoms of most common illnesses in the school setting. These may
include administering medications for pain and fever as well as oral
rehydration in cases of nausea, vomiting, and diarrhea. The school clinic
must provide instructions to parents/caregivers for home care or facilitate
referral as needed.

3. GATHER INFORMATION: With the help of teachers and other staff, the
school clinic or health service must gather the following information:

1. WHO has fallen sick – and how many have been affected? Are there
any persons involved/in the same setting who have a higher risk
for severe illness due to comorbidities such as asthma, poor
immune systems, etc.?
2. WHERE have they fallen sick – are they in the same classes?
Sharing a common space? Participating in the same activities?
3. WHEN did the illness happen? Was the affected person already
feeling ill before entering the school?
4. WHAT HAPPENED BEFORE THE ILLNESS? Was the person taken
sick after consumption of any food or water? Was this associated
with any physical activity? If illness occurred during a field trip or
out of school activity, it is important to check for any exposures to
allergens, toxins, or other possible causes of sudden illness.

4. DEVELOP A COMMUNICATION PLAN: In cases where multiple

students/teachers/staff members have fallen ill, or if an outbreak is
already underway, it is important to communicate information properly to
the school community about the incident and the next steps to undertake.
This is also vital in preventing miscommunication, disinformation and

Module 5: Management of Infectious Diseases 47

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School Reopening
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development through
All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001
Public Health and Education Data Analytics Online Course
Part 1I: Prevention of Infectious Diseases

Module 5: Management of Infectious Diseases

“fake news” from circulating about the situation. Important messages to

convey include:
1. Guidance for parents and caregivers about keeping sick
children/adolescents at home, and seeking medical care at health
facilities
2. Emphasizing the steps taken to protect student and staff safety,
including additional precautions to be taken in the school
environment
3. Coordination with the local health authorities
(barangay/municipality/city) for community-based efforts in
disease management
4. Counter stigma and discrimination against affected students and
staff

Information and messages may be disseminated via written advisories, phone

calls, or other messaging services1.

Check-in Question: What questions must be asked when a student falls ill in
a classroom setting?
a. What time in the day did the student begin feeling sick?
b. Are the student’s seatmates or classmates experiencing the same
symptoms?
c. What did the student last eat?
d. All of the above

5.4 What are some signs or “red flags” for urgent referral
of students with infectious diseases?
Although many children’s infectious diseases are readily treated with home care,
or may even resolve on their own, there are some cases that require urgent or
emergency management at a hospital. It is crucial that school health staff facilitate
referral and coordinate transport of students and other members of the school
community who need this sort of care.

Some “red flags” or signs that an urgent referral is needed are:

1Michigan Department of Education. “Managing Communicable Diseases in Schools.”

Retrieved from:
[Link]
PDF

Module 5: Management of Infectious Diseases 48

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School Reopening
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development through
All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001
Public Health and Education Data Analytics Online Course
Part 1I: Prevention of Infectious Diseases

Module 5: Management of Infectious Diseases

• Trouble breathing characterized by wheezing, grunting with each

breath, fast breathing, or lips starting to turn blue
• Increasing or severe pain to the point that a child is not able to
walk or move
• Uncontrollable vomiting or diarrhea accompanied by signs of
dehydration: dry lips, non-elastic skin, sunken eyes, lethargy
• Greenish vomit (unless the student has recently consumed green
foods)
• Abdomen that is painful, bloated and hard to the touch
• Fever accompanied by a stiff neck
• A rash that is characterized by purple or blood red spots (also
known as petechial rash)
Figure IV: Petechial Rash

Source: [Link]
and-Trisomy-Sobotka-Deal/8dba0cea270b2e9b436547a63444fc7c8d6b5922

• Very high fever (40°C or above)

• Seizures
• Loss of consciousness or change in alertness

• Change in behavior such as irritability or inability to concentrate,

especially if the student has fever, ear pain or ear discharge

Students with these emergency signs must be sent straight to the

nearest tertiary hospital for further evaluation and treatment2.

2SeattleChildren’s Hospital. “Emergency Symptoms Not to Miss.” Retrieved:

[Link]

Module 5: Management of Infectious Diseases 49

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School Reopening
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development through
All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001
Public Health and Education Data Analytics Online Course
Part 1I: Prevention of Infectious Diseases

Module 5: Management of Infectious Diseases

Assessment Questions:
A teacher, Maritess, reports that one of her Grade 1 students Teresa has vomited
two times in the classroom after recess. When Teresa is brought to the school clinic,
she is irritable, feels hot to the touch and complains of nausea. She has a
temperature of 38.1 degrees Celsius.

1. What other questions should you ask Maritess about Teresa and her illness?
a. Was Teresa acting tired or lethargic before recess?
b. Was Teresa playing under the sun during recess?
c. Was Teresa fighting with other students during recess?
d. Both a and b

2. What next step/s would you advise Maritess to take regarding the rest of
Teresa’s classmates?
a. Let her classmates visit her in the clinic
b. Observe them carefully for any other symptoms
c. Keep all of them away from the other students in school
d. None of the above

3. The school clinic contacts Teresa’s family, but her mother says that no one is
available to fetch Teresa till the afternoon. What should be done?
a. Give Teresa money to commute home on her own
b. Ask a teacher to accompany Teresa home
c. Let Teresa stay in the clinic till her parents can come for her
d. Ask a neighbor to pick up Teresa from school

4. While in the school clinic, Teresa vomits several more times and complains
that she is dizzy. Her lips are dry and she looks pale. What should be the next
step/s?
a. Give Teresa more fluids in the clinic
b. Arrange for Teresa to be brought to the hospital, and inform her
parents of this plan
c. Give Teresa medicine to stop her from vomiting
d. Let Teresa rest in the clinic
5. The parents of Teresa’s classmates are now asking if there is COVID-19 in the
school since their children said that their classmate was very sick. What
messages should be conveyed to the parents?
a. All students who have fever and vomiting should not report to
school, and should instead receive medical attention

Module 5: Management of Infectious Diseases 50

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School Reopening
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development through
All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001
Public Health and Education Data Analytics Online Course
Part 1I: Prevention of Infectious Diseases

Module 5: Management of Infectious Diseases

b. The school is carefully monitoring the students to make sure that

illness will not spread in the school community
c. The school is already coordinating with the barangay to further
investigate the situation
d. All of the above

Module 5: Management of Infectious Diseases 51

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School Reopening
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development through
All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001