Foreword
Control of communicable disease is the legally designated responsibility of the Indiana State Department of Health (ISDH) and the local health department. Cooperation of schools, health departments, physicians, and parents is needed to control communicable diseases among school children.
Adequate immunization is fundamental to communicable disease prevention and control. The American Academy of Pediatrics, the Centers for Disease Control and Prevention (CDC), and ISDH recommend that all children be adequately immunized against diphtheria, pertussis, tetanus, measles (rubeola), rubella, mumps, polio, Haemophilus influenzae Type b (Hib), varicella, hepatitis B and pneumococcus by age two. Since immunization requirements frequently change, the school nurse should maintain ongoing contact with the local health department or ISDH to determine the current standards. You may contact the ISDH Immunization Program at (800) 701-0704 for current recommendations.
Control of communicable disease among school children requires careful observation and reporting of symptoms by all school personnel and parents to the school nurse or other designated health team member. When certain specific communicable diseases occur, the school nurse may advise the principal regarding notification of parents/guardians about school policies, length of communicability, symptoms, and care of the ill child.
This manual is designed as an easy reference for the school nurse to use when a question arises concerning a communicable disease. It is very important to follow up with the local health department when directed to do so. The local health department will perform appropriate public health follow up.
This manual highlights Indiana health laws applicable to schools. There may be other laws, both state and federal, relating to schools that could have additional implications.
This reference is intended only as guidance for use in Indiana schools. This manual is not intended as a substitute for timely evaluation by a health care provider. Children who may be seriously ill should always be referred for medical evaluation. School nurses are responsible for adopting their own policy and procedure guide that should be signed by a physician. This reference is not intended to serve as a policy and procedure manual, but rather as a resource for communicable disease information. For control measures of diseases or conditions not listed insofar as applicable, the procedures prescribed in the Control of Communicable Diseases Manual, 17th Edition, 2000, a publication of the American Public Health Association, shall be followed to the extent that they are not in conflict with the laws of Indiana. The local health department should be able to assist you in obtaining information found in this publication. The publication may be purchased from the American Public Health Association, 800 I Street, N.W., Washington, DC 20001-3710. In addition to the information provided in this reference, the ISDH Intranet site may be useful when gathering information for communicable disease policy development. Information at this site includes "Quick Facts" in English and Spanish for many diseases, and the monthly Epidemiology Newsletter. For more extensive information, the following web sites, along with others found in this reference, may prove useful:
The Centers for Disease Control and Prevention (CDC)
Immunization Action Coalition and the Hepatitis B Coalition
The Indiana Department of Education
Although school nurses are not required by law to report individual cases of communicable diseases, it is important to maintain communication with the local health department concerning outbreaks or clusters of communicable diseases. Local health department personnel perform surveillance and follow up on various communicable diseases, and find input from school nurses very useful in monitoring disease activity.
If you have questions concerning the reporting of communicable diseases, refer to Communicable Disease Reporting Rule for Physicians, Hospitals and Laboratories, 410 IAC 1-2.3; October 11, 2000. The rule is available at http://www.IN.gov/isdh/publications/comm_dis_rule.pdf
Indiana Code 20-8.1-7-8 states the following in regard to children with communicable disease and the school:
IC 20-8.1-7-8 Children found to be ill; treatment; readmission; determination of local health officer; appeals.
Sec. 8 (a) If a child is ill, has a communicable disease, or is infested with parasites, the school principal may send the child home with a note to the child’s parent or guardian. The note must describe the nature of the illness or infestation and, if appropriate, recommend that the family physician be consulted.
(b) If the parent or guardian of a child who is sent home under this section is financially unable to provide the necessary medical care, it shall be provided by a public health facility. If no public health facility is available, the township trustee or other appropriate governmental agency shall provide the necessary relief.
(c) A child who is sent home under this section may be readmitted to the school:
(1) when it is apparent to school officials that the child is no longer ill, no longer has a communicable disease, or is no longer infested with parasites;
(2) upon certification of a physician that the child is no longer ill, no longer has a communicable disease, or is no longer infested with parasites;
(3) upon certification by a physician that the child has a communicable disease, but the disease is not transmissible through normal school contacts; or
(4) upon certification by a Christian Science practitioner, who is listed in the Christian Science Journal, that based on the practitioner’s observation the child apparently is no longer ill, no longer has a communicable disease, or no longer is infested with parasites.
If school personnel disagree with the certifying physician or Christian Science practitioner as to whether the child should be readmitted to school, the local health officer shall determine whether the child may be readmitted to school.
(d) A person who objects to the determination made by the local health officer under this section may appeal to the secretary of the Indiana State Department of Health, who is the ultimate authority. IC 4-21.5 applies to appeals under this subsection. (Formerly: Acts 1973, P.L. 218, Sec. 1). As amended by P.L. 196-1987, Sec. 4.
IC 16-41-9-3
Sec. 3.
(a) The local health officer may exclude from school a student who has a dangerous communicable disease that:
(1) is transmissible through normal school contacts; and
(2) poses a substantial threat to the health and safety of the school community.
(b) If the local health officer subsequently determines that a student who has been excluded from school under subsection (a) does not have a dangerous communicable disease that:
(1) is transmissible through normal school contacts; and
(2) poses a substantial threat to the health and safety of the school community; the local health officer shall issue a certificate of health to admit or readmit the student to school.
(c) A person who objects to the determination made by the local health officer under this section may appeal to the executive board of the state department, which is the ultimate authority. IC 4-21.5 applies to proceedings under this section.
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