It’s as inevitable as lost mittens in January: Students make teachers sick, so to speak. When they enter the classroom, teachers face a daily germ-fest from kids harboring colds, flu, sore throats, rashes, and other contagious unpleasantries, some of which can empty a classroom (or most of a school, for that matter) almost as fast as a fire drill. There is no way to avoid every contagious bug. But there are ways to minimize the risk to both teachers and students. Knowing something about the common, communicable illnesses is one of the most important. A teacher who realizes, for instance, that the odd rash on Kevin looks like a case of highly contagious impetigo can refer the child to a doctor for necessary treatment, and can do so before the condition spreads to others.
Young teachers and those who are new to the field are among the most susceptible to picking up everything their students get, says Beverly Farquhar, executive director of the National Association of School Nurses in Scarborough, Me. Their immune systems have not yet undergone the bombardment from kids’ illnesses that veteran teachers’ have; it’s this repeated exposure to diseases that strengthens a person’s resistance. “We always reassure new teachers that we understand about their missed days, and that after teaching for two or three years their health will improve dramatically,’' explains Farquhar.
Likewise, teachers who rotate among several schools, or who substitute for a variety of schools, are more at risk for picking up germs, adds Herb Young, a physician and director of the department of public health and scientific affairs for the American Academy of Family Physicians in Kansas City, Mo. “Each school may have its own particular strain of virus circulating, and so the teacher who’s passing through is exposed to many more infectious organisms,’' he says.
Teachers who teach elementary children are among the hardest hit. “The little ones get sick more often for the same reason that new teachers do-- they haven’t had time to build up a resistance to common ills,’' Farquhar says. “These teachers work so closely with their students, helping put on their coats and hats, for example, that getting sick is unavoidable.’'
If a teacher’s overall health is questionable, susceptibility to whatever is “going around’’ is likely to be much greater. The best defense against germs, say the experts, is an ample reserve of “general healthiness,’' attained by doing all the right things--eating a nutritious diet, getting plenty of sleep, managing stress and weight, and making sure that important inoculations are up to date.
But even teachers in the best of shape have to contend with kids who innocently spread their bugs because they lack good personal hygiene habits.
“A lot of illnesses start when germs are transferred from the hand to mucous membranes such as the lining of the nose or eye,’' says Young. “Washing hands frequently is the best way to cut down on the spread of those germs from student to student to teacher.’'
“There is some evidence that the cold virus can live on objects such as pencils and books for at least a few minutes,’' says Margaret Tipple, a medical epidemiologist with the Centers for Disease Control in Atlanta, Ga. “I recommend students be taught to wash their hands before handling someone else’s belongings, and to dispose of their own tissues immediately.’'
Farquhar, a former school nurse, suggests having students keep a box of tissues in their desks along with a personal plastic bag for disposal. She also recommends that any child or teacher running a fever remain at home until the fever has been gone for a minimum of 24 hours.
Vomiting and frequent diarrhea are also obvious reasons to stay home, says Tipple. But respiratory infections--the kind that cause frequent sneezing or coughing--warrant bed rest, too. This is as much for the sick person’s sake as the rest of the class. “In general, with a common cold and flu viruses, there is a lot of virus shed for the first three or four days of the illness,’' Tipple explains, “and then [the level] drops way off even though the patient may not feel very well. By that time, it’s probably O.K. to come back to school or work.’'
Teachers are exposed to much more than colds and coughs in a typical school year. Starting in September and lasting through late spring, they have to wrestle with a variety of “catchables.’' Here’s what teachers should know about 11 common infectious conditions that may pass their way:
Head Lice. While not an illness per se, lice are certainly contagious. They are more embarrassing than serious, and almost as common as colds. Although many associate the infestation with unclean people or homes, this just isn’t so, according to the National Pediculosis (head lice) Association. No amount of bathing or shampooing will prevent lice or eliminate them once they have taken hold.
The spread of head lice among schoolchildren is notorious. Contrary to popular belief, lice can’t jump from head to head. They’re spread when kids share combs, hats, and clothing. Teachers of younger children are most at risk because they have close contact with their charges and often handle their personal belongings.
Look for head lice as the problem if a student begins scratching his head and complains of constant itching. If an infestation is suspected, send the child to the school nurse immediately for an examination. The nurse will look for nits (eggs), which appear as tiny, yellowish-white oval specks most often attached to hairshafts around the nape of the neck, behind the ears, and on the crown.
Treatment is a two-step process-- shampooing with a special product available at the pharmacy and removing the nits with a special comb. A daily nit check is advisable for at least 10 days, and treatment may have to be repeated in 7 to 10 days if there is evidence of new nits or newly hatched lice. Most schools will not allow a student back into the classroom without proof of treatment.
Conjunctivitis. This highly contagious eye infection can occur any time of the year and is spread most often by hand-to-eye contact. Whether it’s caused by a bacteria or by a virus, the symptoms are the same--redness around the lining of the eye (called the conjunctiva), itchiness, and a pus-like discharge, which may cause the eyelids to stick together in the morning. For a bacterial infection, a doctor will prescribe antibiotic drops or ointment. Expect complete recovery within three to five days.
Colds. From January through March, the peak season for colds, there’s always going to be someone in class sniffling, sneezing, and coughing. “Colds are caused by almost 200 different viruses,’' Young says. “Over time we get exposed to many of them and build up immunities. So it’s not uncommon for established teachers, especially those who have been in the same school district for many years, to have fewer colds.’'
Teachers of younger children can expect each student to have as many as six to seven colds a year. Since colds are spread most often by hand-tohand contact, the most that can be done is to make sure students wash their hands frequently and dispose of their own tissues.
Colds are, at worst, a minor inconvenience lasting from 7 to 10 days. Doctors advise just treating the symptoms and letting nature take its course.
Impetigo. This skin infection occurs when staphylococcus or, less commonly, streptococcus bacteria enter a cut, cold sore, or insect bite. It frequently shows up in the areas around the mouth and nose in the form of blisters resembling chicken pox. These blisters tend to burst and the released fluid dries to tan crusts on the skin. The only symptom is itchiness, but if the child scratches the blisters and crusts, the infection can easily spread to other parts of the body. Children need to be kept at home with this infection until it is completely cleared up, which takes about five days after antibiotic pills or cream have been started. To prevent impetigo from spreading to other classmates or teachers, wash with very hot water anything touched by the infected child.
Strep Throat. Not just any sore throat, strep has the potential, if left untreated, to lead to major complications such as rheumatic fever and inflammation of the kidneys. Although it is contagious, most adults seem to have built up an immunity to the disease. “We occasionally have teachers who complain of a sore throat and come up positive for strep on a throat culture,’' says Farquhar. “And although kids get it somewhat more often, we don’t see it go through a whole school, like chicken pox often does.’'
Adults and kids with strep usually have a very sore throat and/or high fever, and they almost always feel “sick all over.’' They need to see a doctor and have their throat cultured. (There’s now a 10-minute test that’s quite accurate.) If the culture is positive for strep, an antibiotic, usually penicillin, is prescribed. Recovery is dramatic--24 hours after starting the antibiotic, symptoms may be gone. (But beware, warn doctors: Patients must finish all the antibiotic, for although they may feel better, the bacteria are still present. In fact, the strongest germs survive the longest, so stopping the medicine too soon allows regrowth of the most potent bugs, with the potential for a serious relapse.)
Bronchitis. Acute bronchitis is usually a complication of a cold or influenza, but it’s not just an ordinary cough. The inflammation of the lining of the bronchi (the branching air passages that connect the windpipe to the lungs) causes first a dry, hacking cough and then progresses to one that produces yellow or green sputum. The sufferer may have a fever, but the most persistent symptom is the cough. Antibiotics are given only if a bacterial infection is suspected, but not if the cause is viral. Bronchitis typically lasts from 7 to 10 days, but the cough may linger even longer.
Stomach Virus. Also known as gastroenteritis or intestinal “flu,’' this bug usually strikes suddenly, often ripping through the system in one or two days with nausea, vomiting, diarrhea, abdominal cramps, and sometimes fever. There’s not much that can be done except to drink fluids to prevent dehydration and wait out the storm.
Influenza. Outbreaks of flu tend to occur in the winter and spread rapidly through schools. Children are most susceptible to flu after age 5, and can expect to be sick with chills, fever, body aches, and coughing for about three days to a week. Adults may be sick for a week to 10 days and may feel dragged out even longer. Over-thecounter medications relieve symptoms. (A flu vaccine is available and recommended for teachers. See box below.)
Measles. Once believed to be virtually eradicated, measles is making a comeback. In fact, because of recent outbreaks, the American Academy of Pediatrics has revised its policy for measles vaccination, and now recommends two doses of the vaccine for all children. In addition, anyone--especially teachers--born after January 1, 1957, who has not received two doses should be revaccinated.
Although measles will probably cause no lasting harm in most cases, there is the potential for serious, even fatal, complications in a few. After an incubation period of 9 to 11 days, the usual symptoms appear. For most there is just fever, runny nose, sore eyes, and the characteristic rash. But in about 1 in 1,000 cases, the disease can lead to encephalitis, or inflammation of the brain. Seizures and coma may follow, sometimes leading to mental retardation or death.
Chicken Pox. There is no vaccine for this common childhood illness, so every spring it’s bound to make the rounds. Teachers and children who have never had chicken pox are the only ones at risk, since once infected, immunity lasts a lifetime. Patients are highly infectious from about two days before the rash appears until about a week after. The incubation period is 11 to 21 days; after that the danger of infection is over.
Chicken pox is rare in adults, but when it does occur it takes a more severe form than in children. Susceptible adults should stay away from children with chicken pox, as well as anyone with shingles. Shingles is caused by the same germ and can trigger a bout of chicken pox. Women in the final stages of pregnancy should be particularly careful since, if they catch the disease, their newborn may develop a severe attack.
Fifth Disease. This infectious disease got its peculiar name because, many years ago, it was the fifth childhood illness to be described that caused a rash (the other four being measles, rubella, mumps, and chicken pox). It often starts out with a dramatic rash on the cheeks and then spreads in a lacy pattern over the trunk, buttocks, and limbs. The only treatment is bed rest, fluids, and acetaminophen to reduce fever. The rash is usually gone within 10 days.
Fifth disease has gotten a lot of attention lately because the virus that causes it--parvovirus--has now been identified. “It was assumed that most of us had it as children,’' says Tipple. “Now there is some evidence that young adults who have not previously had the infection actually are at some risk if they work with school-age kids where an outbreak is occurring.’'
The biggest concern with Fifth disease, however, centers on pregnant teachers. “We think there is some small risk that an exposed fetus may become anemic and not survive,’' says Thomas Torok, a CDC epidemiologist, “but only if the school is having a widespread outbreak of the disease. Even then, the risk is probably less than 1.5 percent, and indeed nothing bad happens to most of the pregnant teachers who get infected.’'
Despite the low odds, nobody quite knows how to handle the pregnant teacher who may be at risk. “An outbreak of Fifth disease,’' says Tipple, “should prompt anyone who’s pregnant to take it up with her own physician.’'
