Guidelines for exclusion
of people with enteric
infections and their
contacts from work,
school and child care
settings
health.wa.gov.au
Effective: December 2015
Title:
Guidelines for exclusion of people with enteric infections and their
contacts from work, school and child care settings
BACKGROUND
People with enteric infections may be a source of infection to their household contacts, work
colleagues, clients and the wider community. Such people should undertake personal hygiene
precautions such as thorough hand washing after going to the toilet and avoid preparing food
for other people. Contacts of people with enteric infections should wash their hands thoroughly
before preparing or eating food.
In general, people with symptoms of enteric infections should be excluded from work, school,
activities involving groups of people (e.g. sports training, group camps) and other situations
where disease transmission may occur, until they have been asymptomatic for 24 hours and
have normal stools. However, people who are at high risk of transmitting their infection or work
in a high risk setting (i.e. workers in health care, residential care and child care, food handlers,
young children in child care, and cases who are faecally incontinent, as shown in the table
below) should be excluded until they are asymptomatic for 48 hours and have normal stools.
Microbial testing of stools (clearance) and additional exclusions may also be required. Contacts
(see table below for definition) of typhoid and paratyphoid cases may also require additional
precautions.
It is recommended that institutional residents (e.g. residential care facilities, boarding schools)
with symptomatic enteric infections be nursed in a single room with a toilet and bathroom for
their exclusive use (see Reference 2).
This document details the minimum exclusion requirements for gastroenteritis. Additional public
health actions (exclusion and/or microbial clearance) may be required in certain circumstances,
such as during an outbreak.
Guidelines for exclusion of people with enteric infections and their contacts from work,
school and child-care settings
INFECTION
Campylobacteriosis
CASES, LOW RISK
CASES, HIGH RISK
1
Asymptomatic, including
Asymptomatic, including
normal stools, for 24
normal stools, for 48 hours.
hours.
Asymptomatic, including
normal stools, for 48 hours,
Cholera
Asymptomatic, including
then clearance with two
(toxigenic Vibrio cholerae normal stools, for 24
consecutive negative faecal
hours.
01/0139)
specimens collected at least
24 hours apart.
CONTACTS
Nil
Nil
1
Guidelines for exclusion of people with enteric infections and their contacts from
Work, school and child care settings
INFECTION
CASES, LOW RISK
CASES, HIGH RISK
CONTACTS
1
Cryptosporidiosis
Asymptomatic, including
Asymptomatic, including
normal stools, for 24
normal stools, for 48 hours.
hours. Cases should also
Cases should also avoid
avoid using public
using public swimming pools
swimming pools for two
for two weeks after the first
weeks after the first
normal stool.
normal stool.
Nil
Hepatitis A & hepatitis E
infection
At least one week after
onset of jaundice or two
weeks after onset of
symptoms (if not
jaundiced).
At least one week after onset
of jaundice or two weeks after
onset of symptoms (if not
jaundiced).
Nil
Nil
Nil
2
Foodborne toxins.
Salmonellosis infection
(not typhoid or
paratyphoid fever)
Nil
Asymptomatic, including
Asymptomatic, including
normal stools, for 24
normal stools, for 48 hours.
hours.
Nil
Asymptomatic, including
normal stools, for 48 hours,
Shiga-like/Vero- toxigenic Asymptomatic, including
then clearance with two
E.coli (STEC/VTEC)
normal stools, for 24
consecutive negative faecal
infection
hours.
specimens collected at least
24 hours apart.
Nil
Asymptomatic, including
normal stools, for 48 hours,
Asymptomatic, including
then clearance with two
normal stools, for 24
consecutive negative faecal
hours.
specimens collected at least
24 hours apart.
Nil
Asymptomatic, including
Asymptomatic, including
normal stools, for 24
normal stools, for 48 hours.
hours.
Nil
Shigellosis dysenteriae
infection
Shigella infection
(not S.dysenteriae)
High risk contacts:
1, 3
Clearance requires three
consecutive negative faecal
Typhoid fever (Salmonella
specimens, collected at least 4
Asymptomatic, including
typhi) and paratyphoid
24 hours apart, commencing
normal stools, for 24
fever (Salmonella
at least 48 hours after
hours.
paratyphi)
cessation of antibiotic therapy
and not before one month
5
following onset of illness.
Exclude high risk contacts who had
a similar exposure to that of the
case.
Clearance can be begin immediately
and is two consecutive negative
faecal specimens, collected at least
24 hours apart.
Provide information only for high risk
contacts exposed only at the time
the case was symptomatic.
Low risk contacts: Information only
Viral gastroenteritis (e.g.
norovirus, rotavirus)
Asymptomatic, including
Asymptomatic, including
normal stools, for 24
normal stools, for 48 hours.
hours.
Nil
Yersiniosis
Asymptomatic, including
Asymptomatic, including
normal stools, for 24
normal stools, for 48 hours.
hours.
Nil
2
Guidelines for exclusion of people with enteric infections and their contacts from
Work, school and child care settings
INFECTION
CASES, LOW RISK
CASES, HIGH RISK
1
CONTACTS
Other known causes of
gastroenteritis including
Entamoeba histolytica,
Giardiasis,
Vibrio infection (not
Cholera),
Asymptomatic, including
Asymptomatic, including
normal stools, for 24
normal stools, for 48 hours.
hours.
Nil
Asymptomatic, including
Asymptomatic, including
normal stools, for 24
normal stools, for 48 hours.
hours.
Nil
E. coli (not STEC/VTEC).
Unknown organism
6
1
High risk cases and contacts are people who are at high risk of transmitting their infection or work in a high risk setting,
including: workers in health care, residential care and child care; food handlers; children in child care (not including before &
after school care); and people who are faecally incontinent.
2
Foodborne toxins include those produced by Bacillus cereus, Clostridium botulinum, Clostridium perfringens and
Staphylococcus aureus, and ciguatera poisoning and scrombroid/histamine poisoning.
3
Contacts of cases that require microbiological clearance include, but are not limited to, high risk contacts who have had a
similar exposure history to that of the case, in the month prior to the case’s illness onset, such as:
 travelled overseas with the case.
 or if the case acquired the infection in Australia, then contacts would be household members or others who may have
consumed an implicated food.
4
Collect clearance specimens from high risk contacts as soon as possible to exclude asymptomatic infection. If a cleared
contact subsequently develops symptoms, re-test and apply exclusions if required.
5
Contacts of the case exposed only at the time the case was symptomatic (that is, those who did not share possible infecting
exposures as defined in footnote 3) include household members, carers or sexual partners. These contacts should be given
information on typhoid/paratyphoid and advised to seek medical assistance immediately and stop work if they develop
typhoid-like symptoms.
6
Where patients or contacts are symptomatic and not diagnosed, manage and test as required, which may depend on the
person’s illness, the setting, their occupation or the diagnosis in the index case.
1
REFERENCES
1. Operational Directive 0490/14 Public Health Follow-up of Sporadic Enteric Disease
Notifications. http://www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=13056
2. Guidelines for the management of gastroenteritis outbreaks in residential care facilities.
http://www.public.health.wa.gov.au/cproot/1072/2/residential-care-facility-gastroenteritisguidelines.pdf
3. Operational Directive 0465/13 Guidelines for the Prevention and Management of
Gastroenteritis Outbreaks in Residential Care Facilities.
http://www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=13023
4. Operational Directive 0228/09 Hepatitis A: National guidelines for public health units.
http://www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=12564
5. Heymann D L. Control of Communicable Diseases Manual (19th Edition). American Public
Health Association.
6. Preventing person-to-person spread following gastrointestinal infections: guidelines for
public health physicians and environmental health officers.
www.hpa.org.uk/cdph/issues/CDPHvol7/No4/guidelines2_4_04.pdf.
3
Guidelines for exclusion of people with enteric infections and their contacts from
Work, school and child care settings
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© Department of Health 2015
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