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New International School Thailand
Introduction

The New International School Thailand (NIST), places a high priority on the need to prevent the spread of
infectious diseases in our school and community. By using the information and protocol/s described in this
document, it is hoped that the health and regular school attendance of students can be improved so that they
may attain or maintain their maximum potential for learning.
These protocols and adopted guidelines relating to the appropriate manner of managing infectious diseases,
are based on current information available as of October 2005 from the World Health Organization, Center
for Disease Control
and International SOS
This document contains the most current information on how to maintain school programs that will meet the health and educational needs of students who have infectious diseases and additionally how to prevent the spread of diseases in the school setting. It is hoped that these protocols will assist NIST’s employees and community in their efforts to maintain and not compromise the health and safety all student’s. “These measures are designed to protect students as well as to reduce the likelihood of the spread of infection through the school and the wider NIST community”. If avian flu becomes pandemic, there is a possibility that some countries may close their borders; this
is an option that is being considered by some nations throughout the world. Decisions to close
borders may be taken very quickly following declaration of a pandemic. Therefore, you need to
consider in advance how you can care for yourself, and your family, wherever you are.

Important Note
Children who are unwell should not be allowed to attend school. These guidelines have been drawn up on the premise that children who have been ill with an infectious disease will not return to school until they have fully recovered. The only exception to this rule is that children with certain skin diseases may return once appropriate treatment has commenced. These recommended periods are issued as a guide to teaching staff and medical/health practitioners, and may be modified in individual cases as circumstances warrant. In cases of doubt, or for guidance, in cases of conditions not mentioned on the list, advice should be sought from an appropriate health authority.
Infectious Diseases Protocol

Exclusion from School Protocol
The following Protocol will be implemented by the New International School of Thailand on a discretionary basis during a high level alert as directed by WHO, CDC, SOS or MoE. NIST Employees • Any NIST employees who have visited high level of human infections by either the World Health Organization, the Center for Diseases Control or International SOS, will not be permitted access to the school campus for what ever reason, for a period of time stipulated by the aforementioned organization (this period will be posted on NIST website, at the front of school and staff rooms). • Employees who are infected will attempt to keep in contact with NIST via phone, fax or e-mail. Teaching staff should attempt to contact students and school via e-mail, so that student studies are not affected. • All NIST students who have visited an area designated high level of human infections by either the World Health Organization, the Center for Diseases Control or International SOS, will not be permitted access to the school campus for what ever reason, for a period of time stipulated by the aforementioned organization (this period will be posted on NIST website, at the front of school and student bulletin boards) • Teachers will keep in contact via phone and e-mail during this period • No other students should be asked to deliver homework to infected student/s during this • Parents and Visitors who are known to have visited an area designated high level of human infections by either the World Health Organization, the Center for Diseases Control or International SOS, will not be permitted access to the school campus for what ever reason for a period of time stipulated by the aforementioned organization (this period will be posted on NIST website and at the front of school). Parents and Visitors should visit the following websites for current information and guidelines. • Parents and Visitors who know they have visited an infected area should not enter NIST campus for the wellbeing of the greater NIST community. Infected Persons – see parents supplement • Infected persons should not come in contact with other persons from the NIST community, • Infected persons should seek medical advice immediately and MUST inform the Hospital,
Clinic or Doctor of their condition and possible exposure, before seeing medical staff or entering a health care facility. • Family members of an infected person should monitor their health very closely for any sign of illness, and have as little direct contact with the infected person as possible.
Infection control measures in the home –Parents Supplement
hygiene -- All persons in the household should carefully follow recommendations for hand hygiene (i.e., hand washing with soap and water or use of an alcohol-based hand rub) after touching body fluids (e.g., respiratory secretions, stool, urine, vomitus) and potentially contaminated surfaces and materials (e.g., linen). Hand hygiene supplies (soap/water, alcohol-based hand rub, disposable towels) should be available and replenished as needed. (See control -- Patients should cover the nose/mouth when coughing and dispose of tissues in a lined waste container. If possible, the patient should wear a surgical mask when others are present. If the patient cannot wear a mask, persons in close contact with the patient should wear a mask. Masks should fit snugly around the face and should not be touched or handled during use. If masks will be reused by persons in the home, procedures for identifying each person’s mask and containing it between uses should be in place. A supply of masks should be available based on the volume needed each day. y Gloves and other protective attire -- Use of disposable gloves should be considered for any direct contact with the body fluids of a patient with possible or known disease. However, gloves are not
intended to replace proper hand hygiene.
Immediately after gloves are removed, they should
be discarded and hand hygiene should be performed. Gloves must never be washed or reused.
Laundry (e.g., bedding, towels and clothing) -- Towels and bedding should not be shared. Laundry may be washed in a standard washing machine with warm water and detergent; bleach may be added but is not necessary. Gloves should be worn when handling soiled laundry, and care should be used when handling soiled laundry to avoid direct contact of skin and/or clothing with contaminated material. Soiled laundry should not be shaken or otherwise handled in a manner that may aerosolize infectious particles. y Dishes and other eating utensils -- Objects used for eating should not be shared, but separation of eating utensils for use by the patient is not necessary. Soiled dishes and eating utensils should be washed either in a dishwasher or by hand with warm water and soap. waste -- Gloves, tissues, and other waste generated in the care of a patient should be bagged and placed in another container for disposal with other household waste. y Cleaning and disinfection of environmental surfaces -- Environmental surfaces that are frequently touched by the patient or are soiled with body fluids should be cleaned and disinfected with a household disinfectant. The bathroom used by the patient should be cleaned daily, if possible. Household utility gloves should be worn during the cleaning process. Is It a Cold or the Flu?
Public Information from the National Institute of Allergy and Infectious Diseases
Symptoms
Complications
Prevention
Treatment
relief of symptoms 24-48 hours after onset of symptoms
Common Infectious Diseases

Disease or condition
Exclusion of contacts
Exclusion of case definition
definition from school
from school or work
chickenpox, some remaining scabs should be excluded for their are not an indication for continued exclusion. Readmit when fully recovered from shingles. the infection—readmit when discharge has ceased. certificate of recovery, after at least or after receipt of medical measles, in which case exclude until fully recovered. Fifth disease (erythema infectiosum, parvovirus Giardia lamblia (giadiasis), campylobacter,
Common Infectious Diseases

Disease or condition
Exclusion of contacts
Exclusion of case definition
definition from school
from school or work
health authorities regarding need for preventative antibiotics for family and child-care contacts. Exclude for seven days after onset Not excluded of jaundice or illness and receipt of a medical certificate. sores or fever blisters) Impetigo (school sores) Readmit when sores fully healed or if appropriate treatment being applied and exposed sores are fully covered with occlusive dressings. contact with index case, they may return to school.
Common Infectious Diseases

Disease or condition
Exclusion of contacts
Exclusion of case definition
definitionfrom school
from school or work
health authorities regarding need for preventative antibiotics for family and child-care contacts. readmit when exposed areas are treated and covered with dressing. certificate of recovery, or on subsidence of symptoms. certificate of recovery or diarrhoea or vomiting has ceased. immune status against rubella is adequate. Readmit after completion of the first Not excluded treatment (twenty-four hours) treatment should be repeated after one week.
Common Infectious Diseases

Disease or condition
Exclusion of contacts
Exclusion of case definition
definition from school
from school or work
for at least twenty-four hours and the person feels well. least twenty-four hours apart, commencing at least seventy-two hours after cessation of specific therapy. Exclude non-immunised contacts under five years
Food Safety Guidance
There is no evidence that any human cases of avian influenza have been acquired by eating poultry products. Influenza viruses such as H5N2, H7N2, and H5N1 are destroyed by adequate heat, as are other foodborne pathogens. Consumers are reminded to follow proper food preparation and handling practices, including: • Cook all poultry and poultry products (including eggs) thoroughly before eating. (This means that chicken should be cooked until it reaches a temperature of 180 degrees Fahrenheit, throughout each piece of chicken.) • Raw poultry always should be handled hygienically because it can be associated with many infections, including salmonella. Therefore, all utensils and surfaces (including hands) that
come in contact with raw poultry should be cleaned carefully with water and soap
immediately afterwards. The World Health Organization has developed food safety guidance
for the current situation. This is available at;
http://www.who.int/foodsafety/fs_management/No_02_Avianinfluenza_Dec04_en.pdf

Good Hygiene
The number one method for controlling infectious diseases is regular “HAND WASHING” 1,000 times as many germs spread from damp hands than dry hands. • If you are ill, especially with any gastrointestinal problems, avoid handling foods for others. • Cover all cuts, burns and sores and change dressings regularly - pay extra attention to any • Avoid working in the kitchen in soiled clothing - when cooking, use a clean apron but don't • If you are preparing lots of food - for a family meal perhaps - take off your watch, rings and bracelets as well as washing your hands and wrists before you start. • If you wear a ring there could be as many germs under it as there are people in Europe. Millions of germs can also hide under watches and bracelets. • Don't brush or comb your hair when you are in the kitchen or near food. • A 1mm hair follicle can harbour 50,000 germs. Don't cough, sneeze, spit or smoke near food and avoid touching your nose, teeth, ears and hair, or scratching when handling food.
Antiviral Drugs
Type 1 M2 Inhibitors – Amantadine and Rimantadine Only effective against influenza A and not B Teratogenic. Treatment: Must be given within 48 hours of showing symptoms, will shorten the duration of symptoms by about one day, reduces viral shedding, and does not reduce complications. Prophylaxis: 70 – 90 percent effective in preventing human influenza A, some avian influenza A H5N1 is resistant to M2 inhibitors. Type 2 Neuraminidase Inhibitors – Oseltamivir and Zanamivir Active against both influenza A and B (including (H5N1) No resistance / few side effects / not teratogenic / can be used for children (not licensed for this use in the USA) Treatment: if used within 48 hours of symptoms, reduces length of illness, reduces complications up to 24%, Antibiotic use, best if =< 6 hours between applications. Prophylaxis: about 80 percent effective in preventing influenza. Currently used for close contact personnel for H5N1 cases and health care workers, Oseltamivir is approved for prophylaxis, Zanamiviris not approved for prophylaxis in all counties. Pandemic: will be used to try and slow down spread of infections or during infectious period. Safety,
Type 2
TAMIFLU (TAM-ih-flew) is indicated for the treatment of influenza in patients 1 year and
older who have had symptoms for no more than 2 days. TAMIFLU attacks the influenza virus (the flu)
and stops it from spreading inside your body. TAMIFLU treats flu at its source by attacking the virus
that causes the flu, rather than simply masking symptoms. TAMIFLU is generally well tolerated. One
out of 10 people may experience mild-to-moderate nausea or vomiting. Taking TAMIFLU with food
may reduce the potential for these side effects. Other less common side effects may include
bronchitis, sleeplessness and vertigo. As soon as you feel the sudden onset of flu symptoms, visit
your doctor (within 2 days) and ask if TAMIFLU is right for you.
TAMIFLU is also indicated for the prophylaxis of influenza in adults and adolescents 13 years and older. In prophylaxis studies adverse events were qualitatively similar to those seen in the treatment studies, despite a longer duration of dosing. The most frequently reported adverse events were headache, fatigue and nausea. There is no evidence for the efficacy of TAMIFLU in any other illness other than influenza types A and B. Treatment efficacy in high-risk patients has not been established, and there were no differences in the incidence of complications between treatment and placebo groups in this population. The safety and efficacy of repeated treatment or prophylaxis courses have not been established. Patients with severe influenza-like illnesses, especially patients with chronic medical conditions, may have bacterial infections instead of, or in addition to, viral illnesses. The efficacy of TAMIFLU in reducing the incidences of secondary illnesses in elderly subjects and in patients with chronic cardiac/respiratory diseases has not been established.
Type 2RELENZA (zanamivir) FDA has approved Relenza (zanamivir), an anti-viral drug, for
persons aged 7 years and older for the treatment of uncomplicated influenza virus. This product is
approved to treat type A and B influenza, the two types most responsible for flu epidemics. Clinical
studies showed that for the drug to be effective, patients needed to start treatment within two days of
the onset of symptoms. The drug seemed to be less effective in patients whose symptoms weren't
severe or didn't include a fever.
Relenza is a powder that is inhaled twice a day for five days from a breath-activated plastic device called a Diskhaler. Patients should get instruction from a health-care practitioner in the proper use of the Diskhaler, including a demonstration when possible. Relenza has not been shown to be effective, and may carry risk, in patients with severe asthma or a lung condition called chronic obstructive pulmonary disease. Some patients with mild or moderate asthma experienced bronchospasm (marked by shortness of breath) after using Relenza. Some patients have had bronchospasm (wheezing) or serious breathing problems when they used Relenza. Many but not all of these patients had previous asthma or chronic obstructive pulmonary disease. Relenza has not been shown to shorten the duration of influenza in people with these diseases. Because of the risk of side effects and because it has not been shown to help them, Relenza is not generally recommended for people with chronic respiratory disease. Anyone who develops bronchospasm worsening respiratory symptoms such as wheezing and shortness of breath should stop taking the drug and call their health-care provider. Patients with underlying respiratory disease should have a fast-acting inhaled bronchodilator available when taking Relenza. Relenza is not approved for use in prevention of influenza (prophylaxis) and is not a substitute for influenza vaccine.
NIST – Decision Making Matrix
Infectious Disease Decision Making Matrix – based on current information available from WHO, CDC and International SOS

Levels are defined by the presence
Circulation
Field Trips and
Education
School Provided
Emergency
of the following indicators within the
on Campus
Community
International
Communication
Delivery
Transportation
Operations
Personnel
Thai environment
and Activities
(Information – Low Risk)
(Precautionary – Moderate Risk)
(Action – Medium Risk)
(Mobilization – High Risk)

Source: http://www2.nist.ac.th/Shared%20Documents/NIST%20Infectious%20Diseases%20Protocol%20community%20handout.pdf

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