Illness Surveillance and Outbreak Management

Germs can spread rapidly in group settings such as a child care centre. In addition to prevention, timely detection and management of outbreaks are key to reducing the impact of illness in these settings. This section provides guidelines on how to recognize and manage illness and outbreaks in the child care setting.

Role of Child Care Centres

Child care centres have requirements related to illness surveillance and outbreak management.

Under the Child Care and Early Years Act, 2014 O.Reg. 137/15, child care centres are required to observe all children daily for signs of ill health. If a child receiving child care at the centre appears to be ill, the child must be separated from other children and the symptoms of the illness must be noted in the child’s records.
Under the Health Protection and Promotion Act, R.S.O. 1990, c.H.7, Regulation 135/18, all child care centres are required to report a suspected outbreak to their local public health unit.

Role of the Health Unit

The Health Unit is required by the Ministry of Health and Long-Term Care to assist child cares in the management of outbreaks including:

Declaration of the outbreak
Enforcing control measures
Providing support and education to the staff and families affected

Surveillance

Ensure Proper Surveillance

Daily surveillance of signs and symptoms in the children and staff will give the child care operator/supervisor a baseline rate of illness. Keeping a daily logbook and documenting signs and symptoms will assist in identifying trends and determining if there is an unusual increase in illness. Early reporting of the suspected outbreak, as well as practicing proper infection prevention and control measures, will decrease the number of children and/or staff who become ill and reduce the duration of the outbreak.

Steps to ensure proper surveillance:

Monitoring for signs & symptoms: Children and staff should screen daily for signs and symptoms of illness prior to attending the child care facility. Screening is important and staying home helps prevent transmitting illness to others.
Active surveillance throughout the day. Operators and/or supervisors should actively observe staff and children for signs and symptoms of illness upon arrival at the child care facility and throughout the day, to determine the need to isolate or exclude children and/or staff.

Signs and Symptoms of Illness (not related to known causes or conditions):

Diarrhea
Vomiting
Nausea
Abdominal pain
Fever or chills
Rash
Runny nose or nasal congestion
Cough or difficulty in breathing
Sore throat
Headache (unusual or long lasting)
Unusual behaviour
Extreme Fatigue
Muscle aches or joint pain
Decreased or loss of taste or smell
Decreased or no appetite in young children
Pink eye

Surveillance Tips for Success

Have written policies in place for handling illness in your facility
Record the following information in a daily logbook:
- Attendance and absence of children and staff
- Signs and symptoms of illness
- Date and time of symptom onset
- The outcome of the situation (child/staff sent home, etc.)
Ensure that parents/guardians are aware of and understand your policies before they register their children in your facility.
Advise parents/guardians to have alternate plans or arrangements in case their child gets sick and needs to be picked up. This includes the name, address, and phone number of an alternate contact.

Identifying an Outbreak

An outbreak should be suspected when a greater number of children or staff become ill with the similar symptoms in a given period of time.

When a potential outbreak is identified at your child care facility, notify the North Bay Parry Sound District Health Unit’s Communicable Disease Control (CDC) Program immediately at 1-800-563-2808 ext. 5229. A CDC staff member will assist you in deciding if an outbreak exists and will help you bring the outbreak under control.

If an operator has knowledge of, or suspects that a child in their child care facility has a reportable disease listed on the Diseases of Public Health Significance list, the Health Unit’s CDC program must be informed in accordance with the Health Protection and Promotion Act (R.S.O. 1990, H.7; Part IV).

Enteric Outbreak / Gastrointestinal Illness

Gastrointestinal illness is caused by a variety of pathogens that affect the gastrointestinal tract (stomach and bowels) and is typically acquired through consuming contaminated food, or water, or contact with infected animals, environments, or people (Ministry of Health, 2022).

All gastroenteritis outbreaks in child cares are reportable to the Health Unit’s CDC Program (HPPA, R.S.O. 1990, H.7) regardless of whether they are caused by:

A reportable agent
A non-reportable agent
An unknown cause

The CDC program can be reached at 1-800-563-2808 ext. 5229.

Outbreak & Case Definition

A gastroenteritis outbreak exists when there are two or more cases meeting the case definition with a common epidemiological link (i.e., toddler room, same caregiver) with an initial onset within a 48-hour period. To be considered a case, at least one of the following must be met:

Two or more unexplained episodes of diarrhea (i.e., loose/watery bowel movements) within a 24-hour period.

OR

Two or more unexplained episodes of vomiting within a 24-hour period.

OR

One or more episodes of diarrhea and one or more episodes of vomiting within a 24-hour period, not explained by another cause.

Fact Sheet

Please refer to the linked fact sheet, Outbreaks: Information for Childcare Providers for general information on outbreaks.

The flow chart on the following page will help determine if there is an enteric outbreak at your child care facility.