Outbreaks and Increased Absenteeism in Schools

What are outbreaks? 

Respiratory outbreaks

A respiratory outbreak is an increase in respiratory illness among a group of people at the same time and place. Respiratory illnesses can be caused by bacteria or viruses that affect the respiratory system (e.g., nose, throat, and lungs).​​

Symptoms of a respiratory illness include fever, cough, runny nose, congestion, sneezing, sore throat, and difficulty swallowing. Other symptoms may include headache, sore muscles, fatigue, poor appetite, and irritability. COVID-19, influenza and respiratory syncytial virus (RSV) are examples of viruses that cause respiratory illness​es. Respiratory illnesses can spread:​

• From person to person through contact with droplets of someone who has a respiratory illness. This can be spread from coughing, sneezing, and talking. ​
• Indirectly through contact with contaminated objects/surfaces​.

Gastrointestinal outbreaks

Enteric outbreaks (or gastroenteritis outbreaks) is a sudden onset of gastrointestinal illness and may occur in schools throughout the year. Gastrointestinal illness (GI) is caused by bacteria, viruses, or parasites leading to symptoms such as nausea, vomiting and diarrhea.

GI illnesses can spread:​​

• From person-person through contact with bodily fluids​​
• Through consumption of contaminated food/water​​
• Indirectly through contact with contaminated object/surfaces

IPAC measures during outbreaks or increases in illness

Schools follow infection prevention and control (IPAC) measures as part of their daily operations. During an outbreak, some measures need to be adjusted or enhanced. The outbreak control measures outline the measures that should be enhanced or implemented to prevent the spread of illness.  

Please refer to OPH's Outbreak Control Measures for Institutions, Congregate Living Settings, Child Care Centres and Schools for guidance of control measures based on your setting. 

Sample communication during outbreaks or increases in illness

It is recommended to share communication with the school community (staff and families) when there is an outbreak or increase in absences due to illness to promote the public health measures that can reduce the spread of illness.  

Specimen kits and collection

Collecting stool samples will tell us which organism or germ is making people sick. This will help ensure the right measures are put in place to stop and prevent more people from getting sick. Only ill students or staff may be asked to collect a stool sample. Kits are not for parents or other household members.  

Gastrointestinal (GI) symptoms like vomiting, diarrhea, and nausea can be symptoms of COVID-19, which continues to circulate in the community. It is highly recommended that individuals who are experiencing symptoms complete both a Rapid Antigen Test and a stool sample.   

How to Collect a Stool Sample

Step 1: Get the kit

Get a stool sample kit from the school if you have had GI symptoms within the last 48 hours.  The kit should include two sterile containers. The container with the WHITE cap is empty and will test for viruses. The container with the GREEN cap has a red liquid called transport medium and will test for bacteria. DO NOT drink the red liquid! You will put a stool sample into both containers using the individual lids of the containers that have a scoop on the inside. 

• Check the expiration date on the sterile containers. DO NOT use expired kits. Contact the school for another kit.

Step 2: Label the sample containers and fill in the requisition form. ***This step is very important.

If the label and/or form are missing information, or is illegible, or filled out incorrectly, the lab will not test the sample.  

1. Label the sample containers with the individual’s name, health card number (ID number on the label), and the date/time the stool sample is collected.     
2. Complete all the required sections of the “General Test Requisition” form provided

• Patient information section
• Public health unit outbreak number – This number can be found on the Increased Illness Letter or by calling the school
• Date stool sample collected
• Date of symptom onset (the day symptoms started)

Step 3: Collect the stool sample  

Do not allow the stool to come in contact with the toilet water. If the stool touches the toilet water, it is no longer an acceptable sample. 

If blood or mucus is present in the stool, always take a sample from this part of the stool 

1. Adults and toilet trained children can defecate into a clean container (i.e. a disposable plate). TIP: Urinate first if needed. Children who are not toilet trained, the stool sample can be taken from the soiled diaper or directly from the child's training "potty."

2. Using the individual "scoop" attached to lid of each container, transfer stool into the corresponding sterile container. Fill the white cap container first.  

• Fill to the line indicated on the container. Do not overfill.   
• Tighten the caps. Do not use extra force to tighten the caps as the containers may crack and leak.  
• Place the containers in the inner pocket of the plastic biohazard bag and seal the zip-lock bag.  

3. Place the General Test Requisition form in the small outer pocket of the plastic biohazard bag. DO NOT place the form in the inner pocket where the sample containers are. Place the biohazard bag into the brown paper bag and refrigerate the sample(s) immediately after collection. 

4. Stool samples should be placed on the bottom shelf of a fridge that does NOT contain food. 

• A cooler with ice or an ice pack can be used if a separate fridge is not available.
• DO NOT freeze the sample.

5. Perform hand hygiene. If hands are visibly soiled, use soap and water.

6. Call your school for stool sample pick-up and delivery to the Public Health Laboratory located in Ottawa. The deadline for same-day pick up is Monday to Friday before 3 pm.

• Please ensure you provide verbal consent to the school so they may provide your name and address to OPH for stool sample pick up. 

Shared items and high touch surfaces can be sources for spread of infection, especially in child care settings and schools. Such surfaces may include door knobs, taps, handrails, phones, computer keyboards, elevator buttons, countertops, as well as shared sports equipment or toys. These surfaces and items can easily become contaminated by viruses or bacteria which can spread from one person to another. Developing policies and procedures for cleaning and disinfection is important to prevent the spread of infections in your setting or school.

Cleaning

Cleaning is the physical action of removing debris from a surface. Cleaning with soap or detergent, and water, will remove organic material such as food, body fluids, fecal matter, or soil from surfaces. Residue from the soap or detergent must be rinsed off prior to disinfection to prevent neutralization of some disinfectants.

Disinfection

Disinfection must occur after cleaning. Disinfection inactivates or kills microorganisms (germs) that may be present on surfaces and that cleaning does not remove.
All-in-one cleaning/disinfecting products must contain a drug identification number (DIN) from Health Canada. The disinfectant contact time, which is the time that a surface must remain wet for a disinfectant to be effective, varies between products. Follow manufacturers' instructions for disinfectant contact times, dilution and handling of products, including for pre-saturated disinfectant wipes.
Flip-top bottles are preferred to apply cleaning solution. If using a spray bottle, saturate the cloth first then wipe the surface. Avoid the use of aerosol cans as this can propel the germs and cleaning solution into the air.
Household bleach diluted in water is an inexpensive and effective disinfectant and can be used for most surfaces. It should be prepared daily. Ensure that surfaces are cleaned with a detergent or cleaning agent before the household bleach mixture is used as a disinfectant.
Mixing some cleaners and disinfectants (like chlorine bleach and ammonia) can be harmful, even deadly. Others can irritate your eyes, nose, or throat and cause breathing problems.

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