Module 1 

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Understanding Communicable Diseases

Outcomes

    After completing this module, participants will be able to explain what communicable diseases are and how they spread

Key Concepts

• Communicable diseases are illnesses that spread from person to person. They are the most common cause of illness in young children.
• Communicable diseases are caused by microscopic germs and bugs. They are carried in "body fluids"-blood, mucus, saliva, vomit, stool, urine, and eye discharges-and on the skin and hair.
• Communicable diseases are spread in different ways, depending on the disease-for example by touching, breathing, and eating.
• People have different beliefs about communicable diseases that are shaped by culture, education, experience, and fears. We must build our approach to communicable diseases on sensitivity and respect for different beliefs and practices.

Background Information

A. What Are Communicable Diseases?

Communicable diseases are illnesses that spread from one person to another. They are also called contagious or infectious diseases.

Communicable diseases are caused by germs and tiny bugs. The germs are so small that they can only be seen with a microscope, not with the naked eye. The germs and bugs are categorized as:

• viruses (e.g., "colds," chicken pox, hepatitis A & B, HIV),
• bacteria (e.g., "strep," tuberculosis), or
• fungi (e.g., ringworm, thrush), and
• parasites (e.g., giardia, pinworms, scabies, head lice).

Illnesses caused by bacteria, fungi and parasites always need medical evaluation and antibiotic treatment. Many illnesses caused by viruses are mild and go away on their own, but some need medical evaluation and treatment.

NOTE: Some illnesses and health conditions are not communicable and do not spread from one person to another. Examples of these include asthma, allergies, seizures, cerebral palsy, and blindness.

B. How Do Communicable Diseases Spread?

Germs that cause communicable diseases are found in and on people, animals, food, water, air, and dirt. Most of the germs are carried in human "body fluids"-blood, mucus, saliva, vomit, stool, urine, and discharges from the eyes and skin lesions. Most communicable bugs are carried on the skin and hair.

Germs spread when the body fluids of one person get into the body of another person. Most communicable bugs spread by getting onto the skin or hair.

Communicable diseases can be categorized by the way they spread:

• Respiratory diseases (e.g., colds) affect the head and chest. They are spread by:
• coughing, sneezing, and breathing,
• touching nasal mucus, saliva, and eye discharge.
• Gastrointestinal diseases (e.g., infectious diarrhea) affect the stomach and intestines. They are spread by:
• touching stool, vomit, or contaminated surfaces,
• eating food contaminated by stool,
• drinking or bathing in water contaminated by stool.
• Dermatologic diseases (e.g., ringworm) affect the skin and hair. They are spread by:
• touching skin or hair,
• sharing items such as clothes, hats, towels, and hairbrushes that touch skin or hair.
• Blood-borne diseases (e.g., hepatitis B) affect the entire body. They are spread by:
• getting blood onto broken skin,
• receiving blood transfusions,
• sharing needles used for injections, piercing, or tattoos,
• having sexual contact that shares body fluids.

The majority of illnesses spread in early childhood programs are respiratory, gastrointestinal, and dermatologic diseases. The spread of blood-borne diseases is extremely rare.

C. Why Are Communicable Diseases Common Among Young Children?

Young children have frequent illnesses caused by communicable diseases. Studies show that preschool-age children have symptoms of illness one- third to one-half of the days out of the year.

Young children are more vulnerable to illnesses because their immune systems-the body's natural defenses against disease-are not yet built up. Infants and toddlers tend to get sick more often than older children. And when children enter a new child care setting, they tend to get sick more in the first year. Over time, as children develop and learn, their immune defenses also develop and learn to protect them against diseases and keep them healthier.

For example, children get frequent colds, but the average number they suffer per year decreases as they get older:

• Infants and toddlers have 6-10 colds/year.
• Preschool-age children have 3-5 colds/year.
• Older children have 1-3 colds/year.

Communicable diseases spread in early childhood programs because:

• There is close contact among many children and germs.
• Young children explore their environment by touching people and things and by putting their hands and objects-and germs-into their mouths.
• Most young children have not yet developed good hygiene practices. They touch their noses, mouths, bottoms, animals, dirt, food, and toys, and often forget to wash their hands.
•  Surfaces and objects can carry germs. These include toys, tabletops, floors, diapering and toileting areas, sinks, doorknobs, water fountains, sandboxes, and water play tables.
• Teachers and parents also spread germs. Studies of early childhood programs show that the surface most likely to carry germs is the caregiver's hands. In meeting the needs of many children-wiping runny noses, changing diapers, assisting with toileting, and handling food-proper hygiene practices are sometimes neglected.

D. What Is the Impact of Communicable Diseases on Head Start?

Most of the communicable diseases that children experience, such as colds and stomach upsets, are mild. Children are usually sick for a few days and then get better on their own.

Some illnesses, however, are more serious and require medical evaluation and treatment. For example, strep throat needs treatment with antibiotics. Some frequent illnesses can lead to complications. For example, colds can lead to frequent ear infections in some infants and toddlers, which can lead to hearing loss. Some children with immune problems, such as HIV/ AIDS, are more susceptible to illnesses. Rarely, communicable diseases such as meningitis, measles, and tuberculosis can be fatal.

The illnesses don't simply spread among the children-they also spread to staff, parents, and other family members. Communicable diseases can lead to significant pain and suffering, time missed from school and work, and medical costs for families and staff.

E. How Do Beliefs and Attitudes Affect the Management of Communicable Diseases in Head Start?

Each person has a unique set of beliefs about health and illness. These beliefs are shaped by many factors including cultural background, education, and personal experience. People in the Head Start community-staff, children, parents, and other professionals-have diverse beliefs about communicable diseases, including:

• Beliefs about the causes of illness, for example, germs, poor hygiene, lowered resistance, weak constitution, emotions and stress, eating bad food, exposure to cold air, evil eye, punishment for sins, hot/cold imbalance, lack of harmony with nature, and fate.
• Practices to maintain health and treat illness, for example, washing hands, eating certain foods, exercise/rest, bathing/not bathing, taking medicine, drinking teas, injections, prayer, laying on hands, religious ceremonies, hot/cold remedies, acupuncture, cupping, coin rubbing, massage, offerings, and family support.
• Sources of health information and treatment, for example, doctors, nurses, psychologists, chiropractors, homeopaths, family members, elders, healers, religious leaders, pharmacists, acupuncturists, medicine men, santeros, and curanderos.

Head Start's approach to preventing and managing communicable disease must be built on respect for different health beliefs and practices.

Illnesses among children, staff, and parents can strain emotions and workloads. When staff and parents react to illness with anger or shame, illnesses may not be handled effectively, leading to more severe symptoms and further spread. However, when staff and parents react to illness with information and sensitivity, it leads to more effective treatment and reduced spread.

Head Start children are also developing their own ideas about health and illness based on the attitudes and responses of the adults around them. When staff and parents respond to illness with blaming or fear, children may feel afraid and isolated. When adults respond with concern and acceptance, children develop a more comfortable and "healthier" attitude toward illness.

Questions for Discussion/Reflection

Think about the last communicable disease that "went around" your Head Start program. What was the impact on children, families, and staff?

• How many got sick?
• How much pain and suffering did they experience?
• How many days of school or work were missed?
• What were the costs for health care and medicine?
• What might have been done to prevent or manage the illness more effectively?

Activity 1:
Who Has Had
This Experience?

Purpose: This activity is a brief "icebreaker" to help participants recognize the impact of communicable diseases on their daily lives.

For this activity, you will need:

• One copy of Handout A: Who Has Had This Experience? for each participant
• Pens/pencils

Step 1: Explain that this exercise helps us get to know each other through discussing some of our experiences with communicable diseases.

Trainers Note: Participants may feel uncomfortable discussing some communicable diseases or have concerns about confidenitiality. Encourage participants to discuss these issues only to the extent to which they feel comfortable.

Step 2: Ask participants: What are communicable diseases? (see Background Information)

Step 3: Distribute Handout A: Who Has Had This Experience? Give participants a minute to review the questions on the worksheet.

Step 4: Have participants take 5-10 minutes to mingle with each other, introduce themselves, and discuss some of their experiences with communicable diseases. Participants should sign their names on other participants' worksheets next to an experience that they have had.

Step 5: After most people have completed their worksheets, have participants return to their seats. Ask participants:

• What were some common experiences or practices?
• What were less common experiences or practices?
• Were there some diseases that you felt ashamed of having? Did that affect the way you dealt with having those diseases? How?
• Were there some diseases that you felt angry about or blamed others for spreading? Did that affect the way you dealt with the diseases? How?
• How can we make the management of communicable diseases more effective in Head Start?

Points to Consider:

• Communicable diseases are illnesses that spread from person to person. They are the most common cause of illness in young children.
• All of us do many things each day to prevent and manage communicable diseases-both at home and at work.
• Head Start staff and families have some similar and some different experiences, information, fears, and questions about communicable diseases. We can learn from reflecting on our own experiences, sharing them with others, and asking questions.
• Fear, anger, blame, and denial are common responses to communicable diseases, but they make us deal poorly with our illnesses. Acceptance and information can help us manage these diseases more effectively.
• To manage communicable diseases effectively, Head Start programs need clear health policies, up-to-date information, and sensitive communication among staff, parents, and children about communicable diseases.

Activity 2:
What Do We
Think?

Purpose: This activity helps participants develop strategies to work with people in the Head Start program who have diverse beliefs about communicable diseases.

For this activity, you will need:
• A copy of Handout B: What Do We Think? for each participant
• A copy of the Appendix handout: Colds and Flu, for each participant

Step 1: Explain that this activity helps us examine different beliefs about communicable diseases.

Step 2: Distribute Handout B: What Do We Think? Explain that participants should first write down their own answers to the questions. Then they should interview two people-another Head Start staff person and a parent-and write down their responses to the same questions. Ask participants to try to select people who are different from them in age, ethnicity, or lifestyle.

Step 3: After the interviews are complete, bring the participants back together to discuss their findings.

• What were some of the similar beliefs about colds?
• What were some of the different beliefs about colds?
• How are the beliefs based on culture, education, and personal experience?

Step 4: Distribute the Appendix handout: Colds and Flu. Explain that this handout is the current information from public health authorities that guides Head Start's practices regarding colds. Give participants a few minutes to review it.

Step 5: Ask:

• What differences are there between the "Colds and Flu" handout and the other beliefs about colds?
• Understanding that the Head Start program is made up of people with all of these beliefs and more:
• What might be some potential conflicts in managing colds in a Head Start program?
• What are some strategies to resolve conflicts and establish common practices for preventing and managing communicable diseases in Head Start?

Points to Consider

• People have different beliefs about communicable diseases, including beliefs about the causes, prevention, and treatment of illnesses, and about different resources for information and treatment.
• Each person's beliefs area shpaed by culture, education, and personal experience.
• Head Start staff must demonstrate sensitivity and respect for different beliefs and practices.
• Staff must also follow Head Start health policies guiding the management of communicable diseases in the program. Ploicies should be clear, up to date, and developed in cooperation with public health authorities and the Health Services Advisory Committe.

Activity 3: Working with
People with Diverse Beliefs

Purpose: This activity helps participants develop strategies to work with diverse beliefs about communicable diseases in Head Start.

For this activity, you will need:

• Four sheets of flip chart paper and a marker for each participant
• A copy of each of these Appendix handouts: Colds and Flu, Infectious Diarrhea, Head Lice, HIV/AIDS, for each participant

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Preparation Note: Before the training, take out four pieces of flip chart paper. Write one of the following sentences at the top of each paper:

1. Colds and flu are caused by...
2. Most diarrhea is caused by...
3. Head lice keep going around the center because...
4. When caring for children with HIV/AIDS, I sometimes worry that HIV will be spread by... 

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Step 1: Explain that the purpose of this exercise is to explore the wide range of beliefs nad feelings about communicable diseases.

Step 2: Post the four flip chart sheets you have prepared around the room. Give participants markers and ask them to write as many phrases as possible on ech sheet to complete each sentence with what they believe, what others believe, and things that they've heard.

Step 3: After about 10 minutes, ask participants to sit down. Read each statement and the different beliefs and feelings that were listed.

Step 4: Ask participants:

• What is similar about all of the lists?
• How are the beliefs based on culture, education, and personal experience?

Step 5: Distribute the Appendix hadouts to participants. Explain that these handouts offer current information from public health authorities that guides Head Start's ploicies on communicable diseases.

Step 6: Beginning with Colds and Flu, give participants a few minutes to review the hadout. Ask participants:

• Which statements from the flip chart list of causes of colds and flu are supported most by the information on the handout? (Circle them or write them down.)
• Do the same for infectious diarrhea, head lice, and HIV/AIDS

Step 7: Ask:

• When  managing colds and flu in a Head Start program, what might be some potentail conflicts...
• due to diverse beliefs and feelings among staff and parents?
• due to strong feelings (e.g., anger, blaming, fear, shame)?
• What are some strategies to resolve conflicts and establish common practices for managing communicable diseases in Head Start?

Points to Consider

• People have different beliefs about the causes, prevention, and treatment of communicable diseases and about resources for information and treatment.
• Each person's beliefs are shaped by culture, education, and personal experience.
• Anger, blaming, fear, and shame can make it difficult to prevent and manage communicable diseases effectively.
• To manage communicable diseases effectively, Head Start staff must:
• demonstrate sensitivity and respect for diverse beliefs and practices.
• follow Head Start health policies.
• Head Start health policies should be clear, up to date, and developed in cooperation with public health authorities and the Health Services Advisory Committee.

Activity 4: How
Communicable
Diseases Spread

Purpose: This activity helps participants understand how communicable diseases spread and why they spread so widely.

For this activity, you will need:

• Flip chart paper
• Colored markers (red, blue, brown, green)
• Key to Activity 4: A: Communicable Diseases in Children; Key to Activity 4: B: How Communicable Diseases Spread (for trainer only)
• One index card and pen/pencil for each participant
• Overhead projector and transparency

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Preparation Note: Before the activity:

• Copy the chart on Communicable Diseases in Children (Key to Activity 4: A) onto an overhead transparency.
• Copy the outline of the human body (Key to Activity 4: B) onto flip chart paper.
• Separate out eight of the index cards:

• On four cards, write a small letter in the lower right corner: "R" on one, "G" on another, "D" on another, and "B" on another
• On four cards, write a small letter "H" in the lower left corner

• Review Appendix Communicable Disease Fact Sheets

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Step 1: Explain to participants that this activity helps them understand how communicable diseases spread.

Step 2: Show the overhead chart on Communicable Diseases in Children (Key to Activity 4: A). Briefly review the four main ways that communicable diseases are spread (respiratory, gastrointestinal, dermatologic, and blood-borne), common examples of the diseases, general symptoms of the diseases, and specific ways they spread in Head Start programs.

Step 3: Post the flip chart paper with the outline of the human body. Explain that, for each type of disease, the germs are carried by and spread from specific parts of the body. Color the parts accordingly (See Key to Activity 4: B):

• Respiratory (blue): nose, mouth and lungs
• Gastrointestinal (brown): mouth, stomach, intestines, bottom
• Dermatologic (green): skin, hair Bloodborne (red): blood throughout the body

Emphasize that all of the different germs can be carried on one part of the body-the hands. Color the hands with all of the colors.

Step 4: Explain to participants that they will play a game to see how quickly communicable diseases spread.

Step 5: Distribute an index card to each participant (Make sure that the eight index cards with letters on them are distributed). Ask participants to stand up, mingle with each other, and do the following:

• Introduce yourselves to someone and shake hands with them. Write your name on the other person's index card. Then return the card to the owner.

Tell participants that they will have one minute to do this as many times as possible. When the minute is up, have everyone sit down together.

Step 6: Ask the person who has an "R" in the lower right corner of his card to stand up. Explain that he has a respiratory disease-a cold-and got germs on his hands from blowing his nose.

Ask all participants who shook his hand and have his name on their cards to stand up. Explain that they caught his cold. Ask them all to continue to stand up.

Step 7: Ask the person who has an "G" in the lower right corner of her card to stand up. Explain that she has a gastrointestinal disease-diarrhea-and got germs on her hands from going to the bathroom.

Ask all participants who shook her hand and have her name on their cards to stand up. Explain that they caught her diarrhea. Ask them all to continue to stand up.

Step 8: Ask the person who has a "D" in the lower right corner of his card to stand up. Explain that he has a dermatologic disease-scabies-and got germs on his hands from scratching his rash.

Ask all participants who shook his hand and have his name on their cards to stand up. Explain that they caught his scabies. Ask them all to continue to stand up.

Step 9: Ask the person who has a "B" in the lower right corner of her card to stand up. Explain that she has a blood-borne disease-hepatitis B-and got germs on her hands from cutting her hand on a piece of glass.

Ask all participants who shook her hand and have her name on their cards to stand up. Explain that they caught her hepatitis B because they had a cut on their hand that allowed infected blood to enter their system. Ask them all to continue to stand up.

Step 10: Have participants look around the room. Ask: What do you observe?

Step 11: Ask for all participants who have an "H" in the lower left corner of their cards to raise their hands. Explain that they did not catch the disease because of good hand washing-they washed their hands at the proper time and so did the other people. Ask them to sit down.

Step 12: Ask: What did you observe about the spread of diseases through this activity?

Points to Consider:

• The majority of illnesses spread in early childhood programs are respiratory, gastrointestinal, and dermatologic diseases. The spread of bloodborne diseases is extremely rare.
• When only a few individuals have communicable diseases, they can spread widely among a group of people, for example, among children and adults in a Head Start program. The more people have close contact with each other, the more germs and diseases can spread.
• A few simple prevention measures, such as hand washing, can reduce the spread of disease.

Communicable Diseases in Children                            Key to Activity 4: A
 

	Diseases	Possible Symptoms*	Spread By
Respiratory	"colds", "flu", ear infection, "strep" throat, scarlet fever, conjunctivitis, roseola, pneumonia, tuberculosis(TB), chicken pox, fifth disease("slap cheek"), haemophilus influenza B(HIB), measel, mumps, rubella(German measels), pertussis(whooping cough)	runny nose, ear ache, sore throat, cough, headache, fever, rash	wiping nose with hand and then touching people and objects wiping children's noses and not washing hands afterwards coughing or sneezing into air sharing of mouthed toys by infants kissing children on the mouth poor ventilation
Gastronomical	rotavirus, hepatitis A, salmonella, shigella, campylobacter, giardia, pinworms, Coxsackie virus(hand,foot,and mouth), Escherichia coli(E. coli), polio, amebas	stomach ache, nausea, vomiting, diarrhea	not washing hands after toileting/diapering and before cooking/eating sharing of mouthed toys by infants not cleaning and disinfecting diapering/toileting areas improper refregeration and preparation of meat, poultry, eggs, or milk products
Dermatologic	impetigo, herpes, ringworm, lice, scabies	rash, oozing lesions, itching	touching infected skin/hair sharing clothes, hats, bedding, linen, hairbrushes, etc.
Bloodborne	hepatitis B, HIV/AIDS	fatigue, weight loss, fever	contact with blood into broken skin or eyes, nose, or mouth sexual contact

*NOTE: These are several symptoms that may be associated with the general classes of diseases. However, many diseases have symptoms which may or may not be listed in the brief list of possible symptoms.

How Communicable Diseases Spread                             Key to Activity 4: B

 

 Activity 5:
Spreading Germs

Purpose: This activity helps participants understand how communicable diseases spread and identify specific behaviors that spread disease in Head Start.

For this activity, you will need:

• Flip chart paper
• Colored markers (red, blue, brown, green)
• Key to Activity 4: A: Communicable Diseases in Children; Key toActivity 4: B: How Communicable Diseases Spread (for trainer only)

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Preparation Note: Before the activity:

• · Copy onto flip chart paper:
• The chart on Communicable Diseases in Children (Key to Activity 4: A). Don't fill in the last column, "Spread by..."
• The outline of the human body (Key to Activity 4: B)
• · Review Appendix: Communicable Disease Fact Sheets

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Step 1: Explain to participants that this activity will help them understand how communicable diseases are spread.

Step 2: Post the chart on Communicable Diseases in Children. Briefly review the four main ways that communicable diseases are spread-Respiratory, Gastrointestinal, Dermatologic, and Bloodborne. Discuss common examples of the diseases and general symptoms.

Step 3: Post the outline of the human body. Explain that, for each type of disease, the germs and parasites are carried by and spread from specific parts of the body. Color the parts accordingly (See Key to Activity 4: B: How Communicable Diseases Spread):

• Respiratory (blue): nose, mouth, and lungs
• Gastrointestinal (brown): mouth, stomach, intestines, bottom
• Dermatologic (green): skin, hair Bloodborne (red): blood throughout the body
• Emphasize that all of the different germs can be carried on one part of the bodythe hands. Color the hands with all of the colors.

Step 4: Have participants list the specific ways that communicable diseases spread in early childhood programs, keeping in mind the parts of the body and the body fluids that carry different types of diseases. Write these down in the last column ("Spread By...") of the chart on Communicable Diseases in Children (See Key to Activity 4: A: Communicable Diseases in Children).

Step 5: Ask participants:

• Were you surprised by the way that any of the diseases was spread? (For example, although chicken pox involves skin lesions, it is spread by the respiratory route; and hand, foot, and mouth syndrome is spread by the gastrointestinal route.)
• Why might it be important to know how specific diseases are spread?

Points to Consider:

• The majority of illnesses spread in early childhood programs are respiratory, gastrointestinal, and dermatologic diseases. The spread of bloodborne diseases is extremely rare.
• It is important to understand how diseases are spread in order to know how to prevent their spread. For example, if there is an outbreak of hand, foot, and mouth syndrome (Coxsackie virus), which is spread by the gastrointestinal route, staff members should review their universal precautions to prevent gastrointestinal diseases (e.g., diapering, hand washing, disinfecting, and food preparation) to see where there has been a breakdown.

 Next Steps:
Ideas to
Extend Practice

Teaching Children about Germs

Set up activities to help children understand about germs and illnesses, for example:

• Explain what germs are, where you find them, and how they spread. Remind children that we usually cannot see germs even when they are there.
• Have them draw pictures of germs and make a collage.
• Grow germs on a piece of bread. Introduce germs by touching the bread or putting mucus, saliva, or dirt on it. Moisten it with water, seal it in a plastic baggie, and keep in a warm place. Observe germs growing for a week..
• Demonstrate a microscope.

Discussing Beliefs about Communicable Diseases

    Set up a staff-parent workshop to discuss communicable diseases. Invite health professionals and families from different cultural backgrounds. Discuss different beliefs and emphasize the importance of respecting diverse beliefs and practices. Discuss the lessons for children on communicable diseases and encourage parents to reinforce the lessons at home. Allow staff and parents to ask questions and express their concerns about the prevention and management of communicable diseases in Head Start.
 

Observing the Spread of Germs in Head Start     As a follow-up to Activities 4 and 5, have staff return to their Head Start duties and observe behaviors that may spread germs. Staff should be aware of their own behaviors as well as the behaviors of other staff, parents, and children. Pay special attention to coughing/sneezing, wiping noses, diapering, toileting, and handling food. Also note behaviors that might prevent the spread of germs, such as, hand washing, cleaning, and disinfecting. Discuss the observations in a staff meeting.