Outbreak Control Measures in Childcare

When several children and/or staff become ill on the same day:

  1. Notify the health unit IMMEDIATELY.
  2. Health unit staff will provide information to assist in bringing outbreaks under control and in communicating with parents if necessary. You will be given an outbreak number by the health unit.
  3. Health unit staff will provide you with a line list and outbreak control measures to review together.

Identifying an outbreak


Daily surveillance of children and daily recording of any enteric and/or respiratory symptoms will give a clear picture of the baseline incidence in the child care centre. An outbreak may be occurring when there are clusters of cases, characterized by common symptoms, above the normal or baseline levels for the centre in a short period of time.

Early reporting of the suspect outbreak, along with implementation of infection control measures, will decrease the number of children and staff who could be affected and will also reduce the duration of the outbreak.

Be aware of any children in the child care centre with cancer, including leukemia or other immune deficiency illnesses. These children may need special attention due to increased risk of illness.

Signs of Enteric Illness

Signs and symptoms of enteric illnesses include:

  • More than one episode of diarrhea or vomiting, which may be accompanied by:
    • Abdominal cramps/stomach aches
    • Fever
    • Nausea
    • Loss of appetite
    • Bloody and/or mucous stools

It is important to determine whether the diarrhea may be a reaction to medication, change in diet or other reasons that may not be linked to an enteric illness.

Signs of Respiratory Illness

A respiratory infection usually starts with:

  • Onset of a fever and may be accompanied with one or more of the following:
    • Runny nose
    • Cough
    • Nasal congestion
    • Sore throat
    • Chills
    • Muscle aches
    • Fatigue
    • Poor appetite
    • Young children may also have diarrhea

Suspecting and reporting an outbreak

Suspecting an Outbreak

A suspect outbreak exists when there is an increase in the baseline incidence indicating there are a higher than expected number of children or staff who are experiencing similar symptoms of illness.

To determine whether a suspect outbreak exists:

  • Review illness surveillance recording forms, communication books or daily log
  • Identify similar symptoms of illness among the symptomatic children/staff
  • Check recent child/staff absenteeism records

Contact the health unit (1.888.221.2133) to discuss unusual clustering of symptoms.

Reporting an Outbreak

When several children and/or staff become ill on the same day, notify the health unit IMMEDIATELY.

Health unit staff will provide information to assist in bringing outbreaks under control and in communicating with parents if necessary. You will be provided a line list, outbreak number, and outbreak control measures.

For quick reference, a copy of the Diseases of Public Health Significance for Schools and Childcare [PDF] is available.

Role of childcare centre and HPPH in outbreak control

HPPH role in outbreak control

The health unit has three major roles related to the investigation of an enteric or respiratory outbreak in child care centres.

Legislated Role

In order to protect the public’s health, the health unit’s Medical Officer of Health and public health staff have the authority to require:

  • The exclusion of ill children/staff from the centre
  • Children/staff to submit samples
  • The centre to follow specific outbreak control measures.

Consulting Role

The health unit will provide advice to the child care centres regarding:

  • Signs and symptoms of enteric and respiratory illnesses including case definitions
  • Information about infectious diseases capable of causing illness in a centre
  • How to reduce the spread of infectious microorganisms in a centre
  • How to obtain and store specimen samples
  • Policies to support outbreak reporting and management

Co-ordinating Role

The health unit will help to co-ordinate the necessary steps to bring the outbreak under control by:

  • Identifying the type and number of specimen samples needed
  • Delivering enteric outbreak kits to the centre and possibly to pick-up/drop-off sites in the community
  • Ensuring specimen samples collected are appropriately transported to the Public Health Laboratory in a timely manner
  • Conducting a kitchen inspection at the centre if an outbreak of foodborne illness is suspected
Childcare centre's role in outbreak control

All child care centres are legally responsible for reporting enteric and/or respiratory outbreaks to the local public health unit. Once the outbreak has been reported, the centre is required to:

  • Follow all health unit recommendations and requirements
  • Assist the investigating public health staff by facilitating the collection of requested specimen samples and providing the necessary information about children and staff
  • Immediately report changes associated with the outbreak and provide updated information about the outbreak on a daily basis
  • Communicate necessary information to the families of children attending the centre