Guidance

A to Z of infectious diseases in children and young people's settings

Updated 8 April 2026

Athlete’s foot 

People with athlete’s foot can come to the setting as usual and interact with other. 

You do not need to contact your health protection team about athlete’s foot. 

Managing athlete’s foot 

If someone at your setting has athlete’s foot: 

• tell them or their parent or carer to get medical advice, for example from a pharmacist or doctor 

• make sure they cover the infected foot with a rubber sock when going in a swimming pool or communal wash area 

• let them wear shoes that are made of breathable fabric, for example trainers 

• tell them to change their socks daily  

• tell them to wear footwear at all times in the setting, especially in showers and changing areas 

• tell them to dry the skin between their toes after bathing 

People with athlete’s foot should not share items that touch their feet, for example socks, shoes, towels or bathmats. 

About athlete’s foot 

Athlete’s foot is a common fungal infection that affects the skin of the feet. It is spread through: 

• direct contact with the infected skin 

• being barefoot on surfaces or items that infected skin has touched, for example floors or footwear 

People with athlete’s foot are infectious until treatment is complete. 

Find out more about athlete’s foot on the NHS website.

Chickenpox 

People with chickenpox should stay away from the setting, or communal areas in a residential setting, until the spots have formed a scab. This is usually 5 days after the spots first appears. For people with a weakened immune system, this is until all spots have crusted over.

In most cases, you do not need to contact your health protection team about chickenpox.  

Contact your local health protection team if you have chickenpox and scarlet fever at the same time in the same group in the setting. Getting both infections together can lead to more serious illness. The health protection team will tell you if you need to take any other actions. 

Managing chickenpox 

You do not need to take any special actions if someone at your setting has chickenpox (varicella). 

There is no specific treatment for chickenpox, but some of the symptoms can be treated. For example, calamine lotion and cooling gels can lessen the itching, and paracetamol can lower a high temperature (fever). These treatments are available over the counter at a pharmacy. 

Tell people with chickenpox, or their parent or carer, to get medical advice quickly if: 

• they are seriously ill  

• the blisters become infected 

• they develop any unusual symptoms, such as chest pain or trouble breathing  

People at higher risk from chickenpox 

Chickenpox is usually a more serious illness in adults than in children. Adults are also at higher risk of complications if they get chickenpox. 

People at higher risk of serious complications from chickenpox include: 

• pregnant women who have not been vaccinated or have never had chickenpox or shingles before  

• newborn babies, and children up to the age of 1 in some cases 

• people with a weakened immune system (immunocompromised people) 

People who are at higher risk from chickenpox should get medical advice if they: 

• are exposed to chickenpox  

• develop symptoms of chickenpox 

They may need to get a blood test to check if they are immune to chickenpox.

Chickenpox vaccination

The measles, mumps, rubella and varicella (chickenpox) (MMRV) vaccine is the simplest and most effective way to protect people from chickenpox. This was introduced in January 2026 and is part of the NHS vaccination schedule.

There is no reason to exclude children who have been recently vaccinated as long as they are well.

About chickenpox 

Chickenpox is a common and usually mild viral illness. Most people will catch chickenpox during childhood. It is most common in winter and spring, particularly between March and May. From January 2026, all children will be offered the MMRV vaccine when they turn 12 months and 18 months old. This means that chickenpox will become less common.

Chickenpox is highly infectious and spreads easily through: 

• direct contact with fluid from the spots of someone with chickenpox or shingles 

• being around an infectious person who is coughing or sneezing 

• breathing the same air as an infected person 

• touching contaminated objects or surfaces, then touching your mouth, eyes or nose  

People with chickenpox are infectious from one day before the rash appears to 5 days after the rash first appears. For people with a weakened immune system, this is until all blisters have crusted over.

Find out more about chickenpox on the NHS website.

Chlamydia 

People with chlamydia can come to the setting as usual. 

You do not need to contact your health protection team about chlamydia. 

Managing chlamydia 

If someone at your setting has chlamydia: 

• you should advise them and their sexual contacts to get medical advice, for example from a sexual health clinic, pharmacist or doctor 

• if a child shows signs of harm or risk, especially if they are under 13, you should follow local rules and make a safeguarding referral 

About chlamydia 

Chlamydia is a bacterial sexually transmitted infection (STI). It is most common in sexually active people aged 15 to 24.  

Chlamydia is spread by contact with an infected person’s genital fluids. For example, contact with semen or vaginal fluids during vaginal, anal or oral sex. Using condoms can help protect against chlamydia.

Chlamydia can have serious complications if it is not treated quickly. It can be treated with antibiotics. 

Most people with chlamydia do not have any symptoms, but they can still be infectious to others. Symptoms usually develop 1 to 3 weeks after becoming infected.  

There are tests to diagnose chlamydia, but there is no chlamydia vaccine. 

Find out more about chlamydia on the NHS website.

Cold sores 

People with cold sores can come to the setting and interact with others as usual.

You do not need to contact your health protection team about cold sores.

Managing cold sores 

If someone at your setting has cold sores, advise them or their parent or carer to get advice from a pharmacist or doctor.

People with cold sores should avoid: 

• touching or picking at the cold sore 

• kissing others 

• touching their eyes, for example while applying or removing make-up 

People with cold sores should not share items that touch their face, for example: 

• towels or flannels 

• toothbrushes or razors 

• food, plates, cups or other cutlery 

About cold sores 

Cold sores are blisters that usually appear on and around the lips, or on other areas of the nose and face. They are spread through contact with: 

• an infectious person’s saliva 

• fluid from the cold sores 

Cold sores are caused by a common virus called herpes simplex. Most people get infected with this virus early in life, but not everyone will get cold sores.  

People usually get cold sores after a trigger, for example: 

• having a high temperature (fever), a cold or another infection 

• stress 

• sunlight 

• having a weakened immune system (being immunocompromised) 

Find out more about cold sores on the NHS website.

Conjunctivitis (pink eye) 

People with conjunctivitis can come to the setting and interact with others as usual. 

You do not need to contact your health protection team about conjunctivitis. 

Managing conjunctivitis 

If someone at your setting has conjunctivitis, you should tell them or their parent or carer to get advice from a pharmacist or doctor. 

You should also tell them: 

• to wash their hands frequently using soap and water 

• to cover their mouth and nose when sneezing 

• to avoid touching or rubbing their eyes 

People with conjunctivitis should not share items that touch their eyes, for example: 

• towels or flannels  

• pillows or bedding 

Clean shared objects and surfaces regularly for example: 

• wipe down equipment, hard surfaces, hard toys and sleep mats

• machine wash soft toys

• vacuum carpets and soft furnishings

About conjunctivitis  

Conjunctivitis is an inflammation of the outer lining of the eye and eyelid. It can be caused by bacteria, viruses or allergic reactions. 

Find out more about conjunctivitis on the NHS website.

COVID-19 

See Respiratory infections.

Cryptosporidiosis 

People with cryptosporidiosis should stay away from the setting, or communal areas in a residential setting, until at least 2 days after any diarrhoea or vomiting have stopped.

Contact your local health protection team if there are 2 or more people at your setting with similar symptoms and who are linked. For example, people in the same class, group or location. They will tell you if you need to take any other actions.

Managing cryptosporidiosis 

If someone at your setting has cryptosporidiosis: 

• do not let them go into a swimming pool until 14 days after they last had diarrhoea 

• encourage everyone to wash their hands frequently using soap and water 

• clean shared areas more regularly, for example kitchens and toilets and common touchpoints such as door handles, toilet flush handles and taps
• use personal protective equipment (PPE) and a spill kit when cleaning up body fluids, for example diarrhoea or vomit 

• they should not prepare food for others until they have been symptom-free for at least 2 days 

• wash all used clothes, bedding and towels on the hottest cycle of the washing machine and tumble dry if available 

The use of alcohol hand gel is not as effective as using soap and water. 

About cryptosporidiosis 

Cryptosporidiosis is caused by a microscopic parasite called Cryptosporidium when it enters the gut through the mouth. This can be through:

• eating contaminated food or drinking contaminated liquids, including contaminated or untreated water and milk 

• swallowing contaminated swimming pool water, even if the water is chlorinated 

• touching your mouth, eyes or nose with contaminated hands or objects 

• swallowing contaminated river or lake water during recreational activity 

• touching your mouth with contaminated hands or objects 

• contact with an infected person, particularly if changing nappies 

• direct contact with farm animals or their environment and poo, particularly cows and sheep 

People with cryptosporidiosis are usually infectious: 

• from when their symptoms start 

• until at least 2 days after their symptoms stop 

The usual incubation period for cryptosporidiosis (the delay between getting infected and showing symptoms) is on average 7 days but ranges between 1 and 10 days. Symptoms usually last for about 2 weeks.  

Cryptosporidiosis is most common in children aged 1 to 5 years but people with a weakened immune system are at higher risk of severe and prolonged illness. 

Find out more about cryptosporidiosis.

Diarrhoea and vomiting (gastroenteritis)

People with diarrhoea or vomiting should stay away from the setting, or communal areas in a residential setting, until at least 2 days after their diarrhoea and vomiting have stopped.

People may need to stay away longer for some infections. For example, if they have diarrhoea or vomiting caused by E.coli (STEC) or hepatitis A.

Contact your local health protection team about diarrhoea and vomiting if: 

• there is an unusually high number of absences at your setting with onset of illness around the same time

• there are 2 or more people at your setting with similar symptoms and who are linked – for example, people in the same class, group or location or have recently been on a school trip or attended the same event

• someone who handles or prepares food at your setting is symptomatic 

• someone has been admitted to hospital 

• someone reports bloody diarrhoea 

The health protection team will tell you if you need to take any other actions. 

Managing diarrhoea and vomiting 

If someone at your setting has diarrhoea or vomiting: 

• encourage everyone to wash their hands frequently using soap and water 

• clean shared areas more regularly, for example kitchens and toilets, door handles, light switches and taps and toilet handles 

• use personal protective equipment (PPE) and a spill kit when cleaning up body fluids, for example diarrhoea or vomit 

• keep clothing, bedding and other fabrics that have diarrhoea or vomit on them separately from other laundry 

 The use of alcohol hand gel is not as effective as using soap and water. 

Clean shared objects and surfaces daily with bleach-based cleaning products where possible. For example:

• wipe down equipment, hard surfaces, hard toys and sleep mats  

• machine wash soft toys and soft furnishing with removable covers 

• vacuum carpets and wash any soft furnishings such as removable cushion covers 

Some surfaces get touched a lot, for example door handles, taps and toilet flush handles. You should clean these surfaces multiple times a day.

If there are 2 or more cases of diarrhoea or vomiting at your setting in the same class, group or location or you should: 

• ask your staff to supervise or check children’s hand washing, encourage everyone to wash their hands frequently using soap and water 

• not allow children to play with soft toys, water or sand, or to take part in cooking activities 

• move people who have had diarrhoea or vomited at the setting to a private, or less communal area in residential settings, to wait until their parent or carer collects them 

You should encourage good food hygiene, for example:

• have as few people handling or preparing food as possible 

• serve snacks in individual portions and hand them to people directly  

• cover food and snacks until they are about to be served 

• label drink bottles clearly with their owner’s name 

You should limit how much people move around your setting, for example: 

• allow as few visitors into the setting as possible, and let any visitors know about the outbreak and to wash their hands frequently using soap and water 

• if possible, do not move or add children and young people to classes or groups with a lot of infections 

• have your staff work only in specific areas, if possible 

• check if you have any staff who work at other settings, including agency staff, and ensure their work movements are restricted  

You could also consider: 

• having a box of spare clothing at your setting to replace soiled clothing  

• putting up signs that let people know about the outbreak, and inform them when to stay away from the setting 

• have bags to put spoiled clothing in 

About diarrhoea and vomiting  

Diarrhoea means 3 or more liquid or semi-liquid poos within a 24-hour period in adults and older children. In young children, diarrhoea means any change in their poo. 

Body fluids, including diarrhoea and vomit, have a high risk of contaminating hands and the nearby environment.  

Many different things can cause diarrhoea and vomiting.  

Not all types of diarrhoea and vomiting are infectious. However, you should assume that all cases of diarrhoea or vomiting are infectious unless there is good reason not to.  

Infectious diarrhoea and vomiting can be caused by: 

• bacterial and gastrointestinal (GI) infections, for example food poisoning

• viral infections, for example rotavirus or norovirus

Gastroenteritis is a general term for the inflammation of the stomach or intestines.  

Gastrointestinal infections spread when germs enter the gut through the mouth. The most common gastrointestinal infections are caused by salmonella, norovirus or campylobacter bacteria, usually associated with food poisoning.

People with diarrhoea and vomiting are infectious from the start of their symptoms until 2 days after their symptoms stop.  

Find out more about diarrhoea and vomiting on the NHS website.

Diphtheria 

People with diphtheria should stay away from the setting or communal areas in a residential setting, until their health care professional confirms its safe for them to return, or in line with current guidance.

Contact your local health protection team if anyone at your setting has diphtheria. 

Managing diphtheria 

If someone at your setting has suspected diphtheria: 

• tell them or their parents or carers and any close contacts to get medical advice from a doctor 

• tell them to complete the full course of prescribed antibiotics  

People with diphtheria should not share items, such as 

• cups or cutlery 

• clothing 

• bedding 

Diphtheria vaccination 

Diphtheria is preventable by vaccination. 

Diphtheria vaccination protects against severe infection and is very effective. It is rare to see diphtheria in the UK now, due to the vaccination programme of infants in the 1940s. Diphtheria vaccination is given as part of the NHS vaccination schedule. 

Although it is rare in the UK, you can still catch diphtheria if you’re travelling to some parts of the world. You may need a booster vaccination if you have been vaccinated against it more than 10 years ago. 

About diphtheria  

Diphtheria is a highly contagious bacterial infection that affects the nose and throat and sometimes the skin. 

Diphtheria bacteria can live in the mouth, nose, throat, or skin of people with the infection. It is commonly spread through coughs and sneezes of an infected person, or when a person comes into close contact with them. Symptoms usually begin 2 to 5 days after becoming infected. Symptoms include: 

• a thick grey-white coating that may cover the back of the throat, nose and tongue 

• a high temperature (fever) 

• sore throat 

• swollen glands in the neck 

• difficulty breathing and swallowing 

The bacteria responsible for diphtheria can cause small skin sores that form larger ulcers, usually appearing on the legs, feet and hands. The sores can be difficult to distinguish from impetigo. 

Find out more about diphtheria on the NHS website.

E. coli (STEC) 

People with E. coli (STEC) infections should stay away from the setting, or communal areas in a residential setting until 2 days after symptoms end, or until confirmed safe to return by their doctor, or in line with any current guidance. 

See Diarrhoea and vomiting.

Some groups of people may need to stay away longer, for example: 

• children aged 5 or under  

• food handlers 

• care staff working with children 5 years old or under or those who may need help with their personal hygiene or help with feeding 

• some people who have tested positive for E. coli (STEC) but do not have symptoms 

• those who are unable to perform adequate personal hygiene due to their lack of capacity or ability to comply or lack of access to hygiene facilities 

Contact your local health protection team if anyone at your setting has E. coli (STEC).  

Managing E. coli (STEC) infections 

If someone at your setting has an E. coli (STEC) infection:  

• encourage everyone to wash their hands frequently using soap and water   

• clean shared areas more regularly, for example kitchens and toilets  

• use personal protective equipment (PPE) and a spill kit when cleaning up body fluids, for example diarrhoea or vomit 

The use of alcohol hand gel is not as effective as using soap and water. 

About E. coli (STEC) infections 

There are several different types of Escherichia coli (E. coli) bacteria. They are commonly found in: 

• food 

• the environment  

• the guts of people and animals 

Most types of E. coli are harmless, but some produce a toxin that can cause illness. These are called Shiga toxin-producing E. coli, or STEC. 

E. coli (STEC) are spread by: 

• eating contaminated food, for example undercooked meat, unwashed vegetables or unpasteurised milk or cheese  

• direct contact with an infected person, particularly in families, childcare and residential settings – this includes closed settings (for example, boarding schools, care homes, prisons, or homeless hostels)

• direct contact with infected farm animals, wildlife or their poo or indirect contact through contaminated soil or water 

The incubation period for E. coli (STEC) infections (the delay between getting infected and showing symptoms) is between one and 10 days. Symptoms usually stop after 5 to 7 days. In rare cases E. coli (STEC) infections can cause serious complications, such as acute kidney failure. 

Find out more about E. coli (STEC).

Flu (influenza) 

People with flu symptoms, including a high temperature (fever), should stay away from the setting, or communal area in a residential setting, until they are better and no longer have a temperature. People do not need to stay away from the setting if they only have mild symptoms, for example:

• runny nose 

• sore throat 

• mild cough 

• headache 

Contact your local health protection team about flu if: 

• there is an unusually high number of absences at your setting 

• the number of absences is increasing quickly 

• there is any serious illness where someone has been kept in hospital 

• there are other infections also circulating in the same group of people, such as scarlet fever 

Managing flu 

If someone at your setting has flu or flu symptoms you should: 

• encourage everyone to wash their hands frequently using soap and water and have good respiratory hygiene. 

• clean shared areas more regularly 

• Encourage ventilation in shared spaces to bring in fresh air 

Flu vaccine 

Flu viruses will be slightly different each year. Encourage people at your setting to get the current flu vaccine.  

Anyone can get flu, but all those aged 6 months or older in the clinical risk group are at higher risk of complications. Some of these people can get a free NHS flu vaccine.  

Check who can get the:  

• adult flu vaccine 

• children’s flu vaccine 

About flu 

Flu, or influenza, is a viral respiratory infection. See Respiratory infections. 

Children with flu may have different symptoms from adults. For example, they may have diarrhoea but not a high temperature (fever). 

Flu is spread through: 

• breathing the same air as an infected person 

• being around an infected person who is coughing or sneezing 

• touching your mouth, eyes or nose with contaminated objects 

• touching contaminated objects or surfaces, then touching your mouth, eyes or nose 

Contaminated objects or surfaces are any things that an infected person may have touched, or may have breathed, coughed or sneezed on. For example, toys, door handles or used tissues. 

People with flu are infectious: 

• from one day before symptoms start 

• until 3 to 7 days after symptoms start 

Flu spreads easily in crowded or enclosed spaces.  

Find out more about flu on the NHS website. 

Find resources for the flu programme.

Food poisoning 

People with food poisoning should stay away from the setting until at least 2 days after their diarrhoea and vomiting have stopped. 

See Diarrhoea and vomiting. 

Contact your local health protection team if there are 2 or more people at your setting with similar symptoms and who are linked. For example, people in the same class, group or location. All outbreaks of food poisoning should be investigated.

Managing Food poisoning 

If someone at your setting has food poisoning: 

• encourage everyone to wash their hands frequently using soap and water 

About Food poisoning 

Food poisoning can be caused by: 

• eating contaminated food, for example if food is prepared by an infected person who did not wash their hands properly 

• drinking contaminated liquids 

• touching your mouth, eyes or nose with contaminated hands or objects 

• contact with an infected person 

Find out more about food poisoning on the NHS website.

Genital herpes 

People with genital herpes can come to the setting and interact with others as usual. 

You do not need to contact your health protection team about genital herpes. 

Managing genital herpes 

If someone at your setting has genital herpes: 

• you should advise them and their sexual contacts to get medical advice, for example from a sexual health clinic or doctor  

• if a child shows signs of harm or risk, especially if they are under 13, you should follow local rules and make a safeguarding referral

About genital herpes 

Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus. It is spread through: 

• sexual contact with an infected person’s genital fluids, for example contact with semen or vaginal fluids during vaginal, anal and oral sex 

• skin contact with the infected genital area, including non-penetrative sex 

Using a condom does not provide full protection from genital herpes. 

Most people with genital herpes do not have any symptoms, but they can still be infectious to others.  

There is no cure or vaccine for genital herpes. If the infection is identified quickly, it can be treated with antiviral drugs (such as acyclovir), which can reduce the length and severity of symptoms. 

Find out more about genital herpes on the NHS website.

Genital warts and human papillomavirus (HPV) 

People with genital warts or HPV can come to the setting and interact with others as usual. 

You do not need to contact your health protection team about genital warts or HPV. 

Managing genital warts and HPV 

If someone at your setting has genital warts or HPV: 

• you should advise them to get medical advice, for example from a sexual health clinic or doctor 

• if a child shows signs of harm or risk, especially if they are under 13, you should follow local rules and make a safeguarding referral 

Genital warts and HPV vaccination 

The HPV vaccine is free for children 12 to 13 years old. The HPV vaccine protects against some types of HPV, including the viruses that cause genital warts.  

The HPV vaccine does not protect against all types of HPV. People over 25 should consider having cervical screening (smear test) when it is offered, even if they have had the HPV vaccine. 

About genital warts 

Genital warts are a common sexually transmitted infection (STI) caused by HPV. 

Genital warts spread through skin contact with the infected genital area, including non-penetrative sex. Using a condom does not provide full protection from genital warts. 

Genital warts usually appear 1 to 3 weeks after becoming infected with HPV. 

Find out more about:

• genital warts on the NHS website
• HPV on the NHS website

About HPV 

There are many different types of human papillomavirus (HPV). Some cause genital warts and some cause cancers, including cervical cancer. 

HPV is spread through: 

• contact with an infected person’s genital fluids, for example contact with semen or vaginal fluids during vaginal, anal or oral sex 

• skin contact with an infected person’s genital area, including non-penetrative sex 

Using condoms does not protect against all types of HPV. 

Many people with HPV do not have any symptoms, but they can still be infectious to others.  

Find out more about human papillomavirus (HPV) on the NHS website.

Giardiasis 

People with giardiasis should stay away from the setting until at least 2 days after their diarrhoea has stopped.  

See Diarrhoea and vomiting.  

Contact your local health protection team about giardiasis if there are 2 or more infected people at your setting who are linked, for example people in the same class, group or location.

Signs of linked cases include:

• an unusually high number of absences at your setting
• the number of absences increasing quickly 
• if this occurred after return from a school outing to a farm or wild swimming in lakes or rivers

The health protection team will tell you if you need to take any other actions. 

Managing giardiasis 

If someone at your setting has giardiasis:  

• do not let them go into a swimming pool until 14 days after they last had diarrhoea 

• encourage everyone to wash their hands frequently using soap and water 

• clean shared areas more regularly, for example kitchens and toilets 

• use personal protective equipment (PPE) and a spill kit when cleaning up body fluids, for example diarrhoea or vomit 

The use of alcohol hand gel is not effective so hands needs to be cleaned using soap and water. 

About giardiasis 

Giardiasis is caused by a microscopic parasite called Giardia duodenalis or Giardia intestinalis when it enters the stomach through the mouth. It is often caught in the UK or during travel abroad.

Giardiasis can be spread by: 

• eating contaminated food or drinking contaminated liquids 

• touching your mouth, eyes or nose with contaminated hands or objects 

• through sexual contact 

People with giardiasis are infectious until at least 2 days after their symptoms have stopped. 

The incubation period for giardiasis (the delay between getting infected and showing symptoms) is between 7 and 10 days. In some cases it can be between 1 and 28 days. 

Symptoms of giardiasis usually last between 2 and 6 weeks. Symptoms may last longer in people with weakened immune systems. 

Find out more about giardiasis on the NHS website.

Glandular fever 

People with glandular fever can come to the setting and interact with others as usual. 

You do not need to contact your health protection team about glandular fever. 

Managing glandular fever 

If someone at your setting has glandular fever, encourage everyone to wash their hands frequently using soap and water and have good respiratory hygiene.

About glandular fever 

Glandular fever is a viral infection that mostly affects young adults. In children, the disease is usually mild. 

Glandular fever is spread through contact with the saliva of infected people. For example, through: 

• kissing an infected person 

• being around an infected person who is coughing or sneezing 

• sharing eating or drinking utensils with an infected person 

• touching your mouth, eyes or nose with contaminated hands or objects 

The incubation period for glandular fever (the delay between getting infected and showing symptoms) is up to 7 weeks. 

Symptoms of glandular fever usually last for 2 to 3 weeks. The tiredness (fatigue) can sometimes last longer. People can still be infectious for several months after being unwell. 

Find out more about glandular fever on the NHS website.

Gonorrhoea 

People with gonorrhoea can come to the setting and interact with others as usual. 

You do not need to contact your health protection team about gonorrhoea. 

Managing gonorrhoea 

If someone at your setting has gonorrhoea: 

• you should advise them and their sexual contacts to get medical advice, for example from a sexual health clinic or doctor 

• if a child shows signs of harm or risk, especially if they are under 13, you should follow local rules and make a safeguarding referral 

About gonorrhoea 

Gonorrhoea is a bacterial sexually transmitted infection (STI).  

Gonorrhoea spreads through contact with an infected person’s genital fluids. For example, contact with semen or vaginal fluids during vaginal, anal or oral sex. Using condoms can help protect against gonorrhoea. 

Most types of gonorrhoea can be treated with antibiotics. There is no vaccine for gonorrhoea. 

The incubation period for gonorrhoea (the delay between getting infected and showing symptoms) is usually between one and 14 days. 

Find out more about gonorrhoea on the NHS website.

Group A strep 

People with a group A strep (GAS) or invasive group A strep infections (iGAS) (which is a severe outcome of GAS) should stay away from the setting, or communal areas in a residential setting, until 24 hours after they started treatment with antibiotics. 

You do not need to contact your health protection team about individual cases of GAS. 

Contact your local health protection team if anyone at your setting has iGAS. They may also contact you if they are notified that someone at your setting has iGAS and if so will ask about other GAS infections such as scarlet fever. The health protection team will tell you if you need to take any other actions.  

Managing group A strep 

If someone at your setting has GAS encourage them to:

• wash their hands frequently using soap and water 
• cover their mouth with a tissue when coughing or sneezing and bin immediately after use 
• cover their wounds if they can 

About group A strep 

Group A Streptococcus, also known as group A strep (GAS) or strep A, is a type of bacteria. It can cause many different infections, for example: 

• scarlet fever
• impetigo
• sore throat
• tonsillitis
• wound infections

Most GAS infections are usually mild and can be treated with antibiotics.  

Invasive group A strep is a severe and uncommon complication of group A strep. Bacteria infect parts of the body where it is not usually found, such as the lungs or the blood. This can cause a serious or even life-threatening infection. Invasive group A strep infections need to be treated in hospital. Close or family contacts of confirmed cases may be offered antibiotics (prophylaxis) after discussion with local health protection teams. 

Group A strep is spread through coughs or sneezes or from a wound of an infected person. Close contact should be avoided to prevent the spread of the infection.  

Find out more about strep A on the NHS website.

Hand, foot and mouth disease 

People with hand, foot and mouth disease can come to the setting and interact with others as usual. 

You do not usually need to contact your health protection team about hand, foot and mouth disease.  

Contact your local health protection team if there is an unusually high number of people at your setting with hand, foot and mouth disease. 

Managing hand, foot and mouth disease 

If someone at your setting has hand, foot and mouth disease, encourage everyone to wash their hands frequently using soap and water and have good respiratory hygiene. 

People with hand, foot and mouth disease should get medical advice quickly if they have any complications, including: 

• high temperature (fever)
• headache
• stiff neck
• back pain

People most affected by hand, foot and mouth disease 

Younger children and staff involved in toileting 

Younger children are more at risk of getting hand, foot and mouth disease, because they often play close together. 

Anyone who changes nappies or helps with toileting should, wash their hands frequently using soap and water because of their risk of contact with an infected person’s poo. 

Pregnant women  

Pregnant women should avoid close contact with anyone who has hand, foot and mouth disease. This is because: 

• hand, foot and mouth disease can cause a high fever
• getting hand, foot and mouth disease soon before giving birth means the baby can be born with a mild version of the disease

Pregnant women who have been in contact with someone who has hand, foot and mouth disease should get advice from their doctor or midwife. 

About hand, foot and mouth disease  

Hand, foot and mouth disease is a viral infection that is common in children. It is usually a mild illness, and some people do not have any symptoms. In rare cases, hand, foot and mouth disease can be more serious.  

Hand, foot and mouth disease is spread by: 

• being around an infected person who is coughing or sneezing 

• direct contact with the infected person’s poo or body fluids, for example blood or urine 

People with hand, foot and mouth disease are infectious until a few weeks after their symptoms have stopped. They are most infectious during the first week of the illness. 

The incubation period for hand, foot and mouth disease (the delay between getting the infection and showing symptoms) is 3 to 5 days. Symptoms usually stop after 7 to 10 days. 

Hand, foot and mouth disease is different from foot and mouth disease, which is a more serious infection found in animals. 

Find out more about hand, foot and mouth disease on the NHS website.

Head lice (nits) 

People with head lice can come to the setting as usual and interact with others.  

You do not need to contact your health protection team about head lice. 

Managing head lice 

If someone at your setting has head lice you can encourage parents or carers to regularly check, clean and comb their child’s hair. This will help them find and treat head lice more quickly. 

About head lice 

Head lice are small insects that only live in human hair. Their empty eggs are called ‘nits.’ 

Head lice are spread by direct head-to-head contact. The insects cannot jump, fly or swim. Getting head lice has nothing to do with dirty hair. 

Head lice are common in young children and their families, because young children often play close together. 

The head lice can be seen with the naked eye. Symptoms such as itchiness usually start 2 to 3 weeks after coming into close contact with someone who has head lice. 

Find out more about head lice and nits on the NHS website.

Hepatitis A 

People with hepatitis A should stay away from the setting, or communal areas in residential settings, until 7 days after their symptoms started. For example, jaundice (yellowing of the skin and eyes). 

Contact your local health protection team about hepatitis A if there are 2 or more infected people at your setting who are linked, for example people in the same class, group or location.

If there is an outbreak of hepatitis A, your local health protection team will contact you to give you advice on what to do. 

Managing hepatitis A 

If someone at your setting has hepatitis A:  

• encourage everyone to wash their hands frequently using soap and water
• clean shared areas more regularly, for example kitchens and toilets  

Close contacts of people with hepatitis A may be offered a vaccine if they are not immune. This may include people the infected person lives with, for example in a residential setting. The health protection team will be able to advise on vaccines for hepatitis A. 

About hepatitis A 

Hepatitis A is a viral infection that affects the liver. The virus is highly infectious and is found in the poo of infected people. 

Hepatitis A is often caught outside of the UK, particularly in places with poor personal or public hygiene. People should get vaccinated before travelling to a place where hepatitis A may be more common.

Hepatitis A spreads through: 

• eating contaminated food or drinking contaminated liquids 
• touching your mouth, eyes or nose with contaminated hands or objects 
• close contact with an infected person, including having sex and sharing needles to take drugs
• drinking unclean water

Hepatitis A can be a mild illness which lasts one to 2 weeks, or a more serious illness that lasts several months. Young children may have mild infections with no jaundice, or even no symptoms at all. 

People with hepatitis A are infectious for 7 days from when their symptoms first appear. 

Find out more about hepatitis A on the NHS website.

Hepatitis B 

Most people with hepatitis B can come to the setting and interact with others as usual. People with acute (short-term) hepatitis B may be too sick to come to the setting. Follow their doctor’s advice about when they can come back. 

You do not need to contact your health protection team about hepatitis B. 

If a child shows signs of harm or risk, especially if they are under 13, you should follow local rules and make a safeguarding referral.

Managing hepatitis B 

If someone at your setting has hepatitis B: 

• use personal protective equipment (PPE) and a spill kit when cleaning up body fluids, for example diarrhoea or vomit 
• complete your setting’s accident book with details of injuries or incidents such as a bite or needlestick injury and get advice from a doctor. 

People with hepatitis B should not share personal hygiene items, for example toothbrushes, nail cutters and razors. 

About hepatitis B 

Hepatitis B is a viral infection that affects the liver. It is not common in children and young people in the UK. 

Hepatitis B is caused by infected blood, or other body fluids entering the bloodstream. For example: 

• having vaginal, anal or oral sex without using a condom or dam
• injecting drugs using shared needles
• being injured by a used needle
• having a tattoo or piercing with unsterilised equipment
• having a blood transfusion in a country that does not check blood for hepatitis B

Blood transfusions in the UK are checked for hepatitis B. 

Many people with hepatitis B do not have any symptoms, but they can still be infectious to others.  

The incubation period for hepatitis B (the delay between getting infected and showing symptoms) can be between 4 weeks and 3 months. 

Babies and people at higher risk of hepatitis B are offered the hepatitis B vaccine. 

Find out more about hepatitis B on the NHS website.

Hepatitis C 

People with hepatitis C can come to the setting and interact with others as usual.  

You do not need to contact your health protection team about hepatitis C.

If a child shows signs of harm or risk, especially if they are under 13, you should follow local rules and make a safeguarding referral.

Managing hepatitis C 

If someone at your setting has hepatitis C: 

• use personal protective equipment (PPE) and a spill kit when cleaning up body fluids, for example diarrhoea or vomit
• complete your setting’s accident book with details of injuries or incidents and get advice from a doctor
• make sure your setting has appropriate disposal containers and contracts in place for sanitary items, for example tampons and sanitary pads 

People with hepatitis C should not share personal hygiene items, for example toothbrushes, nail cutters and razors.

About hepatitis C 

Hepatitis C is a viral infection that affects the liver. It is caused by infected blood, saliva or other body fluids entering the bloodstream. For example: 

• sharing needles
• sharing razors or toothbrushes
• from a pregnant woman to her unborn baby
• through unprotected sex (not using condoms)

Many people with hepatitis C do not have any symptoms, but they can still be infectious to others.  

Find out more about hepatitis C on the NHS website.

HIV 

People with HIV can come to the setting and interact with others as usual. 

You do not need to contact your health protection team about HIV. 

Managing HIV 

If someone at your setting has HIV: 

• you should advise them and their sexual contacts to get medical advice, for example from a sexual health clinic or doctor
• if a child shows signs of harm or risk, especially if they are under 13, you should follow local rules and make a safeguarding referral 

About HIV 

HIV is a viral infection that affects the immune system. Without treatment, HIV can damage a person’s immune system and can cause AIDS (acquired immune deficiency syndrome). 

HIV treatment is so effective that people can expect to live long healthy lives. Most people treated with HIV have undetectable levels of virus, and cannot pass HIV on, even if they have sex without condoms. 

HIV is only found in the body fluids of people living with HIV. It spreads more commonly if someone living with HIV is not treated and through:  

• sexual contact with a person’s genital fluids, for example contact with semen or vaginal fluids during vaginal, anal and oral sex
• piercing the skin with a contaminated object, such as a needle or a syringe

Many people living with undiagnosed HIV do not have any obvious symptoms, but they can still infect others with HIV. It can take many years for symptoms to show after being infected with HIV. 

There are free HIV tests and treatment available for anyone living or studying in the UK regardless of residency status. There is no HIV vaccine.

There are ways to reduce the risk of catching HIV, for example: 

• using condoms correctly during sex

• preventative medication called pre exposure prophylaxis (PrEP), which can be taken daily 

• emergency medication called post-exposure prophylaxis (PEP) 

Both PrEP and PEP are available for free from sexual health clinics. The emergency PEP medication is also available out of hours from A&E departments. 

Find out more about HIV and AIDS on the NHS website.

Impetigo 

People with impetigo should stay away from the setting, or communal areas in a residential setting, until all sores or blisters have formed scabs, or until 2 days after starting treatment with antibiotics. 

You do not need to contact your health protection team about impetigo. 

Managing impetigo 

If someone at your setting has impetigo: 

• tell them or their parent or carer to get medical advice, for example from a pharmacist or doctor 
• encourage everyone to wash their hands frequently using soap and water 
• you should tell them not to touch or scratch their sores, or let other people touch their sores 
• clean toys and equipment more regularly  

People with impetigo should not share items with others, for example: 

• towels or flannels 

• plates, cups or cutlery 

About impetigo 

Impetigo is a bacterial infection of the skin caused by group A strep (GAS) or Staphylococcus aureus (Staph aureus). It is very contagious and mostly affects infants and young children.

Impetigo can happen on its own, or it can be a complication of another skin condition, for example eczema, scabies or insect bites. 

Impetigo is spread through: 

• direct physical contact with the infected skin 

• sharing towels, flannels or drinking utensils 

The incubation period for impetigo caused by GAS (the delay between getting infected and showing symptoms) is between 4 and 10 days.  

The incubation period for impetigo caused by Staph aureus is between 1 and 3 days.  

People with impetigo are infectious as soon as symptoms appear until all sores or blisters are crusted over, or until 2 days after starting treatment with antibiotics 

Find out more about impetigo on the NHS website.

Measles 

People with measles should stay away from the setting, or communal areas in a residential setting, until 4 days after their rash started. 

Contact your local health protection team if anyone at your setting has measles. They will tell you if you need to take any other actions. 

Managing measles 

If someone at your setting has measles, you should encourage all those who are not vaccinated to get up to date with the Measles, Mumps, Rubella and Varicella (MMRV) vaccine or Measles, Mumps and Rubella (MMR) vaccine, depending on their age. 

People at higher risk from measles 

Anyone who is unvaccinated, is at risk of catching measles and becoming unwell. 

Some people are at higher risk of complications from measles include: 

• people with a weak immune system (immunocompromised people) 
• pregnant women who have not been fully vaccinated against measles, or who have never had measles
• children under 12 months 

People at higher risk should get medical advice if they have been in contact with someone with measles, for example, from their doctor or midwife. 

Measles vaccination

The MMRV vaccine is the simplest and most effective way to protect people from measles. It needs 2 doses to work. This is part of the NHS vaccination schedule.  The MMRV replaced the MMR in the NHS vaccination schedule in 2026. The MMR vaccine is still available to children and adults born on or before 31 December 2019 who were not vaccinated against measles, mumps and rubella when they were younger.

You should encourage everyone in your setting to check they are up to date with their MMRV or MMR vaccine. 

Anyone who is not sure if they have had their two doses of MMRV or MMR should check their Red Book or contact their GP practice. You can catch up for free on the NHS whatever your age.  

There is no reason to exclude children who have been recently vaccinated as long as they are well. 

About measles  

Measles spreads very easily so anyone who is unvaccinated is at risk of catching it and becoming unwell. 

Measles is caused by a virus and is highly infectious. It is spread by: 

• being around an infected person who is coughing or sneezing
• breathing the same air as an infected person 

People with measles are infectious: 

• from 4 days before their rash started
• until 4 days after their rash started

The incubation period for measles (the delay between getting infected and showing symptoms) can be between 7 and 21 days. It is usually between 10 and 12 days. 

Find out more about measles on the NHS website.

Meningitis and meningococcal meningitis 

Most people with meningitis should stay away from the setting, or communal areas in residential settings, until they do not have symptoms.  

People with meningococcal meningitis should stay away from the setting until at least 24 hours after they started treatment with antibiotics. Close contacts of people with meningococcal meningitis do not need to stay away from the setting unless they have symptoms. 

Contact your local health protection team if anyone at your setting has a meningococcal meningitis diagnosis.  

Managing meningitis 

If someone at your setting has meningitis, tell them or their parents or carers to get medical advice immediately. 

Meningitis vaccination 

The NHS vaccination schedule protects people against many causes of meningitis. This includes mumps, polio, Haemophilus influenzae type b (Hib), pneumococcal meningitis and 5 groups of the meningococcal bacteria (A, C, W, Y and B).

You should encourage everyone to stay up to date with their vaccinations. 

There is no vaccination for some types of meningitis. 

About meningitis 

Meningitis is a general term for an inflammation of the membranes that cover the brain and spinal cord (meninges).  

Meningitis can be caused by a range of germs including: 

• viruses 
• meningococcal bacteria 
• other bacteria, for example Hib and pneumococcus 

Viral meningitis is more common and less serious than bacterial meningitis.  

The incubation period for meningitis (the delay between getting infected and showing symptoms) varies depending on the cause. For bacterial meningitis, the incubation period is between 2 and 10 days.

About meningococcal meningitis and septicaemia 

Meningitis caused by meningococcal bacteria is called meningococcal meningitidis.  

Meningococcal meningitis can sometimes lead to blood poisoning or sepsis (septicaemia). Together, meningococcal meningitis and septicaemia are known as ‘invasive meningococcal infection.’

Meningococcal disease needs urgent medical attention. It is rare but life-threatening and can cause long-term complications.  

A septicaemic rash will be visible through a clear glass pressed to the skin (the glass test). This is a symptom of blood poisoning (sepsis) and needs immediate medical attention.  

Meningococcal infection is spread through: 

• respiratory droplets
• direct contact with nose and throat secretions

The bacteria can only be passed to others after a long period of close contact, for example with someone in the same household or through prolonged kissing. People may be offered antibiotics and a vaccine if they have had significant, close contact with someone with meningococcal disease in the last 7 days.

People with meningococcal meningitis are infectious until 24 hours after starting antibiotics.

Find out more about meningitis on the NHS website.

MRSA 

People with MRSA (methicillin-resistant Staphylococcus aureus) infections can come to the setting and interact with others as usual. 

You do not need to contact your health protection team about MRSA infections. 

Managing MRSA infections 

If someone at your setting has an MRSA infection: 

• cover all of their infected wounds, for example with plasters 
• encourage everyone to wash their hands frequently using soap and water 
• clean shared areas more regularly   

About MRSA 

MRSA is a type of bacteria. Staphylococcus aureus bacteria often live on healthy skin and can cause infections (staph infections). Sometimes these infections are very serious.

Most MRSA infections can be treated with more common antibiotics. Some are more resistant. Those resistant to the antibiotic methicillin are termed MRSA and often require different types of antibiotics to treat them.

MRSA bacteria spread mainly by direct contact with contaminated hands and objects. 

Find out more on the NHS website about: 

• MRSA  

• staph infections

Mpox 

If someone at your setting has mpox they should stay away from the setting, or communal areas in residential settings, until their health care professional confirms it’s safe for them to return, or in line with any current guidance.

You should advise them to seek prompt medical advice if their illness is worsening.  

Contact your local health protection team for further advice on management and support for anyone considered a close contact of the confirmed case. 

Managing mpox 

If someone at your setting has mpox you should advise them to seek prompt medical advice if the illness is getting worse 

People at higher risk from mpox 

Mpox is usually a mild illness. Some people are at higher risk of serious complications if they get mpox, for example: 

• children under 5 years 

• pregnant women 

• people with weakened immune systems 

Mpox vaccination 

Vaccination within 4 days of contact with mpox may provide some protection against catching the disease. 

The mpox vaccine may also be offered up to 14 days after contact for people at higher risk of serious complications if they get mpox. These include: 

• children under 5 years 

• pregnant women 

• people with weakened immune systems 

About mpox 

Mpox is a rare disease that is caused by infection with a virus called MPXV. 

The risk of catching mpox in the UK is low. 

Most people who get mpox recover within several weeks. However, severe illness can occur in some individuals. 

Mpox does not spread easily between people, unless there is close contact. 

Spread between people may occur through: 

• direct contact with rash, skin lesions or scabs (including during sexual contact, kissing, cuddling or other skin-to-skin contact)
• contact with bodily fluids such as saliva, snot or mucous
• contact with clothing or linens (such as bedding or towels) or other objects and surfaces used by someone with mpox

People with mpox are infectious: 

• from when their symptoms started
• until their rash has formed scabs and all the scabs have fallen off and there is intact skin underneath
• the scabs may also contain infectious virus material

The incubation period for mpox (the delay between getting infected and showing symptoms) is between 5 and 21 days. 

Find out more about mpox on the NHS website.

Mumps 

People with mumps should stay away from the setting, or communal areas in a residential setting, until at least 5 days after the swelling on the side of the face and under the ears starts.

You do not need to contact your health protection team about mumps unless there is an outbreak in your setting.

Managing mumps 

If someone at your setting has mumps: 

• tell them or their parent or carer to get advice from a doctor 
• encourage everyone to wash their hands frequently using soap and water 
• encourage everyone, including staff, to check they are up to date with their MMRV or MMR vaccinations

Anyone who is not sure if they have had their 2 doses of the MMRV or MMR vaccines should check their Red Book or contact their GP practice. You can catch up for free on the NHS whatever your age.  

People at higher risk from mumps 

Mumps is usually a mild illness in young children. Males over the age of puberty are at higher risk of serious complications if they get mumps. 

Mumps vaccination 

The MMRV vaccine is the simplest and most effective way to protect people from mumps. It needs 2 doses to work. This is part of the NHS vaccination schedule. 

The MMRV vaccine replaced the MMR in the NHS vaccination schedule in 2026. The MMR vaccine is still available to children and adults born on or before 31 December 2019 who were not vaccinated against measles, mumps and rubella when they were younger.

There is no reason to exclude children who have been recently vaccinated as long as they are well. 

About mumps 

Mumps is caused by a highly infectious virus. It is spread by: 

• droplets from the nose and throat
• saliva

Find out more about mumps on the NHS website.

Norovirus

People with norovirus should stay away from the setting, or communal areas in a residential setting, until at least 2 days after their diarrhoea or vomiting have stopped. See Diarrhoea and vomiting.

Contact your local health protection team about norovirus if: 

• there are 2 or more people at your setting with similar symptoms and who are linked, for example, people in the same class, group or location  
• there is an unusually high number of absences at your setting 
• the number of absences is increasing quickly 

Managing norovirus 

If someone at your setting has norovirus: 

• encourage everyone to wash their hands frequently using soap and water 
• clean shared areas more regularly, for example kitchens and toilets using a bleach-based cleaning product where possible 
• use personal protective equipment (PPE) and a spill kit when cleaning up body fluids, for example diarrhoea or vomit 
• limit contact of symptomatic individuals with other to prevent spread 
• wash all dirty clothes, bedding and towels on the hottest possible cycle of the washing machine and tumble dry, if available
• they should not prepare food for others until they have been symptom-free for at least 2 days 

The use of alcohol hand gel is not effective against norovirus. 

People at higher risk from norovirus 

Most people usually recover from norovirus infection within 2 to 3 days, however some groups including young children and elderly or people with a weakened immune system are at risk of serious complications. For example, they may become dehydrated and may need to go to hospital.

About norovirus 

Norovirus is the most common cause of diarrhoea and vomiting (gastroenteritis) in England. It is also known as the ‘winter vomiting bug’.

Norovirus is highly infectious and spread when the virus enters the gut through the mouth: 

• contact with an infected person, particularly if changing nappies or clearing up vomit 
• hand to mouth contact 
• contact with contaminated surfaces or objects such as bathrooms, equipment, toys, or dirty nappies 
• eating contaminated food, for example which has been prepared by someone who is infected with norovirus 

Find out more about norovirus on the NHS website.

PVL-SA 

People with PVL-SA (Panton-Valentine Leukocidin Staphylococcus aureus) infections should stay away from the setting if they have any wounds that cannot be covered with a plaster or bandage.

Contact your local health protection team if there are 2 or more people at your setting with similar symptoms and who are linked. For example, people in the same class, group or location.  

Managing PVL-SA infections 

If someone at your setting has a PVL-SA infection: 

• do not let them go into gyms or swimming pools until their wounds have healed 
• tell them to keep their wounds covered, for example with plasters 
• regularly clean surfaces the infected person has touched, and clean shared areas more regularly, for example kitchens, toilets and locker rooms  
• encourage everyone to wash their hands frequently using soap and water 
• and good respiratory hygiene 

People with PVL-SA infections should not share items that touch their infected skin, for example: 

• towels or flannels 
• razors 
• pillows or bedding 

People at higher risk from PVL-SA infections 

People with long-term skin conditions, for example eczema, are more at risk of getting PVL-SA infections. 

PVL-SA infections are more likely when people are in close contact. This includes: 

• living with an infected person, for example in boarding schools or residence halls
• playing close contact sports with an infected person
• touching surfaces or equipment that an infected person touches, for example gym equipment or towels

About PVL-SA infections 

PVL-SA are a type of bacteria. Staphylococcus aureus bacteria often live on healthy skin and can cause infections (staph infections). Sometimes these infections are very serious.

PVL-SA bacteria are spread by touching contaminated objects or surfaces. They produce a toxin and can cause various problems if they get into the skin, for example through an open cut or graze.

PVL-SA infections can be more serious if the bacteria get into the bloodstream. For example, if the skin is pierced by a contaminated object.

Find out more about staph infections on the NHS website.

Respiratory infections

People do not need to stay away from the setting if they only have mild respiratory symptoms, for example, if they have a:

• runny nose
• sore throat
• mild cough
• headache

People should stay away from the setting if they have more respiratory symptoms, for example a high temperature (fever).

Contact your local health protection team about respiratory infections if: 

• there is an unusually high number of absences at your setting 
• the number of absences is increasing quickly 
• you have had serious respiratory infections at your setting, for example if someone has been kept in hospital overnight 

After getting a positive COVID-19 test result

People aged 18 or younger with a positive COVID-19 test result, should stay away from the setting, or communal areas in a residential setting, for 3 days. After 3 days, if they feel well and do not have a high temperature, the risk of passing the infection on to others is much lower and can return to the setting.

People aged over 18, should stay at home and avoid contact with other people for 5 days. At the end of this period, if they have a high temperature or feel unwell, they should continue to follow this advice until feeling better and any temperature has gone. 

Household contacts of someone with a positive COVID-19 test result can come to the setting as usual.  

Children and young people should not be tested for COVID-19 unless instructed to by a health care professional. 

Managing respiratory infections 

If someone at your setting has a respiratory infection, encourage everyone to have good respiratory hygiene. 

Regular cleaning using standard cleaning products such as detergents are an important part of reducing transmission. 

Frequently touched surfaces such as door handles, light switches and work surfaces should be wiped down twice a day and one of these should be at the beginning or the end of the working day. 

Cleaning frequently touched surfaces is particularly important in bathrooms and kitchens. 

Ensure occupied spaces are well ventilated and let fresh air in. Read more about ventilation to reduce the spread of respiratory infections including COVID 19.

Advise everyone to follow the guidance on living safely with respiratory infections, including COVID-19. 

People at higher risk from respiratory infections 

Respiratory infections are usually mild illnesses. 

Some children are at higher risk of serious complications if they get a respiratory illness, such as: 

• younger children, particularly infants (under 12 months) 
• children with serious underlying medical conditions, including asthma, major congenital conditions (present from birth) or profound and multiple learning disabilities that can affect breathing

About respiratory infections 

Respiratory infections are common, especially during the winter months (November to February). Common respiratory infections include: 

• common cold 
• flu
• COVID-19
• respiratory syncytial virus (RSV) 

The symptoms of different respiratory infections can look very similar. It is not easy to know which illness a person has, just based on their symptoms. 

Respiratory infections can spread easily through: 

• being around an infected person who is coughing, sneezing, talking or singing 
• touching contaminated objects or surfaces, then touching your mouth, eyes or nose 

Find out more about: 

• resources for the flu vaccine programme
• respiratory tract infections on the NHS website
• common cold on the NHS website
• flu on the NHS website
• COVID-19 on the NHS website
• respiratory syncytial virus

Respiratory syncytial virus (RSV) 

See Respiratory infections. 

Find out more about RSV vaccines on the NHS website.

Ringworm 

People with ringworm should stay away from the setting, or communal areas in a residential setting, until they have started treatment. 

You do not need to contact your health protection team about ringworm. 

Managing ringworm 

If someone at your setting has ringworm: 

• tell them or their parents or carers to get advice from a pharmacist or doctor 
• tell them not to touch or scratch the infected skin, to avoid spreading the rash to other areas of their body 
• if they have ringworm on their feet, tell them to wear footwear at all times in the setting, especially in showers and changing rooms. See Athlete’s foot. 
• encourage everyone to wash their hands frequently using soap and water 

People with ringworm should not share items that touch their infected skin, for example: 

• towels or flannels
• pillows or bedding
• clothing, socks or shoes

About ringworm 

Ringworm is a general term for rashes caused by different types of fungus. Ringworm infections can affect many different parts of the body. 

Ringworm is spread by: 

• touching the infected skin of a person or animal 
• touching surfaces or objects that infected skin has touched 

Find out more about ringworm on the NHS website.

Rotavirus 

People with rotavirus should stay away from the setting, or communal areas in a residential setting, until 2 days after any diarrhoea or vomiting have stopped.  

See Diarrhoea and vomiting. 

You do not need to contact your health protection team about rotavirus. 

Managing rotavirus 

If someone at your setting has rotavirus: 

• encourage parents and carers of babies under 24 weeks to get the rotavirus vaccine  

• encourage everyone to wash their hands frequently using soap and water 

• clean shared areas more regularly, for example kitchen and toilet areas  
• use personal protective equipment (PPE) and a spill kit when cleaning up body fluids, for example diarrhoea or vomit 

People at higher risk from rotavirus 

Rotavirus is more common in infants and younger children than in teenagers and adults. 

Rotavirus is usually a mild illness in adults. Most babies and children recover in 3 to 8 days. 

In rare cases, rotavirus can have serious complications. For example, babies with rotavirus can get dehydrated easily. People with a weakened immune system are more at risk of developing severe symptoms. If this happens, they may need to go to hospital. 

About rotavirus 

Rotavirus is highly infectious. It can spread at any time of year, but it is more common in the winter and spring months (January to April). 

Rotavirus spreads easily through touching contaminated objects or surfaces, such as equipment, toys and dirty nappies, then touching your mouth, eyes or nose. 

Babies under 24 weeks are given oral vaccines against rotavirus as part of their NHS vaccination schedule. 

Find out more about rotavirus on GOV.UK.

Rubella 

People with rubella should stay away from the setting, or communal areas in a residential setting, until 5 days after their rash first started. 

In most cases, you do not need to contact your health protection team about suspected rubella. The health protection team will contact you if there is a confirmed case of rubella at your setting and you need to take action. 

Managing rubella 

If someone at your setting has rubella they will need to stay at home, or avoid communal areas in a residential setting, until 5 days after the rash started. Encourage anyone who has not had 2 doses of the MMRV or MMR vaccines to get vaccinated.

People at higher risk from rubella 

If a pregnant woman who is not immune gets rubella during the first 20 weeks of their pregnancy, there can be serious consequences for the unborn baby. 

Pregnant women should get advice from their doctor or midwife if: 

• they have not had both doses of the MMR vaccine, or are not sure if they are immune to rubella 
• they have been in contact with someone who has rubella 

Rubella vaccination  

The MMRV vaccine is the simplest and most effective way to protect people from rubella. It needs 2 doses to work. This is part of the NHS vaccination schedule. 

The MMRV vaccine replaced the MMR in the NHS vaccination schedule in 2026. The MMR vaccine is still available to children and adults born on or before 31 December 2019 who were not vaccinated against measles, mumps and rubella when they were younger.

There is no reason to exclude children who have been recently vaccinated as long as they are well. 

About rubella 

Rubella is caused by a virus and is highly infectious. 

Rubella is spread by: 

• respiratory droplets through coughing or sneezing 
• direct contact with the saliva of an infected individual 

Confirmed cases of rubella are quite rare, even if the person has a rash that looks like rubella. Someone who has had both doses of the MMRV  or MMR vaccine is very unlikely to have rubella.

People with rubella are infectious from one week before their symptoms started until 5 days after the rash first started. 

Find out more about rubella on the NHS website.

Scabies 

Younger children (5 and under) with scabies, or children with scabies who are unable to follow the guidance, should stay away from the setting, or communal areas in a residential setting, until 24 hours after they have completed their first treatment.  

Older children and young people with scabies can come to the setting as usual. They should be told to avoid close skin contact with others until after they have completed their first treatment. 

Residential settings should follow the UKHSA guidelines for managing cases in communal settings. 

Contact your local health protection team if there are 2 or more people at your setting with scabies and who are linked for example, by being in the same class, group or location. 

Managing scabies 

If someone at your setting has scabies or they suspect they have scabies, tell them to get medical advice from a pharmacist or doctor.

Close contacts of people with scabies, for example their family or household: 

• should also have treatment for scabies, if advised to by a pharmacist or other health care professional  
• do not need to stay away from the setting 

About scabies 

Scabies is a skin rash caused by tiny mites that burrow into the skin. The mites lay eggs in the top layer of the skin. The rash usually spreads across the whole body, except the head.  

Scabies spreads through close skin-to-skin contact, such as holding hands or sleeping in the same bed. 

The scabies rash is most commonly seen: 

• between the fingers 
• on the wrists, palms or elbows 
• on the genitals or buttocks 

People with scabies are infectious until they are treated. 

Find out more about scabies on the NHS website.

Scarlet fever 

People with scarlet fever should stay away from the setting, or communal areas in residential settings, until 24 hours after they started treatment with antibiotics.  

People who are not being treated with antibiotics should stay away from the setting, or communal areas in a residential setting, until their symptoms are gone. 

Close contacts of people with scarlet fever can come to the setting as usual, as long as they do not have symptoms. This includes siblings or household members. They should get medical advice if they develop scarlet fever symptoms. 

Contact your local health protection team if: 

• there are 2 or more people at your setting with scarlet fever in a 10-day period and who are linked – for example, by being in the same class, group or location 
• anyone at your setting has been kept in hospital overnight because of scarlet fever or invasive Group A Streptococcus infection or there is a death 
• you have cases of scarlet fever and chickenpox, or scarlet fever and flu, at your setting at the same time who are linked – for example, by being in the same class, group or location
• the outbreak continues for over 3 weeks, despite taking steps to control it and you are concerned that case numbers are still rising

The health protection team will tell you if you need to take any other actions. 

Managing scarlet fever 

If someone at your setting has scarlet fever: 

• tell them or their parent or carer to get medical advice 
• tell them to clean and cover all cuts, scrapes or other wounds, for example with plasters 

• encourage everyone to wash their hands frequently using soap and water and have good respiratory hygiene 

• clean shared areas more regularly, for example kitchen and toilet areas 

Clean shared objects and surfaces daily. For example: 

• wipe down equipment, hard surfaces, hard toys and sleep mats  
• machine wash soft toys 
• vacuum carpets and soft furnishings  

Some surfaces get touched a lot, for example door handles, taps and toilet flush handles. Clean these surfaces multiple times a day. 

About scarlet fever 

Scarlet fever is caused by group A strep (GAS) bacteria and is highly infectious. It is sometimes called ‘scarlatina.’ 

Scarlet fever mostly affects young children but can affect people of any age. It is usually a mild illness but can sometimes have more serious complications. For example, ear infections, rheumatic fever or kidney problems. 

The scarlet fever rash can sometimes be confused with the measles rash. The fever typically lasts 1 to 2 days. 

Scarlet fever spreads through: 

• close contact with someone carrying the bacteria 
• being near an infectious person who is coughing, sneezing, talking or singing 
• touching contaminated objects or surfaces, for example cutlery or toys, then touching your mouth, eyes or nose 
• through broken skin, such as an open cut or a bite wound 

The incubation period for scarlet fever (the delay between getting infected and showing symptoms) is usually between 2 and 5 days. 

Find out more about scarlet fever on the NHS website.

Shingles 

People with shingles should stay off work or school if the rash is still oozing fluid (weeping) and cannot be covered with loose clothing or a non-sticky dressing, or until the rash has dried out. 

They can come to the setting as usual once the blisters have formed scabs. 

You do not need to contact your health protection team about shingles. 

About shingles 

Shingles is caused by the same virus that causes chickenpox. When people get chickenpox, the virus remains in the body. It can cause shingles later in life when someone’s immune system is lowered.  

You can catch chickenpox for the first time from someone who has shingles, by touching the fluid from their rash. You cannot catch shingles from someone with shingles. 

People with shingles are infectious until their rash has formed scabs. 

Find out more about shingles on the NHS website.

Slapped cheek syndrome  

People with slapped cheek syndrome can come to the setting and interact with others as usual. 

You do not need to contact your health protection team about slapped cheek syndrome. 

Managing slapped cheek syndrome 

Advise people with slapped cheek syndrome, or their parent or carer, to get advice from their pharmacist or doctor if they have any unusual symptoms or other complications. 

People at higher risk from slapped cheek syndrome 

People at higher risk from slapped cheek syndrome include: 

• pregnant women, particularly in the first 20 weeks of pregnancy
• people with a weakened immune system (immunocompromised people)
• people with some inherited blood disorders

Pregnant women should get advice from their doctor or midwife if: 

• they have been in contact with someone who has slapped cheek syndrome
• they are in the first 20 weeks of their pregnancy

About slapped cheek syndrome 

Slapped check syndrome is caused by a virus. The name of the condition comes from the red rash it causes on the cheeks. It is also known as ‘parvovirus B19’ or ‘fifth disease’.  

Slapped check syndrome is common in children and is usually a mild illness. It spreads through the respiratory route 

People with slapped cheek syndrome are infectious from 3 to 5 days before the rash starts. 

Find out more about slapped cheek syndrome on the NHS website.

Threadworm 

People with threadworm can come to the setting and interact with others as usual. 

You do not need to contact your health protection team about threadworm. 

Managing threadworm 

If someone at your setting has threadworm: 

• tell them or their parent or carer to get advice from a pharmacist or doctor 
• tell them to keep their fingernails short

• encourage everyone to wash their hands frequently using soap and water

• clean shared areas more regularly, for example kitchen and toilet areas
• do laundry more regularly and on a hot temperature setting  

About threadworm 

Threadworm is a very common intestinal infection in children and it spreads very easily.  

Threadworms are tiny worms that live in the gut. The worms can be seen in the infected person’s poo or around their bottom. They look like pieces of white thread. 

Threadworm spreads by: 

• touching contaminated body parts, objects or surfaces, then touching your mouth
• touching surfaces or objects that the infected person has touched, for example bedding or clothing
• environmental dust

It is common for people to re-infect themselves, for example by not cleaning their hands after touching the infected area. 

Find out more about threadworms on the NHS website.

Tuberculosis (TB) 

Some kinds of tuberculosis (TB) are infectious, and some are not.  

People with non-infectious (latent TB) can come to the setting as usual.

People with infectious TB (active TB) should stay away from the setting for at least 2 weeks after they started taking antibiotic treatment and be guided by their health care professional before returning.

Close contacts of people with TB can generally come to the setting as usual. This includes siblings, friends or household members. However, they should stay away from the setting if advised to by your health protection team or by specialist TB services. 

If anyone at your setting has TB or suspected TB, contact your local health protection team, specialist TB services or a school nurse or health care professional.  

Managing tuberculosis

If someone at your setting has TB, get advice from your local health protection team, specialist TB services or a school nurse or health care professional. They can advise you on how to manage TB at your setting. Do not take any action without this advice.

Help the health protection team do a risk assessment for your setting and follow their advice. For example, they can advise you on sending out communications and they may recommend TB testing at your setting. 

About tuberculosis

TB is caused by bacteria, and it can infect any part of the body. 

TB can be infectious if it is in the lungs (active TB). Active TB is spread through: 

• breathing the same air as an infected person for a long period of time
• being around an infected person who is coughing or sneezing

The incubation period for TB (the delay between getting infected and showing symptoms) is usually between 4 and 12 weeks. 

Find out more about TB on the NHS website.

Typhoid and paratyphoid fever 

People with typhoid fever or paratyphoid fever should stay away from the setting, or communal areas in a residential setting, until at least 2 days after any diarrhoea and vomiting have stopped. See Diarrhoea and vomiting.

Some groups of people with typhoid or paratyphoid fever may need to stay away longer, for example: 

• young children
• people who handle food

Contact your local health protection team for advice about typhoid or paratyphoid fever.

Managing typhoid and paratyphoid fever 

If someone at your setting has typhoid or paratyphoid fever: 

• encourage everyone to wash their hands frequently using soap and water 
• clean shared areas more regularly, for example kitchen and toilet areas  

About typhoid and paratyphoid fever 

Typhoid and paratyphoid fever are uncommon illnesses caused by bacteria. They are usually caught outside of the UK. 

Typhoid and paratyphoid fever can have no symptoms, but sometimes they are very serious, even life-threatening. They are spread through eating contaminated food or drinking contaminated liquids. 

The incubation period for typhoid fever (the delay between getting infected and showing symptoms) is usually between 1 and 3 weeks. Symptoms of typhoid fever can last for several weeks or months. 

The incubation period for paratyphoid fever is usually between 1 and 10 days. Symptoms of paratyphoid fever usually last for a few days. 

Find out more about: 

• typhoid fever on the NHS website 
• typhoid and paratyphoid fever at Travel Health Pro

Whooping cough (pertussis) 

People with whooping cough should stay away from the setting, or communal areas in a residential setting, until either: 

• 2 days after they started taking appropriate antibiotics 
• 14 days from when their cough started, if they are not taking antibiotics 

People can come back to the setting after this even if they are still coughing. 

Contact your local health protection team if there are 2 or more people at your setting with similar symptoms and who are linked. For example, people in the same class, group or location.  

Managing whooping cough 

If someone at your setting has whooping cough: 

• tell them or their parent or carer to get medical advice form a pharmacist or doctor 
• encourage everyone to wash their hands frequently using soap and water and have good respiratory hygiene 

Whooping cough vaccination 

You should encourage parents or carers to have their child vaccinated against whooping cough. 

Babies should have all 3 doses of the whooping cough vaccine by the time they are 16 weeks old. Children are also given a pre-school booster. The vaccine and booster are part of the NHS vaccination schedule. 

People who are 16 to 32 weeks pregnant should also get vaccinated against whooping cough. This is so the baby can be protected as soon as it’s born. Those who are pregnant will usually be offered a whooping cough vaccine around the time of their mid-pregnancy scan (20 weeks).  

About whooping cough 

Whooping cough is a bacterial infection. The name comes from the ‘whoop’ noise that infected people often make as their cough gets worse.  

Whooping cough can be a serious illness in pre-school aged children and especially for very young babies.  

Whooping cough is spread by being around an infectious person who is coughing. 

Taking antibiotics can reduce the length of time that the person is infectious. 

Find out more about whooping cough on the NHS website.