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Very slow titration of lamotrigine to menstrual distress questionnaire generic evista 60mg line wards its target dose minimises this risk pregnancy 0-9 months safe evista 60mg, and patients must moni to menopause rash itching discount evista 60mg amex r for new rashes and s to women's health clinic topeka ks buy generic evista 60 mg p lamotrigine if they develop one (although 10% of patients develop a benign rash) 121 3. Sodium valproate can cause greatly elevated lamotrigine levels and, if used to gether, lamotrigine must be titrated very slowly 4) What else is good to knowfi Lithium should be considered the gold standard mood stabiliser, and has special properties including a specific antifisuicidal effect (separate from its effects as a mood stabiliser), as well as neurotrophic properties b. Lithium should ideally only be used in patients who are going to be compliant with its use. Poor compliance while on lithium may have a direct destabilising effect on patients with bipolar disorder c. All of the above mood stabilisers have tera to genic properties, especially valproate and carbamazepine, and young women with bipolar disorder need to be educated about this d. Young women with bipolar disorder can be reassured that having children is possible whilst on psychotropic medication, but that this needs to be carefully planned. Antipsychotics (especially atypicals) are often considered as mood stabilisers, but they are more effective in treating acute episodes of mania or depression in bipolar disorder than they are in preventing them f. Antidepressants tend to be “mood destabilisers” in bipolar disorder, and should only be used for short periods of time if needed. Especially if the patient is suffering from an episode of psychotic depression, is highly suicidal, or is at physical risk due to poor oral intake 2. An anaesthetic consult is needed to ensure that it is safe for the patient to receive a general anaesthetic 122 d. The centre of both electrodes are placed in a position overlying the temporal bones (the centre of the electrode is at a point 4cm above the midpoint of the outer canthus of the eye and tragus of the ear) 2. One electrode is over the right temporal bone (as above), while the centre of the second electrode is placed just to the right of a point where a line drawn from the middle of the skull intersects with a line drawn between the two external acoustic meatuses) ii. Used for patients with severe depression who require rapid improvement of symp to ms b. The anaesthetic doc to r will apply a bite block in the patient’s mouth (so that their teeth are not damaged when their masseter muscles contract), and supplement their oxygen levels using a bag and mask vi. The patient is observed in a recovery bay to ensure that they regain consciousness and can support their own airway 5) What are the sidefieffectsfi Given our frequent use of psychotropic medication, it is important to be aware of medication related sidefieffects which are potentially lifefithreatening. A potentially fatal syndrome caused by dopamine blockade with resulting sympathetic overactivity i. Speak to the onficall to xicologist, and the patient may need treatment in a high dependency or intensive care setting 4. Start depot antipsychotics only after a patient to lerates an oral course of the same antipsychotic d. A potentially fatal syndrome caused by overactivity of sero to nergic pathways in the brain i. Usually occurs in the context of a deliberate overdose, but may occur in the context of unintentional drug interactions 2. Speak to the onficall to xicologist, and the patient may need treatment in a high dependency setting 4. Always look at a patient’s full list of medications prior to commencing them on an antidepressant to avoid unintentionally inducing a sero to nin syndrome (tramadol is a common one to look out for) 2. Cyproheptadine is a sero to nin antagonist that can be used in sero to nin syndrome, but this will depend upon advice from a to xicologist 3. As mentioned previously, eating disorders have the highest rates of mortality of any psychiatric disorder, particularly anorexia nervosa. This reflects the potentially lethal medical consequences that are a result of restricted eating and purging behaviours b. Thus, the care of patients with eating disorders requires us to exercise our skills as medical doc to rs, as we well as our specialist training in mental health c. You will, at one point or another, be required to assess a patient with anorexia who has presented to the emergency department. As with any other patient, you will aim to identify any serious harms to the patient, with a focus on assessing the medical state of the patient, as an anorexic patient with serious physical decline is a medical emergency d. Hyponatremia, if severe and rapid in onset, can lead to confusion and seizures ii. Rapid refeeding in anorexic patients can lead to a sharp rise in insulin levels with shifting of phosphate, magnesium, and potassium in to the intracellular compartment (deficits of these three electrolytes is thought to be vital to the pathogenesis of the disorder) 2. This can lead to cardiac failure (due to fluid retention), hypoglycaemia or hyperglycaemia, Wernicke’s encephalopathy (due to reduced thiamine levels), renal failure due to rhabdomyolysis, and respira to ry compromise iii. Ongoing starvation can reduce cardiac muscle mass and predispose an individual to decompensated heart failure b. Patient’s with anorexia often present as bradycardic and may develop significant postural hypotension c. Prolonged starvation can lead to blood dycrasias, including neutropenia, anaemia, and thrombocy to penia. An “inpatient psychiatric admission” would involve an admission to a psychiatric unit which has expertise in managing patients with eating disorders 2. A patient with an eating disorder, even if admitted to a mental health ward, will have a medical management plan in place, including a plan for refeeding guided by a dietitian i. It is still your responsibility as the psychiatry registrar on call to take an active interest in the physical health of these patients admitted to mental health wards. To moni to r the physical health of patients with anorexia, and seek help if you think a patient is at risk of physical deterioration 4) Delirium a. As a part of your afterhours shifts you will be asked to assess patients in medical wards who have new onset psychiatric symp to ms. A substantial portion of these patients will end up having an episode of delirium, which is suggested by: i. Medical teams may have formed the view that the patient is a “mental health patient”, as they may have psychiatric symp to ms d. This can be dangerous as delirium (otherwise known as an acute encephalopathy) is the equivalent of “acute brain failure”, just as the kidney can suffer from “acute renal failure”, and the liver from “acute hepatic failure”: i. Prolonged delirium is associated with worse medical outcomes, as well as cumulative cognitive deficits which worsen the longer a patient is delirious (particularly for older patients) ii. Explain to medical and nursing staff why you think delirium is the main diagnosis ii. In a minority of cases, medications may be necessary to manage a patient’s behavioural symp to ms, including psychotic symp to ms from the delirium: 1. It should be noted that there is no good quality evidence for the use of antipsychotics in delirium, but there is evidence that they may be harmful in certain population groups (Agar et al, 2017) 5) Alcohol withdrawal a. Patients with substance misuse problems are at risk of developing withdrawal symp to ms when admitted to medical or psychiatric wards b. It is important to be aware of how to recognise and treat alcohol withdrawal, because: i. Alcohol withdrawal can be associated with significant patient discomfort, the risk of withdrawal seizures, and delirium c. Patients may start drinking first thing in the morning to avoid withdrawal symp to ms 6. Alcohol becomes a major part of the patient’s life (referred to as “salience”), and its use causes the patient dysfunction. These somatic features of withdrawal usually occur within 12 hours, peak within 48 hours, and may last for a few days up to 2 weeks: 1. Withdrawal seizures may occur as early as within 12 hours of the patient’s last drink. Explanation and reassurance to the patient that their uncomfortable symp to ms will be attended to, whilst remaining nonfijudgemental. Developing a simple set of relaxation measures the patient can use to manage their anxiety. Utilising benzodiazepines to manage the symp to ms of withdrawal as well as prevent withdrawal seizures: 1. There are many ways to dose benzodiazepines, and diazepam is usually the agent of choice.
Schools shall: (1) Notify the local health department of cases menstrual every 2 weeks order line evista, suspected cases menstrual 3 times a month evista 60 mg line, outbreaks menopause questions and answers discount evista line, and suspected outbreaks of disease that may be associated with the school women's health clinic olympia wa trusted 60 mg evista. The following rules and regulations are adopted under the authority of chapter 43. The burden of proving the existence of one or more of the circumstances identified in (a) through (e) of this subsection shall be on the person asserting such existence. A copy of this publication is available for review at the department and at each local health department. This requirement can be satisfied by: (a) Arranging for the referral labora to ry to notify either the local health department, the department, or both; or (b) Forwarding the notification of the test result from the referral labora to ry to the local health department, the department, or both. Each local health jurisdiction, as well as the department, maintains after-hours emergency phone contacts for this purpose. A party sending a report by secure facsimile copy or secure electronic transmission during normal business hours must confirm immediate receipt by a live person. Reports during normal public health business hours may be sent by secure electronic transmission, telephone, or secure facsimile copy of a case report. A party sending a report outside of normal public health business hours must use the after hours emergency phone contact for the appropriate jurisdiction. Notification may be sent by written case report, secure electronic transmission, telephone, or secure facsimile copy of a case report. Such procedures will also prescribe the steps that will be taken to remove the danger to others. The district will require that the parents or guardian complete a medical his to ry form at the beginning of each school year. The nurse or school physician may use such reports to advise the parent of the need for further medical attention and to plan for potential health problems in school. The board authorizes the school principal to exclude a student who has been diagnosed by a physician or is suspected of having an infectious disease in accordance with the regulations within the most current Infectious Disease Control Guide, provided by the State Department of Health and the Office of the Superintendent of Public Instruction. The principal and/or school nurse will report the presence of suspected case or cases of reportable communicable disease to the appropriate local health authority as required by the State Board of Health. The principal will cooperate with the local health officials in the investigation of the source of the disease. The fact that a student has been tested for a sexually transmitted disease, the test result, any information relating to the diagnosis or treatment of a sexually transmitted disease, and any information regarding drug or alcohol treatment for a student must be kept strictly confidential. If the district has a release, the information may be disclosed pursuant to the restrictions in the release. A school principal or designee has the authority to send an ill child home without the concurrence of the local health officer, but if the disease is reportable, the local health officer must be notified. The local health officer is the primary resource in the identification and control of infectious disease in community and school. The local health officer, in consultation with the superintendent can take whatever action deemed necessary to control or eliminate the spread of disease, including closing a school. Diseases in a contagious state may be controlled by excluding the student from the classroom or by referring the student for medical attention. Staff members of a school must advise the school nurse and principal or designee when a student exhibits symp to ms of an infectious disease based on the criteria outlined in this procedure. The school nurse and principal or designee must be provided with as much health information as is known about the case in a timely manner so that appropriate action can be initiated. List of Reportable Diseases In consultation with the school nurse, the district will report suspected disease or disease with known diagnosis to the local health department as indicated on the Notifiable Conditions page of the Washing to n Department of Health’s website. Localized rash cases diagnosed as unrelated to a contagious disease, such as diaper rash, poison oak, etc. In addition to rash illnesses, any unusual cluster of infectious disease must be reported to the school nurse. The length of absence from school for a student ill from a contagious disease is determined by the directions given in the Infectious Disease Control Guide or instructions provided by the health care provider, or instructions from the local health officer. Follow-up of suspected communicable disease cases should be carried out in order to determine any action necessary to prevent the spread of the disease to additional children. Reporting At Building Level A student with a diagnosed reportable condition will be reported by the school principal or designee to the local health officer (or state health officer if local health officer is not available) as per schedule. When symp to ms of communicable disease are detected in a student who is at school, the regular procedure for the disposition of ill or injured students will be followed unless the student is fourteen years or older and the symp to ms are of a sexually transmitted disease. Call the parent, guardian or emergency phone number to advise him/her of the signs and symp to ms; 2. Keep the student isolated but observed until the parent or guardian arrives; and 4. Notify the teacher of the arrangements that have been made prior to removing the student from school; 5. Notify the school nurse to ensure appropriate health-related interventions are in place. Students should be asked to wash their own minor wound areas with soap and water under staff guidance when practicable. If performed by staff, wound cleansing should be conducted in the following manner: 1. Gloves must be worn when cleansing wounds which may put the staff member in contact with wound secretions or when contact with any bodily fluids is possible; 3. Hands must be washed before and after treating the student and after removing the gloves; and 5. Disposable sheath covers will be discarded in a lined trash container that is secured and disposed of daily. Body fluids of all persons should be considered to contain potentially infectious agents (germs). Body fluids include blood, semen, vaginal secretions, drainage from scrapes and cuts, feces, urine, vomitus, saliva, and respira to ry secretions; B. Sharps containers must be maintained upright throughout use, be tamper-proof and safely out of students’ reach, be replaced routinely and not be allowed to overfill. General cleaning procedures will include use of a 10 percent bleach solution to kill norovirus and C. The student will be accommodated in a least restrictive manner, free of discrimination, without endangering the other students or staff. To be effective, a release must be signed and dated, must specify to whom the release may be made and the time period for which the release is effective. Students thirteen and older must authorize disclosure regarding drug or alcohol treatment or mental health treatment. Students of any age must authorize disclosure regarding family planning or abortion. State law prohibits you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by state law. A general authorization for the release of medical or other information is not sufficient for this purpose. New employee training will be provided within six months from the first day of employment in the district. These rules and regulations are established as minimum environmental standards for educational facilities and do not necessarily reflect optimum standards for facility planning and operation. The following definitions shall apply in the interpretation and the enforcement of these rules and regulations: (1) "School" Shall mean any publicly financed or private or parochial school or facility used for the purpose of school instruction, from the kindergarten through twelfth grade. This definition does not include a private residence in which parents teach their own natural or legally adopted children. Ceiling height shall be the clear vertical distance from the finished floor to the finished ceiling. No projections from the finished ceiling shall be less than 7 feet vertical distance from the finished floor. No student shall occupy an instructional area without windows more than 50 percent of the school day. Sun control is not required for sun angles less than 42 degrees up from the horizontal.
Only the law of statistics mentions that statistical bodies must not publish data with less than three entities in any given cell presented menopause kidney stones order genuine evista. Examples include city women's health clinic fort campbell order 60mg evista with amex, county women's health and birth control generic evista 60mg, state women's health center fremont ca purchase cheapest evista and evista, country of residence, age, race/ethnicity, gender, salary, job position, etc. Because a very rare disease itself could be personally identifiable information, collecting and publishing information about rare diseases in patient registries requires careful consideration. Sharing information, data exchange across the borders could serve several purposes. Several infectious diseases spread from human to human and these do not respect country borders. Therefore, effectively tracking and preventing, or at least minimising the consequence of an outbreak, to the extent it is possible, prompt information sharing and data reporting is extremely important. For example, identification of best practices for reducing hospital readmissions could lead to the implementation of such practice by other health care providers, which could lead to significant cost reduction, and reduce avoidable hospital readmissions. At the same time, lack of services in certain geographical areas can also be identified and a new service may be established. The less time and distance is needed to travel, the better, especially in urgent care, to save life and also costs. It is important to differentiate ad hoc, irregular cross-border data sharing, data communication, which could also have significant public health value, from public health surveillance, which is, by definition, an ongoing, systematic data collection in a timely manner. For example: fi increasing mobility increases the risk of cross-country infections, fi for rare conditions setting up international databases or exchanging data is crucial to establish large enough cohorts to study a specific population or specific rare conditions such as genetic disorders, congenital malformations, and metabolic conditions. Harmonisation of registry data could lead to a reduced cost of managing and using these data, and better quality data would be available for analyses and various indica to rs. Data on environmental fac to rs like air pollutants, agricultural activities such as pesticide exposure can be linked and associations can be analysed. Several genetic research initiatives are going on in Europe and researchers look for data from different sources including patient registries. Inequalities and disparities in health outcomes by country or other fac to rs could drive establishing new or improved clinical guidelines and recommendations, and inform policy makers. The project had a mission to support equal and easy access to the rich resources of official microdata for the European Research Area, within a structured framework where responsibilities and liability would be equally shared. During its four-year lifespan the DwB worked to wards preparing a comprehensive European service with better and friendly metadata, a more harmonized transnational accreditation and a secure infrastructure that would allow transnational 215 access to the highly detailed and confidential microdata, both national and European, so that the European Union would be able to continuously produce cutting-edge research and reliable policy evaluations. Several important and relevant issues had been analysed and a few to ols had been developed in the life-span of the DwB: 1. What are the researchers’ ideas and expectation regarding the re-use of data for research purposes: the most important issues are search strategy, quick overview, good documentation, comparability, information about procedures, user generated context (see Analyses of legal frameworks for data re-use for research purposes have been performed and could be browsed via on-line visualization to ol: fryford. Frequently, a data search may reveal multiple sources of similar data types, but the metadata may reveal that the individual data sets are not compatible, as the data have not been collected in a consistent manner ” (14). Data compatibility is usually considered at technical level (same data structure and format, character coding etc. If we want to compile a national registry from regional ones, this technical compatibility is a prerequisite only, but far from sufficient. But it also can be done at aggregated level, where only sums and (weighted) average numbers are sent. In both cases it is important to be sure, for example, that each patient is registered in one regional registry only, so double counting is excluded. It is also important, that there are no definitional or methodological differences among the regional registries, or at least there should be awareness of such differences. Colloquially speaking, comparability means that one has to be sure to compare apples with apples and not peaches. The more common situation is that the differences that make raw data incomparable are known, and ways can be found to resolve them. Raw mortality figures of different populations are practically never comparable due to the different age structure of different populations. In other cases comparability problems arise from different definitions and categorisations. Contrary to the standardised death rate example, in such cases the problem cannot always be fully resolved. Metadata should describe what is counted in a registry, with what exceptions, how the measured entities are defined, what data collection methodology was applied etc. If there are known external or irrelevant fac to rs that influence the thing to be measured. Semantic interoperability between registries implies that the recipient system is not only able to handle the received information but also able to au to matically interpret it. It is possible that two registries that collect data for the same disease use different disease coding systems. Functional interoperability of such registries implies in such a case that the disease codes can be imported, but does not imply that the semantically identical codes are recognised or codes from one scheme is converted to the other one. Semantic interoperability comes in to question only if (at least one of) the systems are able to process information semantically: it makes inferences, or actions that depend entirely on the meaning of information, not on its syntax. Using standard terminology can help database and system developers, and can facilitate exchange of data among various systems. The following sections explain the standards used for structuring and encoding data. Lots of efforts have been made in this area to develop standards, which have obvious economic benefits as well. Here are a few examples of current standards developed and used for data exchange (see also chapter in 3. These standards define how information is packaged and communicated from one party to another, setting the language, structure and data types required for seamless integration between systems. It defines a set of rules for encoding data structures (including documents) in a textual data format which is both human-readable and machine-readable. An important aspect was the need for unambiguity, either across or within languages. The other reason was to represent the entirety of a domain by a limited number of concepts to conduct statistical studies. For example, diseases can be classified by location (according to the primarily affected organ), by aetiology (infectious, acquired, hereditary etc. Therefore a certain disease can be a member of many different, partially overlapping classes. Nomenclature is a system of terms that is elaborated according to pre-established naming rules. It also created to ols to enable the further development, scaling-up and maintenance of the model. Each concept in the Metathesaurus is assigned one or more semantic types, and they are linked with one another through semantic relationships. The Semantic Network provides these types and relations: there are 135 semantic types and 54 relationships in to tal. Usually the categories of one classification do not fit entirely in the categories of the other. Unless the underlying classifications are to tally identical, no mapping is possible between two coding systems without dis to rtion. The number of e-health applications available for mobile devices steadily increases. Developing communication standards for information and communication technologies to facilitate interoperability among systems and devices, provide privacy and security, and address the needs of the developing world is timely and important. Patients often consult medical information online, and turn to social media communities for peer- to -peer support and information. Most often, “population” is defined as a group or collection of individuals inhabiting a certain terri to ry or forming an interbreeding community. For example, the definition of stillbirths (gestational age cut-off point) varies by country and collecting information on the stillbirths population and comparing characteristics and prevalence could lead to false interpretation of data. When comparing rates of population-based registries, the residency status criterion, whether including or excluding non-resident persons living in a defined geographic area, is very important.
Syndromes
- Abnormal heartbeat
- Take yoga classes
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- Nephrotic syndrome
- Tooth and gum diseases
- Juvenile (Batten disease)
Refer to women's health article on birth control evista 60mg online a licensed health care provider for evaluation of secondary infection (such as skin infections from scratching) xymogen menopause purchase 60 mg evista otc, if suspected pregnancy over 45 generic evista 60mg line. Discreetly manage lice infestations so that the student is not ostracized women's health hands evista 60 mg line, isolated, humiliated, or psychologically traumatized. Routine or periodic classroom and schoolwide screenings are no longer recommended. Follow-up with the student and family to ensure that the infestation is being addressed appropriately until the infestation has ended. Have pro-active policies and procedures in place for dealing with head lice in schools. Such policies are not effective in controlling head lice outbreaks for the following reasons: • Many nits are more than 1/4 inch from the scalp, which means they have already hatched and have left an empty casing, or will not hatch because they are to o far away from the warm scalp to survive the nit stage. Educate school personnel and the parent/guardian in recognizing and managing a head lice infestation. This could include periodically providing information to families of all students on the diagnosis, treatment, and prevention of head lice. Assure students, parents/guardians, and staff that anyone can get head lice, and it is not an indication of lack of cleanliness. Educate school personnel and parents about the revised guidelines regarding “No Nit” school policies. The use of chemical sprays or “bug bombs” to treat the environment within the school setting is not recommended due to potential to xicity, harm to humans, and their lack of efficacy. Launder floor pillows, mats, and other shared fabric items regularly and dry in a hot dryer. Resources American Academy of Pediatrics: Head Lice Policy (2002) Statement of reaffirmation (2009) Policy revision (2010) aappolicy. Centers for Disease Control and Prevention, Head Lice Information for Schools. National Association of School Nurses, Position statement: Pediculosis Management in the School Setting. These complications include ear infections, diarrhea, pneumonia, encephalitis, and even death. Before the introduction of a measles vaccine in 1963, there were more than 500,000 measles cases a year and 500 deaths a year in the United States. The symp to ms include a cough; runny nose; red, itchy, watery eyes; and a high fever (as high as 103–105°F). Two to four days after the symp to ms begin; a raised, red rash will appear on the head and spread downward to become a full-body rash, usually lasting 5–6 days. Mode of Transmission Measles is spread from person- to -person by airborne droplets or by the nasal and throat secretions of an infected person. Incubation Period About 10 days (range 7–18 days) from exposure to upper-respira to ry symp to ms. Infectious Period Measles is infectious from one day before the beginning of the respira to ry symp to ms (usually about 4 days before the rash onset) to 4 days after the appearance of the rash. Any student with a rash illness, especially if fever and/or other symp to ms are present, should be referred to a health care provider for diagnosis. Report to your local health jurisdiction of suspected cases by telephone is manda to ry and must be immediate. Assure that the provider’s office staff is informed about possible measles before patient arrival in order to prevent transmission in the office waiting room. Be alert to any student with a high fever; cough; runny nose; red, itchy, watery eyes; and a rash. Be especially alert to symp to ms in students at about two weeks after international travel or travel to an area with known measles cases or after contact with someone with recent international travel or travel to an area with measles that has had a rash illness in the past 2–3 weeks. Support school administra to r in exclusion of susceptible students and staff as advised by your local health officer. However, there are still some adults born prior to 1957 that have had neither the vaccine nor the disease and thus remain susceptible. However, in the event of a single case of measles in a school, staff will have to produce proof of immunity or vaccination, and your local health officer will exclude susceptible staff. If a student in your school develops confirmed measles, your local health officer may require implementation of the following control measures: a. Exclude confirmed case from school until four full days have passed since the appearance of rash. Exclude students exempted from measles immunization or students without documentation of measles immunization for 21 days after last exposure, regardless of vaccine doses or immunoglobulin received after exposure. Outbreak control measures listed above also apply to all staff at the affected school. Provide a second dose of measles vaccine to all students with a his to ry of only one dose of measles vaccine. Students that do not receive a second dose of measles vaccine during an outbreak will be excluded from school. Instruct students never to share items that may be contaminated with saliva such as beverage containers. Future Prevention and Education Measles can be controlled and eventually eliminated if children are vaccinated fully and on time. Bacterial meningitis can be very severe and may result in brain damage, hearing loss, disability, and death. The two primary bacteria that cause meningitis are Strep to coccus pneumoniae (Pneumococcal) or Neisseria meningitides (Meningococcal). There are also vaccines for Pneumococcal and Meningococcal disease, but neither is required for school entry. Symp to ms of bacterial invasive disease can include bacteremia, meningitis, infected joints, or pneumonia and usually develop quickly (over several hours or up to 1–2 days) and include high fever and chills, stiff neck, headache, pho to phobia (light sensitivity), vomiting, and sometimes a rash, coma, and seizures. Diagnosis is made by a spinal tap and a blood or joint culture, depending on the symp to ms. When treatment with antibiotics is started early, the likelihood of survival is increased. Mode of Transmission Meningococcal disease is transmitted person- to -person through direct contact with respira to ry and throat secretions such as through kissing or coughing in close proximity. It may also be spread by sharing beverage containers, cigarettes, or other smoking related paraphernalia. Both meningococcal and pneumococcal organisms are often found in the upper respira to ry tract of healthy persons. Incubation Period Variable depending on the agent, for meningococcal disease usually 2–10 days, for pneumococcal disease usually 1–4 days. Infectious Period Meningitis is infectious until the bacteria is no longer present in discharges from the nose and mouth; susceptible organisms will disappear from the nose and throat within 24 hours after appropriate treatment is started. Report to your local health jurisdiction immediately suspected or confirmed cases of meningitis or outbreaks associated with a school. Report to your local health jurisdiction of confirmed invasive meningococcal disease is immediate and manda to ry. Referral to licensed health care provider of suspected cases is immediate and manda to ry for meningitis. Obtain accurate facts from your local health jurisdiction so appropriate information can be shared with school staff and parent/guardian of exposed students. Exclude from school until licensed health care provider releases student in consultation with your local health jurisdiction. Household or other close contacts that may have been exposed to the respira to ry secretions of a person with meningococcal disease should be referred to licensed health care provider for possible antibiotic prophylaxis. Schoolroom classmates, teachers, or other school personnel usually do not require antibiotic prophylaxis unless they have had prolonged, close exposure, such as best friends sharing lunch. However, classroom contacts should be observed for signs of illness and be advised to seek medical care promptly if any suspicious symp to ms occur. Teachers and the parent/guardian should contact their licensed health care provider or local health jurisdiction if they have further questions about preventive measures.
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