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Health Alerts

The Snohomish Health District Health Officer Dr. Gary Goldbaum sends alerts via email to local health care providers. Alerts cover current local, regional or national health threats and important updates on medical care and protocols. Alerts are written as needed to cover urgent or emergent health issues.

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Influenza and child care settings

April 1, 2017

Today's topic: Influenza and child care settings

Action requested: Know when to exclude children and staff from a child care setting and when to authorize their return to a child care setting..

Background & Recommendations

Although the number of influenza cases is dropping rapidly, influenza continues to spread in the community. Recently the Health District learned that a child diagnosed with influenza was allowed to return to child care while still infectious.  It is particularly important to exclude staff and children with influenza symptoms who work in or attend early learning and child care programs. The infectious period extends from the day before signs and symptoms appear until at least 7 days after the onset of influenza.  Therefore, staff and children should be excluded from child care settings if they have signs or symptoms of illness (i.e., fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, muscle aches, nausea, vomiting, diarrhea).

Staff and children may return to the child care setting when:

  • Fever (100°F [37.8°C] taken under the arm or 101°F [38.3°] orally has been absent for 24 hours without the use of fever reducing medicines
  • They are feeling well enough to participate in all activities
  • Staff determine they can care for children without compromising their ability to care for the health and safety of all children in the group.

These recommendations and additional information can be found in the American Academy of Pediatrics, Managing Infectious Diseases in Child Care and Schools: A quick Reference Guide, 4th Edition, pages 109-110.  For a wide range of additional resources, see

You can find my recent health alerts posted on the Provider pages of our website, at

Gary Goldbaum, MD, MPH | Health Officer & Director | Administration

3020 Rucker Avenue, Ste 306 | Everett, WA 98201 | 425.339.5210 |


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Health alerts include information about diseases or other health risks or issues that affect Snohomish County.