Athlete's foot (Tinea) factsheet

Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes. The correct name is tinea pedis.
The feet can provide a warm, dark, and humid environment which encourages fungal growth.

Who catches athlete's foot?

The warmth and dampness around swimming pools, showers and locker rooms has made the condition common amongst
people practising lots of sport, hence the name athlete's foot.
It is a very common skin disease, especially amongst teenagers and adult males. It is less common in women and in children
under 12.
It is not known why some people are more likely than others to catch athlete's foot.

How do you catch athlete's foot?

Athlete's foot is usually caught where bare feet come into contact with the fungus.
The warmth and dampness of changing rooms encourages fungal growth.
Infection can also spread through contaminated bed sheets and clothing.

How infectious is athlete's foot?

Athlete's foot is quite infectious.

What is athlete's foot like?

A person with athlete's foot has an itchy, scaly, dry rash on the bottom and sides of his or her feet and between the toes.
There can be inflammation and blisters on the bottom of the feet. The blisters can lead to the cracking of the skin exposing raw
tissue causing pain and swelling.
An infection of the toenails can occur at the same time. The toenails become crumbly and are hard to cut.
The fungus can spread if the infection is scratched and other body parts are then touched.
The initial stage of infection usually only lasts 1-10 days, but a persistent, untreated infection can persist for months or years.

How serious is athlete's foot?

Normally this is only a mild infection.

The blisters can lead to cracking skin which sometimes allows bacterial infections of the feet.

Can you prevent athlete's foot?

Good foot hygiene is the best way to prevent infection. You should:

Wash your feet daily and dry them carefully, especially between the toes.

Reduce foot perspiration by using talcum powder.

Avoid tight footwear, especially in summer.
Wear cotton socks that keep your feet dry and change them frequently, especially if you tend to sweat heavily.

Should a child with athlete's foot be kept off school?

The DfEE/DoH guidelines on infection control in schools and nurseries do not recommend that a child with athlete's foot
should be kept away from school. Precautions should be taken to ensure that the child does not walk around barefoot to
prevent the spread of infection.

How can you treat someone with athlete's foot?

The feet must be washed frequently. All areas between the toes must be dried thoroughly and then kept dry by dusting foot
powder in socks. Many cases need use nothing more than this.
In more severe cases lotions and creams that kill fungi are prescribed by doctors.
The whole course of medication must be taken otherwise the rash may disappear while the infection remains.
Early treatment is better as once infection has spread to the toenails it becomes harder to deal with.
Chickenpox fact sheet
Introduction

Chickenpox is an acute, infectious disease caused by the varicella-zoster virus and is most commonly seen in children under
10 years old. This virus, if re-activated in a person who has had chickenpox previously, can also cause shingles (herpes
zoster). Shingles tends to be more prevalent in adults.

It is not possible to develop shingles from exposure to a person with chickenpox. It is possible however, to develop chickenpox
as a result of exposure to a person with shingles.

Transmission

Chickenpox is highly contagious, infecting up to 90% of people who come into contact with the disease. Transmission is
through direct person to person contact, airborne droplet infection or through contact with infected articles such as clothing and
bedding. The incubation period (time from becoming infected to when symptoms first appear) is from 10 to 21 days.

The most infectious period is from 1 to 2 days before the rash appears but infectivity continues until all the lesions have
crusted over (commonly about 5 to 6 days after onset of illness).

Symptoms of Chickenpox

Chickenpox may initially begin with cold-like symptoms followed by a high temperature and an intensely itchy, vesicular (fluid-
filled blister-like) rash. Clusters of vesicular spots appear over 3 to 5 days, mostly over the trunk and more sparsely over the
limbs.

The severity of infection varies and it is possible to be infected but show no symptoms.

Shingles (Herpes Zoster)

Following chickenpox infection, the virus can lay dormant in the nervous tissue for several years but may reappear following
reactivation of the virus as shingles (also called herpes zoster). It is not known what causes the virus to reactivate but
reactivation is usually associated with conditions that depress the immune system such as old age, immunosuppressive
therapy and HIV infection.

The first sign of herpes zoster is usually pain in the area of the affected nerve - most commonly in the chest. A rash of fluid-
filled blisters then appears in the affected area, typically only on one side of the body. This rash is usually present for about 7
days but the pain may persist for longer. Persistent pain is more common in elderly people and is termed 'postherpetic
neuralgia'. On average this lasts for 3 to 6 months although it can continue for years.

As mentioned above, people with shingles are contagious to those people who have not had chickenpox. However, it is not
possible to catch shingles from a person who has chickenpox.

Possible Complications and High Risk Groups

Chickenpox is usually a mild illness and most healthy children recover with no complications.

Certain groups of people however, such as infants within the first four weeks of life, adults, pregnant women and those who
are immunocompromised due to illness or treatments such as chemotherapy or high-dose steroids, may experience more
serious complications. These include viral pneumonia, secondary bacterial infections and encephalitis.

Varicella infection in pregnant women can cause severe chickenpox with increased risks for the mother from varicella
pneumonia and other complications. It also carries the risk of congenital varicella syndrome for the foetus. Congenital varicella
syndrome can cause a range of problems including shortened limbs, skin scarring, cataracts and growth retardation.

Occasional cases of fetal damage following maternal varicella infection between 20 to 28 weeks gestation have been
reported but the risk is likely to be substantially lower than that of the typical congenital varicella syndrome that can occur in
the first 20 weeks gestation.

Infection with varicella in the later stages of pregnancy can cause premature delivery or neonatal chickenpox infection. This is
particularly serious if the mother becomes infected 7 days before birth.

For these reasons, pregnant women are offered immunoglobulin - a specially prepared vaccine containing preformed
antibodies to help fight the infection.
General information - Impetigo
Impetigo is a bacterial infection of the skin. It is caused by the same bacteria that commonly cause sore throats (group A
streptococci or Streptococcus pyogenesalthough it can also be caused by Staphylococcus aureus), or by mixtures of both
organisms. The skin becomes infected after bacteria enter through a break in the skin, such as a cut or insect bite.

Impetigo is not usually a serious condition and can be treated using antibiotic cream or tablets, but it is very infectious. It is
spread easily through person-to-person contact, or by sharing towels, clothes and other similar items. Outbreaks of impetigo
can occur in areas where there is close contact between people, for example in schools, nurseries or army barracks.

Health protection advice

Impetigo is extremely infectious, but basic hygiene measures can reduce the chances of spreading the infection to other areas
of skin and to other people.

The rash should be kept clean with soapy water and loosely covered, either with a gauze bandage or clothing

Avoid touching the rash, or letting other people touch it, as much as possible
Wash hands frequently, especially after touching the rash
Do not share flannels, sheets, towels with others. After using, these should be washed at a high temperature
Skin crusts should be removed before the application of ointments. Crusts may reappear
Avoid preparing food until at least 48 hours after starting treatment
Keep fingernails short
Avoid contact with newborn babies until the sores have stopped blistering or crusting, or until 48 hours after starting
treatment
Avoid close contact sports or going to the gym until crusting and blistering has stopped
Keep children with impetigo away from school or nursery until the sores have stopped blistering or crusting or until 48
hours after starting treatment
Healthcare workers should not have contact with patients and report to their Occupational Health department
To reduce the chance of catching impetigo, keep cuts and scratches clean and make sure that any conditions
involving broken skin (such as eczema or nappy rash) are treated quickly.

Impetigo - the symptoms?

There are two types on impetigo symptoms; bullous and non-bullous. Non-bullous is the most common, accounting
for up to 70% of cases.

Non-bullous impetigo

Begins with the appearance of red sores, usually around the nose and mouth

These sores burst quickly leaving yellow-brown golden crusts

The crusts then dry leaving a red mark that generally heals without scarring
The sores are not painful, but may be itchy. Other symptoms of infection, such as fever and swollen glands are rare,
but they may occur in more severe cases.

Bullous impetigo

Begins with the appearance of fluid-filled blisters, usually on the trunk of the body or the arms or legs

The blisters quickly spread and then burst after several days, leaving a yellow crust
The crusts dry and heal without scarring
The blisters are not painful, but the area of skin around them may be itchy. Other symptoms, such as fever and
swollen glands, are more common in bullous impetigo.

Complications

It is possible for the bacteria that cause impetigo to enter deeper into the body and cause further infection. Complications can
include:

Cellulitis - when the impetigo infection spreads to deeper layers of skin

 Lymphangitis - inflammation of the lymphatic vessels that carry lymph (water, electrolytes and proteins) from body
tissue to the bloodstream
Guttate psoriasis - a non-infectious skin condition that can develop in children and teenagers after a bacterial
infection. It causes small, droplet- shaped sores on the chest, arms, legs and scalp
Scarlet fever - a rare bacterial infection that causes a fine pink rash across the body
Septicaemia - a potentially life-threatening bacterial infection of the blood
Post-streptococcal glomerulonephritis - a very rare complication of impetigo that causes an infection of the small
blood vessels in the kidneys.

Complications like these are very rare, but anyone with impetigo should stay alert for changing or worsening symptoms.

Impetigo - how do you catch it?

You catch impetigo by coming into contact with the bacteria that cause it. This is usually through direct contact with someone
who is infected. You can also become infected by using towels, facecloths, clothes, or toys that have been used by someone
who is infected.

There are two types of impetigo; primary and secondary:

Primary impetigo is impetigo affecting skin which is otherwise healthy - for example, bacteria may enter the skin
through a small wound, such as a scratch and then start to multiply

Secondary impetigo is when another skin condition leads on to the infection. For example, if the skin is already
damaged by eczema, it is easier for the bacteria to gain entry and cause impetigo.

Anyone can catch impetigo, but it is most common in children and babies and in crowded environments (e.g. schools,
nurseries and army barracks).
Other risk factors include having diabetes, a weakened immune system and playing contact sports.

Impetigo - Diagnosis and Treatment

The characteristic skin lesions produced by impetigo usually makes it easy to diagnose. Occasionally, it may be
necessary for your doctor to take a swab from the affected area for laboratory testing to make the diagnosis, particularly if
the lesions are spreading despite treatment, or if there are complications, such as deeper spread.

Impetigo will normally clear up on its own after 2-3 weeks. However, more serious infections can occasionally
develop, so individuals with symptoms should go to their GP to rule out other potentially more serious infections and to
receive antibiotics to help clear the infection more quickly (usually in 7-10 days). This will also reduce the time during which
the patient is infectious, so fewer people will catch impetigo from them.
Antibiotics are usually given as a cream. This should be applied to the affected area after the crusts have been
cleaned off with warm soapy water. After applying the cream, you should wash your hands to avoid spreading the infection
to other parts of your body, or to other people.
If the rash is more extensive or is spreading rapidly, oral antibiotics (tablets) may be given instead of, or as well as, a
cream.
Impetigo is infectious as long as the blisters continue to produce fluid.
With treatment, impetigo stops being infectious after two days. Crusts can then re-appear, but children may return to
school and adults to work.

Influenza Factsheet for Schools

What is influenza?

Influenza or 'flu' is a viral infection that mainly affects the nose, throat and the lungs.

There are two main types of flu that cause infection; influenza A and influenza B. Influenza A is usually a more severe
infection than influenza B and although influenza B tends to occur most often in children it can affect any age.
Flu symptoms include the abrupt onset of fever, shivering, headache, cough, sore throat, aching muscles and joints.
There is a wide range of illness ranging from minor symptoms through to pneumonia. Flu symptoms are different from a
 cold as a cold is often limited to a runny nose, sneezing, watery eyes and throat irritation. The symptoms usually occur
gradually and do not cause a fever or body aches.
Usually what people call "gastric flu" is a gastrointestinal infection with another virus - usually norovirus or rotavirus.

Who catches influenza?

Anyone can catch flu; the highest rates of infection are usually in school age children.

Most influenza infections occur during the winter months.

The amount of illness occurring each year varies, depending on the particular strain that is circulating. Some
influenza viruses cause more severe illness than others. Hence in some winters people may be more unwell with flu than
in other years.
Pandemics of influenza (see Box 1) occur from time to time and the impact of these can vary enormously. The most
recent pandemic caused by H1N1 (2009) in 2009 was relatively mild, however, the most infamous pandemic was the
Spanish flu of 1918-19 which killed over 40 million people world wide (more people than were killed in the 1st World War).

Box 1: Definitions
Epidemic: Outbreak of a disease in which more cases than expected appear suddenly

Pandemic: An epidemic on a world wide scale.

How do you catch influenza?

Influenza is mostly caught by breathing in air containing the virus when an infected person coughs/sneezes or by
touching a surface where the virus has landed and then touching your mouth or nose.

How infectious is influenza?

Influenza is infectious and can spread rapidly from person to person. Some strains of virus are more infectious than
others, or cause more severe illness.

What is influenza like?

Influenza is worse than an ordinary cold. It usually starts suddenly with a high fever over 38.0C which can last for 3-4
days. A dry cough, headaches and chills are common as are general muscle aches and pains. A stuffy nose, sneezing and
a sore throat can also be present. The fever tends to decrease after the second day when a stuffy nose and a sore throat
become more noticeable. Some children may also feel sick (nausea), or have diarrhoea. Tiredness can last 2-3 weeks.

How serious is influenza?

Most people recover completely from influenza in a matter of days or a week. For others, for example older people,
pregnant women, those with other illnesses (such as chest or heart disease, or diabetes) and newborn babies, influenza
can be a serious illness.

Serious illness from influenza can be caused either by the virus itself causing a severe viral pneumonia, to a
secondary bacterial infection causing bronchitis and pneumonia or to a worsening of any underlying chronic medical
condition such as heart disease.

Listeria Factsheet
What is Listeria?

Listeria is a rare, but potentially life-threatening disease. Although some adults experience only mild infections of the eye and
skin, and gastroenteritis, it can lead to severe blood poisoning (septicaemia) or meningitis.

Pregnant women, the elderly and people with weakened immune systems, including those suffering from cancer, AIDS or
alcoholism, are more susceptible to listeria. It is particularly dangerous in pregnancy as it can cause a mild 'flu-like' illness
which is not serious to the mother but can cause miscarriage, premature delivery, stillbirth or severe illness in a newborn child.
How do you get listeria?

You usually become infected after eating food contaminated with the listeria bacteria. Foods associated with transmission are
most often ready-to-eat refrigerated and processed foods such as: pre-prepared cooked and chilled meals, soft cheeses, cold
cuts of meat, pts and smoked fish.

It is impossible to tell from its appearance whether food is contaminated with listeria. It will look, smell and taste normal.

Listeria is also widespread in the environment and can be found in raw food, soil, vegetation, sewage and in the faeces of
many mammals, birds, and fish.

Up to 5 per cent of the population may be carriers of the disease and do not become ill.

Pregnant mothers sometimes transmit the infection to their baby. This can happen in the womb or when giving birth.

How long does it take for symptoms to develop and how long will it last?

It can take from one to over 90 days for illness to develop. The average incubation time is about 30 days. A patient with
septicaemia or meningitis will be hospitalised for several weeks.

What is the treatment for listeria?

Listeria should be treated promptly with antibiotics. Patients with severe symptoms will need to be treated in hospital.

How can you avoid getting listeria?

Listeria is unusual because it not only grows at normal room temperature and up to about 40 C, but can grow at low
temperatures, including refrigeration temperatures of below 5 C. It is, however, killed by cooking food thoroughly in
conventional or microwave ovens and by pasteurisation.

Keep foods for as short a time as possible and follow storage instructions including 'use by' and 'eat by' dates

Cook food thoroughly, especially meat, ensuring that it is cooked through to the middle
Keep cooked food away from raw food
Wash salads, fruit and raw vegetables thoroughly before eating
Wash hands, knives, and cutting boards after handling uncooked food
Make sure that the refrigerator is working correctly
When heating food in a microwave follow heating and standing times recommended by the manufacturer
Throw away left-over reheated food. Cooked food which is not eaten immediately should be cooled as rapidly as
possible and then stored in the refrigerator
Pregnant women, the elderly, and people with weakened immune systems should not help with lambing or touch the
afterbirth

General Information on Mumps

Introduction

Mumps is an acute viral illness transmitted by direct contact with saliva or droplets from the saliva of an infected person.
Humans are the only known host of the mumps virus. Mumps is a notifiable disease, which means that a doctor who sees a
patient whom they suspect has mumps is required by law to report it.

The illness

Symptoms begin with a headache and fever for a day or two before the disease is characterised by swelling of the parotid
glands which may be unilateral (one side) or bilateral (both sides). However, at least 30% of cases in children have no
symptoms. Complications of symptomatic mumps include swelling of the ovaries (oophoritis), swelling of the testes (orchitis),
aseptic meningitis and deafness. Cases may have no salivary gland involvement but develop symptoms elsewhere (orchitis,
meningitis). Despite common belief there is no firm evidence that orchitis causes sterility. Other symptoms may include
pancreatitis, neuritis, arthritis, mastitis, nephritis, thyroiditis and pericarditis. Mumps was the commonest cause of viral
meningitis in children prior to 1988, when vaccine was introduced.

The incubation period is 14-21 days and mumps is transmissible from several days before the parotid swelling to several days
after it appears. Contagiousness is similar to that of influenza and rubella but not as infectious as chickenpox or measles.
Exposed individuals should be considered infectious from 12 to 25 days after exposure.

Treatment

There is no specific treatment for mumps. Treatment should be based on alleviating symptoms.

Prevention

Mumps vaccine is one of the components of MMR vaccine. The introduction of MMR vaccine in 1988 effectively halted the
three yearly cycles of mumps epidemics in young children.

There are two licensed MMR vaccines: Priorix (SKB) and MMR II (Aventis Pasteur). Both contain the Jeryl-Lynn strain of
mumps. The more reactive Urabe strain was used in the UK from 1988 until it was withdrawn in 1992 due to an unacceptable
risk of aseptic meningitis, although this was considerably lower than with natural mumps infection. There is no single antigen
mumps vaccine licensed in the UK , and single mumps vaccine has never been used as part of the national immunisation
schedule.

Frequently asked questions

Q. What is the reason for giving mumps vaccine?

A. Although rarely fatal, complications of mumps can include 1:

Aseptic meningitis in 10% of cases (usually without further complications)

Orchitis (usually unilateral) in up to 25% of post-pubertal males. Sterility seldom occurs.

Oophritis in 5% of post-pubertal females. Sterility seldom occurs.
Profound deafness occurring in one ear in 4% if cases (usually transient).
Encephalitis: Rates reported for encephalitis range from 0.02-0.3% of cases*.
Pancreatitis, neuritis, arthritis, mastitis, nephritis, thyroiditis and pericarditis may also occur.
Although no evidence of foetal abnormalities, mumps in the first trimester of pregnancy may increase the rate of
spontaneous abortion.