Schools are central to student learning, family stability, and community functioning. This guidance helps school administrators, nurses, teachers, and staff prevent illness, recognize when an outbreak may be occurring, and take well-coordinated actions that prioritize health while keeping schools open.
Outbreaks are unexpected increases in illness; report early
Generally, an outbreak in a school is any unexpected increase in illness within a group of students and staff over 24 – 72 hours.
This may include:
- A sudden rise in students with similar symptoms
- Absenteeism that is noticeably higher than usual
- A disease-specific definition being met, such as:
- 10% of a student population with respiratory symptoms in 24 hours
- Two or more cases of the same illness occurring close in time and place
For full definitions, refer to the Communicable Disease Quick Reference for Schools.
Reporting helps schools respond quickly and stay open
Schools should report outbreaks or any unusual increase in illness or absenteeism.
- If located in a County/Municipal Health Department (CMHD): Report directly to your local health department.
- If NOT located in a CMHD: Report to PA DOH. Report online at this survey link or contact your state health center or call 1-877-PA-HEALTH.
Why reporting matters:
Timely reporting helps health officials provide guidance, prevent wider transmission, and support your school’s operations.
PA County and Municipal Health Departments (CMHD):
Allegheny, Bucks, Chester, Delaware, Erie, Montgomery, Philadelphia, Allentown, Bethlehem, Wilkes-Barre, and York City
Illness spreads easily in schools; understanding this helps target prevention
Schools can bring together large groups of children and staff in shared indoor spaces. Illness often spreads through:
- Coughs, sneezes, and respiratory droplets
- Close contact during classroom activities, meals, recess, sports, and transportation
- Shared materials and surfaces
- Inadequate handwashing or hygiene habits
Everyday prevention keeps students healthy and learning
Core prevention strategies reduce the number of sick days and prevent outbreaks before they begin.
Improve air quality: Ensure existing heating and air conditioning systems meet the minimum outdoor air ventilation requirements in accordance with ventilation design codes. Bring in fresh outdoor air (open windows which can be safely opened), gather outdoors, or purify indoor air.
Cleaning, sanitizing, and disinfecting: Frequently wipe down frequently touched surfaces. Clean other surfaces when they are visibly dirty. Use appropriate cleaning and disinfecting supplies and follow the directions.
Hand hygiene: Provide soap and water, or an alcohol-based hand sanitizer with at least 60% alcohol. Encourage handwashing for at least 20 seconds or use hand sanitizer.
Respiratory etiquette: Encourage everyone to cover coughs or sneezes with a tissue or elbow, then wash their hands immediately.
Vaccines reduce lost school and work days and help prevent serious illness
Vaccinations: By staying up to date with recommended immunizations, individuals can protect themselves, their families, and their communities from serious vaccine-preventable diseases. Vaccinations are required for children to attend school in Pennsylvania. View the requirements.
Schools should encourage families and staff to stay up to date on all recommended vaccines. Routine vaccinations keep school and childcare communities protected. Annual flu and COVID-19 vaccination can also reduce absences for students and staff, supporting stable school operations.
When illness increases, add temporary layers of protection
When illness rises, schools can take more action. Additional strategies include:
Distancing and grouping: Use small groups and allow additional space. For example, when illness rates rise, consider keeping staff and students in the same groups all day to reduce the risk of spreading illness.
Illness monitoring: Keep track of illnesses and symptoms. Schools should create policies for monitoring illness. See below for symptoms which require exclusion.
Allow masking: When illness rates are increasing in your school or community, support individuals who choose this additional measure of protection.
Managing exposure: Handle contact with sick people carefully using proper personal protective equipment (PPE) and precautions. For example, if a student shows symptoms of a respiratory virus, offer a mask and a comfortable place to wait away from other students, like the nurse’s office, until their caregiver can take them home.
These temporary actions help control spread once illness is present.
Keep sick students and staff home until they are improving
Exclusion of sick students or staff:
- Fever, especially with a new rash or behavioral changes.
- Persistent vomiting.
- Persistent diarrhea. Diarrhea that causes ‘accidents,’ is bloody, or >=3 loose stools within a 24-hour period.
- Sores that are draining fluid and cannot be covered.
- Worsening respiratory virus symptoms (stuffy or runny nose, cough, sore throat) not caused by something else, like allergies.
Specific readmission guidelines include:
- No fever for at least 24 hours (without using fever-reducing medicine).
- Fever with a new rash has been checked by a doctor and fever is gone.
- Fever with productive cough has been checked by a doctor and fever is gone.
- Open sores are crusted over and under medical treatment.
- Vomiting has resolved overnight, and the child can hold down food/liquids prior to returning to school.
- Diarrhea has resolved. Bloody diarrhea should be evaluated by a healthcare provider before return.
- Respiratory symptoms are improving for at least 24 hours. Consider additional actions to prevent spreading the illness after return (normally for five days).
- The child is well enough to attend school.
Some illnesses need their own school plan
Certain infections require specific school procedures due to their transmissibility or treatment requirements, including:
- Strep throat
- Pertussis (whooping cough)
- Measles
- Varicella (chickenpox)
- Sport-related skin infections
Follow CDC and specific local or state health department guidance for these conditions.
Communicate clearly with families to help keep students safe
Clear, calm communication helps families understand what illnesses are circulating, recognize symptoms early, follow steps to prevent at home, and know when children should stay home or return to school. Keeping families informed supports early care, reduces spread, and helps keep students safe and schools open.
Protect students and staff at higher risk for severe illness
Some individuals may face higher risks. Schools should support:
- Optional masking
- Adjusted seating or participation
- Coordination with families and healthcare providers
Staff need access to PPE when caring for ill students
Personnel caring for ill students should have access to any PPE needed and follow the recommended precautions. Provide gloves, masks, and eye protection when needed. PPE protects staff and prevents further spread.
Having an emergency operations plan (EOP) with an infectious disease section helps keep students in class and schools open
Schools should use multiple prevention strategies to stay open. Any changes in operations should be coordinated with their local health authorities and other impacted community partners.
PA DOH does not recommend school closures in the event of an outbreak. It is a district-level decision that should be made in collaboration with public health.
For more details, visit Maintaining School Operational Status | Children & School Preparedness | CDC