After varicella exposure, what is the recommended policy for day care attendance?

After varicella exposure, what is the recommended policy for day care attendance?

• A. Attend day care if no rash is present even with mild fever or other symptoms.
• B. Receive oral acyclovir for 5 days to prevent onset of symptoms.
• C. Stay home until the 21-day incubation period has passed even if symptom free.
• D. Stay home if any symptoms occur and may return in 1 week if no rash develops.

Answer: (D)

When managing exposure to varicella in a day care setting, the priority is to prevent contagious children from spreading the virus while avoiding unnecessary absence. Varicella is contagious from about 1–2 days before the appearance of the rash until all lesions have crusted, and the incubation can be up to 21 days. Given this, the best approach is to keep a child home if any symptoms develop after exposure—fever, malaise, or other early signs—since these could indicate the onset of varicella or another contagious illness. If no rash develops after about a week, the child can return to day care, because the risk of becoming contagious without a rash by that time is low. There is no role for antiviral prophylaxis after exposure, so giving an oral antiviral to prevent illness is not appropriate.

When managing exposure to varicella in a day care setting, the priority is to prevent contagious children from spreading the virus while avoiding unnecessary absence. Varicella is contagious from about 1–2 days before the appearance of the rash until all lesions have crusted, and the incubation can be up to 21 days. Given this, the best approach is to keep a child home if any symptoms develop after exposure—fever, malaise, or other early signs—since these could indicate the onset of varicella or another contagious illness. If no rash develops after about a week, the child can return to day care, because the risk of becoming contagious without a rash by that time is low. There is no role for antiviral prophylaxis after exposure, so giving an oral antiviral to prevent illness is not appropriate.