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American Journal of Epidemiology Vol. 133, No. 11: 1161-1167
Copyright © 1991 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Assessment of a School Exclusion Policy during a Chickenpox Outbreak

Dale A. Moore1,2, and Richard S. Hopkins2,3

1Division of Field Services, Epidemiology Program Office, Centers for Disease Control Atlanta, GA
2Division of Epidemiology, Ohio Department of Health Columbus, OH
3Department of Preventive Medicine, Ohio State University College of Medicine Columbus, OH

Reprint requests to Dr Dale A Moore, 115 Henning, Pennsylvania State University, University Park, PA 16802.

Two Ohio schools experienced an outbreak of over 200 cases of chickenpox during the period from October 5 to December 21, 1988, despite adherence to the 1986 American Academy of Pediatrics' recommendation that children be excluded from school for 1 week or until all lesions have crusted. In grades kindergarten through four, the attack rate for susceptibles was 51% (167/329). With the use of person-time analysis, classmates of a child with chickenpox in grades kindergarten through four were 3.6 times more likely to become a case 12–17 days (the range of one incubation period) after the last day the child with subsequent chickenpox was in class than at any other time during the 2.5-month study period (95% confidence interval (Cl) 2.4–5.4). This was even more pronounced during the first half of the outbreak (relative risk (RR), 10.8; 95% Cl 4.4–26.5). Cases were not more likely to aggregate 12–17 days after a child returned to school after having chickenpox (AR, 0.9; 95% Cl 0.5–1.5). No cases occurred in classmates 12–17 days after the 15 children absent <5 days returned to class. Because substantial chickenpox transmission may occur before rash onset, exclusion practices may have a limited effect on outbreak control and increase the indirect costs associated with chickenpox.

chickenpox; disease outbreaks


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