Addressing Ebola Virus Infection Concerns in K-12 Schools: Interim Guidance for District and School Administrators
Who this is for: K-12 district and school administrators (educators)
What this is for: To help address concerns about the risk of Ebola in K-12 schools, and to recommend actions that schools can take if needed to prevent transmission of Ebola in K-12 schools.
- In the United States, Ebola is a very rare disease that has affected only a handful of people. There have been no cases of Ebola transmission in the United States in schools or community settings.
- Most situations regarding Ebola exposure that educators would face would pertain to perceived rather than any actual risk. Educators need to recognize such situations and address them in a timely and appropriate manner without overreaction.
- Ebola is spread by direct contact with blood or body fluids of a person who is sick with Ebola or who has died from Ebola. Many other more common illnesses can present with the same symptoms as Ebola, including influenza or other common viruses. These other infections are far more likely than Ebola virus to be the cause of illness, even in a person who recently arrived from a country with widespread transmission of Ebola.
- It is key that educators proactively establish communication with their local public health department for timely exchange of information related to Ebola, and consult as needed.
- Educators should understand actions that may be taken by public health authorities in their jurisdiction for people exposed to Ebola. However, educators should not take on the role and responsibilities of local public health authorities.
- Whether a student or staff person with possible recent (within 21 days) exposure to Ebola should attend school should be decided by local public health authorities.
- Educators should prevent discrimination, and counter stigma, harassment, and bullying related to perception of Ebola risk.
Purpose of Guidance
This interim guidance is intended to provide K-12 district and school administrators (educators) with information on public health actions pertaining to Ebola virus disease, help address their concerns about the risk of Ebola in K-12 schools in the United States, provide educators with information about situations that do not pose an actual risk of Ebola, enable them to counter stigma associated with perceived risk of Ebola, and recommend actions that they may take, in close consultation with public health authorities, to reduce the potential risk of any Ebola virus transmission in schools. In particular, this guidance provides an overview of the potential roles and responsibilities of public health authorities and educators, describes risk levels and monitoring as determined by public health authorities, and explains implications for schools. This guidance will be updated as needed if new knowledge becomes available.
General Information about Ebola
To date, no cases of Ebola have been identified in U.S. schools, and no community transmission has occurred in the United States.
People who are infected with Ebola but not showing symptoms cannot spread Ebola to other people until after they begin to have symptoms. It is also possible that Ebola virus can be spread through the semen of men who have survived Ebola. CDC has guidance to ensure that people who were possibly exposed to Ebola (e.g., a traveler arriving in the United States from a country with a widespread transmission) will be actively monitored daily, so that immediate public health actions can be taken as soon as symptoms appear.
Ebola is a rare but severe and often deadly disease. Ebola is spread [PDF – 1 page] by direct contact (through broken skin or mucous membranes such as the eyes or mouth) with infected blood or body fluids (including, but not limited to, urine, saliva, sweat, feces, and vomit). It is also spread by direct contact with objects (e.g., needles and syringes) that have been contaminated with infected blood or body fluids. Surfaces and objects that are not contaminated by blood or body fluids from a person sick with Ebola do not spread Ebola. Ebola is not spread through the air (i.e., by coughing or sneezing), by water, or cooked food.
Symptoms of Ebola infection include fever, severe headache, fatigue, muscle pain, vomiting, diarrhea, stomach pain, and unexplained bleeding or bruising. The longest period of time between exposure to Ebola and appearance of Ebola symptoms has been 21 days, although symptoms may appear as soon as 2 days after infection. Many other more common illnesses can present with these same symptoms, including influenza. These other infections are far more likely than Ebola virus to be the cause of illness, even in a person who was recently (within 21 days) in a country with widespread transmission of Ebola.
Roles and Responsibilities of Educators and Public Health Authorities
Public health authorities play a key role in identifying a person’s risk for Ebola exposure and advising on public health actions for individuals at risk of Ebola. Educators play a key role in addressing concerns and questions raised by students, parents, and staff about Ebola, and taking timely steps to respond to public health authorities’ recommendations for school communities. Educators need to understand the roles and responsibilities of public health authorities and consult with them on questions or issues related to Ebola. Conversely, educators should not take on any of the roles and responsibilities of public health authorities.
Working in partnership, public health authorities and educators should proactively establish direct communication and clearly define each partner’s roles and responsibilities. Initial collaborative efforts between public health authorities and educators should include identifying points of contact for communication, creating information-sharing procedures in compliance with the Family Educational Rights and Privacy Act (FERPA) and state and local privacy laws, and developing protocols for implementing public health recommendations.
While the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule does not apply to education records protected by FERPA, in certain circumstances the HIPAA Privacy Rule may apply to student health records (e.g., if the records are maintained by a HIPAA-covered health care provider that is not employed by a school). Educators are encouraged to establish a communication protocol for connecting with their local public health authorities to learn about the local public health authorities’ plans to address Ebola in the community. Additionally, educators, working collaboratively with their local public health authorities, need to review and ensure compliance with public health codes, infection control guidance, and applicable Occupational Safety and Health Administration (OSHA) standards.
Monitoring and Movement of Persons with Potential Ebola Virus Exposure: Implications for Schools
CDC’s Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure can be used by state and local public health authorities to conduct case-by-case assessments of risk of Ebola. The guidance outlines four specific risk categories (no identifiable risk, low [but not zero] risk, some risk, and high risk), and recommends actions to be taken by public health authorities according to each exposure risk category. Public health authorities will determine how a person will be monitored during the 21 days after the last potential exposure (i.e., active monitoring or direct active monitoring) according to the person’s exposure risk level, and whether additional public health restrictions (such as exclusion from public places, group gatherings, and workplaces) are needed. For people who are under active monitoring or direct active monitoring, the issue of school attendance should be determined by public health authorities.
Table 1 [PDF 3 pages] summarizes public health actions to be undertaken by public health authorities based on an individual risk assessment completed by public health authorities, and recommended school actions for each exposure risk category.
In their daily work with students and staff at school, educators need to be aware of practical steps they can take if they need to respond to situations related to Ebola. As part of their preparedness for preventing or responding to possible Ebola infection in K-12 schools, educators should consider the following practical steps:
- Review their school(s) emergency operations plans and revise them if necessary to address Ebola and other infectious diseases.
- Communicate with local public health authorities about their Ebola plan for the community.
- Engage teachers and teachers’ aides in communicating about Ebola with students and parents including messages ensuring that children are not stigmatized based on race, country of origin, or any other reason.
- Teach students, teachers, and staff to take everyday preventive actions (such as staying home when sick, washing hands often, cleaning frequently touched surfaces and objects, and avoiding contact with sick people). Practicing good infection control will help prevent the spread of many infectious diseases.
- Review protocols to ensure schools comply with OSHA’s Bloodborne Pathogens (29 CFR 1910.1030) and Hazard Communication Standard (29 CFR 1910.1200) for management of exposure to blood or other infectious material.
- Encourage teachers, school staff, and parents to obtain annual influenza immunization, which may reduce the number of adults and children coming to school with fever.
- Train teachers, teachers’ aides, and school nurses in early recognition of children with symptoms, such as fever, and how to determine if these symptoms may be occurring in a person who had a recent (within 21 days) possibility of exposure to Ebola. Symptoms that occur in a person who does not have a recent (within 21 days) possibility of exposure to Ebola are NOT related with Ebola, but with some other disease.
Continuity of Teaching and Learning
Educators should be mindful of people who may remain absent from school for an extended period of time while under direct active monitoring, or due to school dismissal, and provide opportunities for continuity of teaching and learning. See the U.S. Department of Education’s supplemental guidance available at: http://rems.ed.gov/KeepSchoolsSafeFromDiseases.aspx.
Civil Rights Issues: Prevention of Fear and Stigma
A person who has been under direct active or active monitoring and who has not developed Ebola within 21 days since the last potential exposure is not infected by Ebola, cannot spread the disease, and does not pose a health threat to others.
People who would be protected by the Federal civil rights laws and who are currently at a high risk of being bullied or harassed include people from, or perceived to be from, West Africa, as well as people who had Ebola and recovered, and those who have been under direct active or active monitoring, even if they did not develop Ebola disease. Educators play a key role preventing and addressing bullying and harassment at schools. For more information on prevention of fear and stigma, please refer to the Fact Sheet: Implementing CDC’s Ebola Guidance for Schools while Protecting the Civil Rights of Students and Others. If you have questions, want additional information, or believe that a school is violating Federal civil rights laws, you may visit the Office for Civil Rights (OCR) website at www.ed.gov/ocr or contact OCR at 800-421-3481 (TDD: 800-877-8339) or at email@example.com. Additional guidance documents from the U.S. Department of Education regarding complying with civil rights obligations, ensuring continuity of learning, and providing special education are available at: http://rems.ed.gov/KeepSchoolsSafeFromDiseases.aspx
Situations that Do Not Pose a Risk of Ebola Transmission
People who have NO identifiable risk of Ebola cannot pose any risk of spreading Ebola to others at school. Also, household members of a person who has returned from a country with widespread transmission of Ebola, does not have symptoms, and is undergoing direct active or active monitoring do not pose any risk to the community. See CDC’s Epidemiologic Risk Factors to Consider when Evaluating a Person for Exposure to Ebola Virus for examples of situations posing NO identifiable risk of Ebola.
Responding to Situations with a Possible Risk of Ebola Transmission: Actions for K-12 Educators
Although the risk of Ebola in the United States is very small, and it is unlikely that educators will need to deal with a situation involving a real threat to the health of the school population, educators should be aware of actions that they may need to take during the school day if a person with possible Ebola exposure, with or without symptoms, attends school.
Responding to situations when a person with possible recent (within 21 days) Ebola exposure and an unknown risk assessment status comes to school
Ideally, people with possible recent (within 21 days) Ebola exposure would be identified by a public health authority before they have attended school, and a public health authority would have assessed their risk of Ebola and recommended any public health actions to be taken. Public health authorities and educators should proactively establish a process for sharing information, in an appropriate and timely manner, about students and staff who are being monitored in their school community. However, it is possible that educators may find out from a source other than a public health authority about a student or staff member who may have been recently exposed to the Ebola virus, and for whom it is uncertain whether public health authorities have conducted an evaluation for Ebola exposure risk. In such situations, educators should consult public health authorities, so that they may conduct a risk assessment if necessary. Upon finding out about such a potentially exposed person at school, educators should determine if the person has symptoms1 suggestive of Ebola infection and follow the steps outlined in Figure 1 [PDF – 1 page].
Description of the steps outlined in Figure 1:
- Educators should learn if the person has symptoms1 suggestive of Ebola infection, while maintaining the individual’s privacy.
- If the person does NOT have symptoms, there is no urgency to share full personal information with public health authorities, but educators should consult as soon as possible to determine the best course of action:
- Contact public health authorities to discuss the situation in general terms without disclosing personally identifiable information from education records of the person with suspected Ebola exposure, so that public health authorities can determine if an individual risk assessment is needed;
- If public health authorities determine that there is no need for an individual risk assessment and the person does not pose a risk to the school community, educators should work to alleviate concerns by providing educational information about Ebola risks to the school staff and school community. Educators are encouraged to prevent harassment and bullying by providing information to the school community, while taking all necessary steps to protect individual privacy;
- If public health authorities determine that an individual risk assessment is needed and the person is a student under the age of 18, educators should inform the parents/guardians to obtain their written consent to disclose personally identifiable information from education records of the student;
- If the parent/guardian does not provide consent, then the school should ask the parent/guardian to contact public health authorities directly to obtain the risk assessment and inform the school of its outcome. Without the parent’s consent, the school should not provide personally identifiable information from education records of the student under the age of 18 who does not show symptoms. However, refusal by the parent/guardian or the student to involve public health authorities in matters of possible public health concern should not prevent the school from contacting public health authorities to discuss the situation in general terms, without disclosing personally identifiable information from education records of the person with suspected Ebola exposure;
- If the student is 18 years of age or older, or if the situation involves a teacher or staff member, the school should obtain consent directly from the person; and
- Wait for further guidance from public health authorities following an individual risk assessment before taking any further action.
- If the person has symptoms1, see the next section on Responding to situations when a person with symptoms suggestive of Ebola attends school and Figure 2.
Responding to situations during an Ebola outbreak when a person with symptoms possibly suggestive of Ebola comes to school
Children, particularly younger children, frequently show symptoms (e.g., fever, headache, or vomiting) that are common for many illnesses, such as influenza. Because Ebola is very rare in the United States, these other illnesses are far more likely than Ebola to be the cause of symptoms. A key consideration is that there must be both a combination of symptoms1 suggestive of Ebola and a possible Ebola exposure within 21 days prior to the onset of symptoms (see Figure 2 [PDF – 1 page]). Therefore, if a student or staff member shows symptoms suggestive of Ebola while at school, educators should first determine if this person has also had possible recent (within 21 days) exposure to Ebola in the following ways:
- by the information from an individual risk assessment conducted by public health authorities and any subsequent and ongoing direct active or active monitoring,
or, if that information is not available at school,
- By asking if:
- The person has traveled within the past 21 days from a country with widespread transmission of Ebola or cases in urban settings with uncertain control measures; or
- The person had a potential contact with a symptomatic Ebola-infected patient within the past 21 days.
No situations other than those described in detail above should be considered as possible exposure to Ebola. For a detailed description of situations that do not pose an actual risk for Ebola exposure, see the section on Situations that Do Not Pose a Risk of Ebola Transmission.
If the person showing symptoms also had a possible recent (within 21 days) exposure to Ebola, educators should follow the steps outlined in Figure 2 [PDF – 1 page]. Of note, in this situation, when a person with symptoms suggestive of Ebola and possible Ebola exposure within 21 days prior to the onset of symptoms has attended school, educators may share immediately all necessary information with the public health authority (which may include personally identifiable information from education records) to facilitate timely investigation, because the health and safety emergency exception of FERPA applies.
Description of the steps outlined in Figure 2:
- Take steps to rapidly separate the ill person from others (see below);
- Notify public health authorities of the situation and have them coordinate the transport of the ill person to medical facilities for a medical evaluation, if necessary; and
- Inform the parents/guardians of the situation and the need to conduct an individual risk assessment (if not done previously) and medical evaluation, if the ill person is a student/minor.
If a medical emergency (e.g., profuse vomiting) does not allow time for consultation with public health authorities, educators should contact 911 and inform them of the emergency, recent travel of the person or potential contact with Ebola (if known), and then contact public health authorities and the parents/guardians as soon as possible. Educators should be prepared to provide all known relevant information regarding the ill person.
While waiting for the arrival of first responders and public health authorities, educators should immediately:
- Move all students, teachers, and staff who were not directly affected by possible contamination (e.g., by splashing vomit) away from the room where the ill person is located and from all areas with possible contamination;
- If other persons were directly affected by possible contamination (e.g., by splashing vomit), ensure that they remove any soiled clothing as soon as possible, without touching the face with soiled clothing or hands. Soiled clothing should be placed in a plastic bag;
- Ensure that anyone who was directly affected by possible contamination promptly washes their hands and any other exposed skin with soap and water, and that they are separated in a different room from other students and staff;
- Limit the number of staff to one or two who will stay in the room with the ill person;
- Ensure staff who are designated to stay with the ill person stay at least 3 feet away and avoid any contact with blood and body fluids (e.g., vomit, urine, saliva, feces);
- Keep a log of everyone who could have had contact with the ill person’s blood or body fluids, in case this information is needed later; and
- Ensure that all areas of the school (or school bus, if the incident occurred on the bus) that are known to have been possibly contaminated with blood or body fluids are closed off from students and staff until cleaning and disinfection are completed, in consultation with public health authorities, and according to established guidelines [PDF – 4 pages]. School staff should not attempt to clean contaminated areas without consulting with public health authorities.
Public health authorities will assess the ill person’s risk of Ebola exposure and evaluate his/her clinical condition to determine appropriate public health actions. They will also decide if laboratory testing is necessary to rule out Ebola infection. Public health authorities will determine if the ill person should stay at home after the initial medical evaluation (e.g., if the person is sick with an infectious disease other than Ebola, such as influenza or enterovirus) or if he or she should be isolated at a hospital if Ebola is suspected.
In rare situations, while the laboratory tests are pending to rule out Ebola (usually only for a day or two, although the actual timing depends on the person’s stage of illness and on local circumstances), temporary school dismissal can be considered in consultation with public health authorities. Examples when temporary school dismissal may be appropriate include:
- When multiple/widespread area(s) in the school may have been contaminated with blood or body fluids (such as vomit, urine, feces);
- When it is impossible to determine where the contamination took place; or
- When an area essential for further school functioning (e.g., cafeteria) has been contaminated.
A positive laboratory test for Ebola means that Ebola infection is confirmed. Public health authorities will conduct a public health investigation, including tracing of all possibly exposed contacts. Educators should collaborate with public health authorities during the investigation and provide all requested information (e.g., lists of people who were present at school during the day) that may be helpful during the investigation. During the investigation, public health authorities may identify some people at school who are at risk of Ebola exposure (high risk, some risk, or low [but not zero] risk). Depending on individual level of exposure, public health authorities will decide if some of these people will need to undergo direct active monitoring (with or without exclusion from public places, group gatherings, workplaces, and school) or active monitoring.
Resources for More Information
- Factsheet: Addressing Ebola Concerns in K-12 Schools
- Questions and Answers about CDC’s K-12 School Guidance for Ebola
- Ebola (Ebola Virus Disease)
- 2014 Ebola Outbreak in West Africa
- 2014 Ebola Outbreak in West Africa – Outbreak Distribution Map
- Ebola Virus Disease – Signs and Symptoms
- Facts about Ebola in the U.S. [PDF – 1 page]
- Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure
- Monitoring Symptoms and Controlling Movement to Stop Spread of Ebola
- Resources for Parents, Schools, and Pediatric Healthcare Professionals
- Advice for Colleges, Universities, and Students about Ebola in West Africa
- Do Your Part to Slow the Spread of Germs [PDF – 1 page]
- Infectious Diseases at School
Other U.S. Department of Health & Human Services resources
- Ebola: Planning Considerations for Human Services Programs
- What Children and Families Need to Know about Ebola
- General Anti-bullying Resources
- Office for Civil Rights Bulletin: HIPAA Privacy in Emergency Situations [PDF – 4 pages]
U.S. Department of Education resources
U.S. Department of Labor resources
- Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards
- Cleaning and Decontamination of Ebola on Surfaces [PDF – 4 pages]
- Ebola symptoms include fever, severe headache, muscle pain, weakness, fatigue, diarrhea, vomiting, abdominal (stomach) pain, unexplained hemorrhage (bleeding or bruising).
- Page last reviewed: February 18, 2016
- Page last updated: February 18, 2016
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