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Herpes (Cold Sores, Fever Blisters)

What is Herpes? 

Herpes is a common infection that causes fluid-filled sores on the face or lips caused by the Herpes simplex virus (HSV) types 1 and 2. Type 1 usually causes cold sores/fever blisters, and type 2 usually causes genital herpes. Sometimes herpes infections are referred to as cold sores or fever blisters, although herpes is not related to having a cold or a fever. The sores can be painful, and usually heal within several days. After the initial outbreak, the virus is usually dormant in the skin or in the nerves until something triggers another eruption. In some people, overexposure to sunlight, fever, physical or emotional stress, hormonal changes, or certain foods and drugs seem to reactivate the virus. In rare cases, the herpes virus can infect the brain and other parts of the nervous system. This complication is usually seen only in immunocompromised individuals.

Signs and symptoms

  • Painful fluid-filled blisters on the face or lips
  • Tingling, itching, or burning of the skin before the blisters appear

Incubation period

Two days to two weeks

Contagious period and spread

Herpes is spread by direct contact through kissing and contact with open sores. Less commonly, it can be spread through articles contaminated by the fluid from the blisters or saliva (for example, mouthed toys). It can be spread to other areas of the body by scratching or abrading the skin after touching an open sore. This can be problematic in a child with eczema. Cases are contagious until the sores heal.

Public health reporting requirements

Individual cases are not reportable. The school nurse or the state or local public health agency should be consulted for specific concerns.

Control of spread

  • A person with sores should wash their hands often and avoid touching their eyes after touching the sore. 
  • Disinfect objects or toys that have come into contact with saliva. See Disease Prevention: The Facility Environment.
  • Do not share food or drinks. 
  • Avoid kissing or nuzzling children on the lips or hands.
  • Consult with local or state public health with implementation of control measures.

Treatment

There is no cure for herpes. Over-the-counter medications can help reduce the irritation while the sores heal. Acyclovir, an antiviral drug, has been shown to reduce shedding of the virus, diminish pain, and accelerate healing time. The virus may be shed intermittently for years and possibly lifelong.

Exclusion

Exclusion is not necessary unless the student has open sores and is drooling uncontrollably. 

Role of teachers, caregivers, and family

  • Report the infection to the designated staff member to develop an action plan for care and notification of possibly exposed family members and staff.
  • Emphasize hand hygiene and measures to control contact with infected secretions.
  • Avoid contact with cold sores with bare hands when possible. If contact with sores does occur, immediate hand hygiene is recommended.