This guidance is intended to support safe, in-person learning and care by mitigating the spread of communicable diseases in childcare settings and TK–12 schools. The following strategies form a general prevention framework to reduce the spread of infections, including but not limited to, COVID-19, influenza, respiratory syncytial virus (RSV), and norovirus. 

Additionally, many of these strategies  also protect against harmful effects of environmental triggers . These may include allergens, pollutants, wildfire smoke, and other external cause of illness.

This guidance provides considerations for various settings where children spend time, including but not limited to the following:

• ​Licensed child care centers and family child care homes

• License-exempt child care providers

• Early childhood education sites, including preschools

• TK–12 schools (public and private)

• Before/after-school programs
  

• Summer school/intersession programs

For ease of reference, these settings are collectively referred to as “schools and child care" throughout this document. 

This guidance is based on best current available scientific and epidemiological knowledge.  It is subject to change. In addition to the CDPH information provided below, schools and child care are encouraged to use CDC guidance on Preventing Spread of Infections in K-12 schools as a resource.​

General Considerations

1. This guidance provides general recommendations, and the provided references are not intended to be comprehensive. Information about certain relevant requirements may be found throughout this guidance but other relevant requirements may also exist.

• ​​​​​​​This guidance does not replace or revise applicable laws or other requirements that apply to school or licensed child care settings, including but not limited to their authority to exclude individuals on the basis of health and safety. See the California Health and Safety Code (e.g., § 120230), Education Code (e.g., § 48213, § 49451), California Code of Regulations (e.g., Titles 17 and 22), and child care center licensing requirements such as daily inspection for illness.  

2. CDPH supports the authority of local health departments and local educational agencies to maintain or establish additional school health guidance.  Licensed child care providers may continue to maintain or establish additional guidance for their licensed facility as long as the guidance does not conflict with licensing laws.

3. In workplaces, employers are subject to the Cal/OSHA COVID-19 Prevention Non-Emergency Regulations.  In some workplaces the Cal/OSHA Aerosol Transmissible Diseases Standard (PDF) may also be applicable.

4. Local health departments or state agencies may implement additional requirements that go beyond this statewide guidance based on local circumstances. If there are differing requirements between the most current CDPH, Community Care Licensing (CCL), Cal/OSHA, and local health department guidance or health orders, providers should follow the strictest requirements.

5.  When applying this guidance, consult with local health officials and consider the factors listed below. An assessment of the complete situation, rather than any one single factor, is recommended

• Vaccination coverage in the community and among children, teachers, and staff;

• Local disease outbreaks or transmission patterns;

• ​Facility-specific indoor air quality;

• ​Availability and accessibility of resources, including health education materials, masks and tests;

• ​Availability and capacity of school and child care;

• ​Population served, with attention to individuals at high risk for severe disease and immunocompromised populations;

• Community input, including from children, families, and staff; and 

• ​Socioeconomic, cultural and linguistic barriers that may disproportionately impact populations and that increase the risk of infection, limit access to health care services and reduce the adoption of recommendations.

6. Provide clear and concise communication. It is recommended that school administrators and child care providers communicate implemented health and safety strategies to children, parents/guardians, and staff, utilizing multiple methods, including direct parent/guardian communications and on-site reminders of policy. Communication materials should be appropriately translated to the languages and literacy levels of community members. 

7. This document updates and replaces the following guidance documents:

• ​​Public Health Guidance for K–12 Schools and Child Care Settings to Support Safe In-Person Services and Mitigate the Spread of Communicable Diseases, 2023-2024 School Year.

• Preliminary Testing Framework for K–12 Schools for the 2022–2023 School Year, pursuant to California Education Code section 32096.

Mitigation Strategies 

Staying Up to Date on Vaccinations

Vaccines (also referred to as “immunizations") can help protect against certain diseases by working with the body's natural defenses to safely build immunity to disease. Vaccinations protect the person who receives the vaccination. In addition, if many people are vaccinated, it may reduce the burden of disease in communities and protect individuals who are not or cannot be vaccinated and individuals who may not develop a strong immune response from vaccination.

Recommended Actions:

1. Encourage children, families, and staff to stay up-to-date on recommended vaccinations. 
2. Review vaccine requirements for entry into pre-K/child care settings and  TK–12 schools, as well as for child care staff. Visit the CDPH Shots for School site for resources related to child care or school vaccine requirements and to see how well-vaccinated your school or child care facility is.
3. Both COVID-19 and influenza vaccination can reduce the risk of serious illness and assist in minimizing outbreaks, absences, and school disruptions. Because of this, COVID-19 and influenza vaccinations are strongly recommended for all eligible people in California, including children, providers, teachers, staff and individuals sharing homes with child care community members. More information can be found at CDPH's Respiratory Viruses webpage.
4. Work with local health departments and community partners to conduct school-located vaccination events. This includes hosting events in the fall to protect against winter respiratory viruses, and events in the spring or summer to meet new school admission and grade advancement vaccination requirements.

Optimizing Indoor Air Quality

The risk of getting and spreading respiratory infections is greater in indoor settings with poor air quality. Effective ventilation and filtration can reduce the spread of these infections and may also protect students, children, and staff from exposure to wildfire smoke, airborne allergens, and other pollutants.

Recommended Actions:

1. Consult CDPH guidance on improving indoor air quality and reducing the health risks from indoor transmission of airborne infections. Facility maintenance staff may also review the Environmental Protection Agency's Indoor Air Quality Tools for Schools for more guidance.
2. Improve ventilation in transport vehicles, such as buses or vans. Open windows to increase airflow from outside when feasible and safe to do so.
3. In circumstances where outdoor air quality is poor (e.g., wildfire smoke), consult with the local health department. They can determine the best approach moving forward. Considerations include using:
• Air filtration strategies that do not rely on outdoor air sources, such as portable air cleaners;
• ​Alternative spaces with better air quality;
• ​Keeping windows and doors closed to not introduce outdoor air;
• Use of higher quality face masks (e.g., N95s, KN95s, or KF94s) as detailed in the CDPH When and Why to Wear a Mask guidance; and
• Use of alternative ways to commute to/from school.
4. Upgrades to facility HVAC systems can improve indoor air quality. These upgrades should follow relevant laws.

For more information, see resources from the CDC Ventilation in Buildings, the California Department of Education and the California Air Resources Board.

Using Face Masks

High quality and well-fitted face masks are tools that are effective and easy to implement to protect oneself and others.

Unless it would pose a safety hazard, no person can be prevented from wearing a mask as a condition for participation in an activity or entry into a school or childcare setting.

Recommended Actions:

1. ​Support access to face masks.
• Develop and implement local protocols to provide appropriately sized, high-quality masks to children who do not have one and desire to use one. 
• As noted in Cal/OSHA COVID-19 Prevention Non-Emergency Regulations, “Employers shall provide face coverings and ensure they are worn by employees when required by a CDPH regulation or order."
2. Unless otherwise directed by local health departments that have more protective requirements, follow and provide recommendations from the CDPH guidance on When and Why to Wear a Mask .  
   
• Encourage and promote health education on when to mask, such as  when around others if you have respiratory symptoms (e.g., cough, runny nose, and/or sore throat) or when around those who are at higher risk of getting sick. 
3. Follow Cal/OSHA COVID-19 Non-Emergency Regulations for guidance on employers' return to work facemasks requirements.
4. The following individuals should not wear face masks:
• Infants and children younger than 2 years old because of the risk of suffocation;
• All persons when they are eating or sleeping; and
• Persons with a medical condition, mental health condition, or disability that precludes wearing a mask safely and effectively or are otherwise unable to remove a mask without assistance. 

Maintaining Good Hygiene

Keeping hands clean with frequent hand washing can help prevent the spread of communicable diseases. Other general good hygiene practices can also protect the health of students, children in care,  and staff at schools and child care.

Recommended Actions:

1. Ensure adequate supplies, including soap and water, tissues, and no-touch trashcans.
2. If using hand sanitizer, it is recommended to contain at least 60 percent alcohol. It should be stored up, away, and out of sight of younger children. Supervise children ages 5 years and younger to avoid ingestion and eye contact. Hand sanitizer is not recommended for children under 24 months.
3. Teach and reinforce proper handwashing. Handwashing with soap and water is preferable over the use of hand sanitizers. It is the only effective way to remove or neutralize some pathogens.
4. Teach and reinforce the practice of covering coughs and sneezes. 
5. Post hand washing and hygiene education materials in appropriate languages where suitable.  
6. Discourage sharing of personal items. This includes cups, food, utensils, water bottles, lip balm, cell phones, and makeup.

Managing Individuals with Symptoms

Staying home when sick can lower the risk of spreading communicable diseases. When a child arrives with symptoms of illness or develops symptoms at school or child care, a decision must be made as to whether the child can remain on site. Schools and child care should refer to CDPH guidance when determining whether to send the child home (i.e., temporarily exclude) or allow them to remain on site. Many factors should be considered when making this decision, including how to limit the spread of diseases to others, and how to limit educational, social, and other losses that might occur due to absence.

Recommended Actions:

1. For a suspected or confirmed COVID-19 infection, follow the recommendations provided in CDC Preventing Spread of Respiratory Viruses When You're Sick.  
2. Follow guidance for when a child has symptoms of illness in a school or child care to support decision-making.
3. Avoid policies that incentivize coming to school or child care while sick.
4. Share educational resources and health-related information (e.g., AAP Healthy Children) when appropriate.

Reporting Diseases and Responding to Outbreaks

Notify local health departments and other authorities about reportable communicable diseases as well as any suspected outbreaks in schools and child care. For additional information on communicable diseases, reference CDPH Disease Information and Reports, Infectious Disease Investigations, and Tuberculosis Control pages.

Recommended Actions:

1. ​Review reporting regulations.
• Schools should review Title 17, California Code of Regulations (CCR) §2500 and §2508 for reporting requirements for school nurses and other healthcare providers. Note that CCR Title 17 §2500 has been temporarily modified by the State Public Health Officer order of October 4, 2022. 
• Child care centers (CCR Title 22 section 101212(d)) and family child care homes (CCR Title 22 section 102416.2(c)(3)) should review Child Care Licensing requirements for outbreak reporting. The appropriate regional office (PDF) of the California Department of Social Services Community Care Licensing Division should be consulted for assistance.
• Workplaces, schools and certain child care providers are subject to COVID-19 workplace outbreak reporting requirements set forth in Cal/OSHA COVID-19 Non-Emergency Regulations FAQs.
2. Typically, local health departments will lead the response to reportable diseases and disease outbreaks and provide recommendations on next steps, including assessing possible exposures. 
• ​Exposure notifications and symptom monitoring should be guided by the local health department. School administrators and child care providers should support the local health department in contact tracing efforts. 
• ​Local health departments are encouraged to contact CDPH for outbreak consultation as needed. Additional information can be found in CDPH Reportable Diseases and Conditions, CDPH Communicable Disease Quicksheets and CDPH Norovirus Toolkits. For COVID-19, see CDPH Workplace Outbreak Employer Guidance. 
  

Local educational agencies are encouraged to consult with local health officials to include communicable disease information in their school emergency operations plans. For additional information and recommendations, refer to CDC guidance on Planning for Outbreaks, Epidemics, and Pandemics.

Cleaning Facilities

Clean and well-maintained facilities reduce the spread of communicable diseases from contact with contaminated surfaces.

Recommended Actions:

1. Routine daily cleaning with water and mild detergent is generally sufficient.  Additional sanitization might be necessary during certain disease outbreaks.
2. If disinfectants are used, use asthma-safer products.
3. Train and confirm that staff follow recommended practices for cleaning, sanitizing, and disinfection. The California Healthy Schools Act requires anyone who uses disinfectants at a school or child care center to complete annual California Department of Pesticide Regulation-approved training. Note: This requirement does not apply to family child care homes.

Getting Tested for Respiratory Infections

Testing can detect and reduce transmission of communicable diseases. At-home testing for respiratory viruses (such as COVID-19 or influenza) provides individuals with convenient and rapid test results that can assist in decision making about treatment and actions to minimize the spread of disease.

Recommended Actions:

1. Facilitate access to at-home testing resources for COVID-19. Review testing resources offered by healthcare insurers, local, state, and federal sources. Share this information with the community.
2. Testing for other respiratory infections may be encouraged. Testing maybe recommended by the local health department during outbreaks or in situations where individuals are at higher risk for severe disease. Follow Cal/OSHA COVID-19 Non-Emergency Regulations for guidance on employee testing requirements.

Additional Considerations

1. Children with disabilities or other health care needs:  When implementing this guidance, schools should carefully consider how to address legal requirements related to the provision of free appropriate public education when identifying infection control strategies. School administrators and child care providers must also comply with the Americans with Disabilities Act (ADA) and provide reasonable accommodation to children with disabilities. Requirements can also be found in Individuals with Disabilities Education Act (IDEA) and Protecting Students With Disabilities (ed.gov).
• Other recommendations can be found in American Academy of Pediatrics (AAP) guidance. Note that although the AAP guidance was developed to manage COVID-19, many considerations are broadly applicable to other communicable diseases in schools and child care.
2. Higher risk activities: Certain activities that involve close physical contact and/or increased and forceful exhalation can pose increased risk for getting and spreading communicable diseases, particularly if conducted indoors, in poorly ventilated settings, and/or without the use of masks. Accordingly, school administrators and child care providers may consider implementing additional measures to mitigate transmission in these settings, especially during disease outbreaks or increased rates of community transmission of certain diseases. Consultation with local health departments is recommended.
3. In-person learning: Broad disruptions to in-person learning, such as temporary closures of schools, classrooms, or child care settings due to a communicable disease outbreak should remain a last resort.  Additionally, it should be considered only after all available resources have been exhausted and after consulting with local health department officials.
4. Boarding schools and programs that may operate residential components: Individuals residing in congregate settings are at increased risk of contracting and spreading communicable diseases. Thus, such settings are recommended to have infection control plans and coordinate closely with their local health department. ​