To reduce the spread of diseases, anyone who feels sick or is a close contact may have to stay home and self-isolate. Complete Toronto Public Health’s Screening Questionnaire or the Ontario Ministry of Health’s Screening Tool each day, and follow guidance below for each disease.

 

Vaccines are our best defence against many diseases. These diseases can be very contagious and cause serious illness, including certain cancers, hospitalization, and even death. Children who are not vaccinated against these diseases are more at risk of getting an infection and getting very sick. Most of these vaccines are part of Ontario’s routine immunization schedule (also available in French), and all are provided free of charge for people who meet the eligibility criteria.

Depending on which vaccine, children and youth can get vaccinated through a healthcare provider or the School Immunization Program clinics (for eligible students). For information on when your child should get these vaccines, see Ontario’s Publicly Funded Immunization Schedule(also available in French). Parents/caregivers can also speak to a health care provider to learn more.

The following vaccines are required under Ontario’s Immunization of School Pupils Act (ISPA) and the Child Care & Early Years Act for children who attend school and child care or have a valid exemption:

  • Measles
  • Mumps
  • Rubella
  • Diphtheria
  • Tetanus
  • Polio
  • Meningococcal
  • Pertussis (whooping cough)
  • Varicella (chickenpox) only applies to students born on or after 2010

These free routine childhood vaccines are not required, but are highly recommended:

  • Pneumococcal-C-15
  • Rotavirus
  • Haemophilus Influenza B (HiB)
  • Hepatitis B
  • Human Papillomavirus (HPV)
  • Influenza

The COVID-19 vaccine isn’t part of the Ontario Immunization Schedule, but is also free and highly recommended.

Diphtheria is a serious bacterial disease of the throat, nose and skin. The bacteria produces a toxin, or poison, that can spread through the bloodstream and cause damage to the heart, kidneys or nerves. Diphtheria kills up to 1 in 10 people who get the disease. It was once the most common causes of death in Canadian for children under the age of five. Today, diphtheria is rare because of vaccination.

What Happens if There’s a Diphtheria Case at School/Child Care

Anyone who has diphtheria or is a close contact of somebody with the disease may have to stay home until they have a negative test for diphtheria or after finishing a course of antibiotics. Follow guidance provided by Toronto Public Health.

Diphtheria Symptoms

  • Difficulty breathing and swallowing
  • Sore throat
  • Swollen neck
  • Weakness
  • Feeling tired
  • Fever and chills
  • Runny nose
  • Open sores on the skin
  • Suffocation (unable to breath)
  • Paralysis (unable to move)
  • Heart failure

How Diphtheria Spreads

  • Close contact with respiratory droplets (from talking, coughing or sneezing)
  • Direct contact with skin sores

About The Diphtheria Vaccine

  • Usually, one vaccine (e.g. DTap-IPV-Hib) is given to protect against diphtheria, tetanus, pertussis and polio
  • Five doses, given at two, four, six, and 18 months of age, and a booster dose at four to six years old

Tetanus is a disease caused by a bacteria that affects the nervous system. It can be serious and can even cause death. Tetanus can be prevented by vaccination.

What Happens if There’s a Tetanus Case at School/Child Care

People with tetanus can continue to go to school or child care if they feel well enough. Close contacts do not need to be notified because tetanus is not directly spread from person-to-person.

Tetanus Symptoms

  • Spasm (uncontrollable muscle movement) in the jaw (“lockjaw”)
  • Painful muscles spasms
  • Difficulty swallowing
  • Difficulty opening mouth

How Tetanus Spreads

  • Direct contact with an open wound, like a cut or sore, with soil, stool/poop (fecal matter) or dust that is contaminated with the bacteria
  • Does not spread from person-to-person

About The Tetanus Vaccine

  • Usually, one vaccine (e.g. DTap-IPV-Hib) is given to protect against diphtheria, tetanus, pertussis and polio
  • Five doses, given at two, four, six, and 18 months of age, and a booster dose at four to six years old

Pertussis (Whopping Cough)) is a bacterial infection of the lungs and airways. It causes violent coughing fits that can lead to choking or vomiting. The coughing can be so intense that a whooping sound is made when trying to catch the next breath. The cough can last for weeks or months. Whooping cough can cause more than just severe coughing, it may also lead to brain damage or death. This disease is most severe in infants under one year old. Pertussis outbreaks cycle in Ontario every two to five years.

What Happens if There’s a Pertussis Case at School/Child Care

Some people who have whooping cough will have to stay home from school or child care if notified by Toronto Public Health. Follow guidance provided by Toronto Public Health, and visit Communicable Disease Information for Schools & Child Care Centres for more information.

Pertussis Symptoms

  • Mild fever
  • Cough that gets worse and can last from six to 12 weeks
  • Coughing fits (can make “whoop” sound)
  • Gasping for breath, difficulty breathing
  • Runny nose
  • Red, watery eyes
  • Feeling tired
  • Choking
  • Vomiting

How Pertussis Spreads

  • Close contact with respiratory droplets (from talking, coughing or sneezing).

About the Pertussis Vaccine

  • Usually, one vaccine (e.g. DTap-IPV-Hib) is given to protect against diphtheria, tetanus, pertussis and polio
  • Five doses, given at two, four, six, and 18 months of age, and a booster dose at four to six years old

Polio is a viral infection that attacks the immune system, causing nerve damage or paralysis (loss of ability to move) for life and may lead to death. It is more common in children under the age of five. Canada has been polio-free for the last 20 years. In 1994, Canada was certified as being free of wild poliovirus by the World Health Organization and as long as polio exists in other countries, there is still a risk of getting it. Vaccination against polio provides the best protection.

Children who received an oral polio vaccine outside of Canada on or after April 1, 2016  will need to receive  full vaccination with the inactivated polio vaccine to get the best protection for all 3 polio strains that are still spreading around the world.

What Happens if There’s a Polio Case at School/Child Care

Anyone who has not been fully vaccinated against polio or is a close contact of somebody with the disease may have to stay home from school or child care if notified by Toronto Public Health. Canada is certified as polio-free, and even one case of polio is considered a public health emergency.

Polio Symptoms

  • Fever
  • Sore throat
  • Nausea
  • Vomiting
  • Headache
  • Feeling tired
  • Weakness
  • Severe muscle pain and stiffness in the neck and back

How Polio Spreads

  • When contaminated stool/poop enters the mouth (fecal-oral spread). For example, eating food or drinking water that is contaminated.
  • Close contact with respiratory droplets (from talking, coughing or sneezing)
  • Direct contact with contaminated objects or stool

About the Polio Vaccine

  • Usually, one vaccine (e.g. DTap-IPV-Hib) is given to protect against diphtheria, tetanus, pertussis and polio
  • Five doses, given at two, four, six and 18 months of age, and a booster dose at four to six years old

Measles is a very contagious viral respiratory illness that can spread quickly. Most people recover fully from measles within two to three weeks.

What Happens if There’s a Measles Case at School/Child Care

Anyone who has measles must stay home from school or child care. Close contacts of somebody with measles may have to stay home from school or child care if they are unvaccinated or not protected (not immune). Follow guidance provided by Toronto Public Health, and visit Communicable Disease Information for Schools & Child Care Centres for more information.

Measles Symptoms

  • Fever
  • Runny nose
  • Dry cough
  • Tiredness
  • Irritability
  • Red eyes/eyelids
  • Rash (start as flat red bumps that join together as they spread)
  • Small white spots (Koplik spots) can appear on the inside of the mouth and throat

How Measles Spreads

  • Highly contagious, spreads easily from person to person through the air
  • Close contact with respiratory droplets (from talking, coughing or sneezing)

About the Measles Vaccine

  • The MMR or MMRV vaccine protects against measles, mumps, rubella and chickenpox
  • At 12 months of age, one dose of MMR vaccine is given.
  • At four to six years, the second dose of the MMR vaccine is usually given in the combined MMR and Varicella (MMRV) vaccine.

Mumps is a viral infection that passes easily from person to person. It is most common in children, but can also infect adults. Complications from mumps can include swelling of the testicles or ovaries, infection of the pancreas, hearing loss and swelling of the brain. Getting infected in the first trimester of pregnancy can cause miscarriage.

What Happens if There’s a Mumps Case at School/Child Care

Anyone who has mumps must stay home from school or child care. Close contacts of somebody with mumps may have to stay home from school or child care if they are unvaccinated or not protected (not immune). Follow guidance provided by Toronto Public Health, and visit Communicable Disease Information for Schools & Child Care Centres for more information.

Mumps Symptoms

  • Fever
  • Headache
  • Sore muscles
  • Earache
  • Loss of appetite
  • Swollen salivary glands under the ear or jaw

How Mumps Spreads

  • Direct contact with saliva or respiratory droplets.

About the Mumps Vaccine

  • The MMR or MMRV vaccine protects against measles, mumps, rubella and chickenpox
  • At 12 months of age, one dose of MMR vaccine is given
  • At four to six years, the second dose of the MMR vaccine is usually given in the combined MMR and Varicella (MMRV) vaccine

Rubella is a viral infection, also called “German Measles,” that can cause miscarriage or serious birth defects if someone is infected when pregnant. It was once a common childhood disease, but due to routine vaccination programs, the risk of getting rubella in Canada is now very low.

What Happens if There’s a Rubella Case at School/Child Care

Anyone who has rubella must stay home from school or child care. Close contacts of somebody with rubella may have to stay home from school or child care if notified by Toronto Public Health. Follow guidance provided by Toronto Public Health, and visit Communicable Disease Information for Schools & Child Care Centres for more information.

Rubella Symptoms

  • Low fever
  • Cough
  • Runny nose
  • Sore throat
  • Pink or red rash
  • Red, itchy eyes
  • Headache
  • Achy joints
  • Swollen lymph nodes (glands in the neck and behind ears)

How Rubella Spreads

  • Close contact with respiratory droplets (from talking, coughing or sneezing)
  • Can pass from a pregnant person to the unborn baby

About the Rubella Vaccine

  • The MMR or MMRV vaccine protects against measles, mumps, rubella and chickenpox
  • At 12 months of age one dose of MMR vaccine is given
  • At four to six years, the second dose of the MMR vaccine is usually given in the combined MMR and Varicella (MMRV) vaccine

Varicella (Chickenpox) is a very contagious disease caused by the varicella-zoster virus. It is most common in young children, but youth and adults can get very sick if they get it. Healthy children tend to have milder symptoms. In rare cases, chickenpox can cause severe complications such as pneumonia, blood infections, serious skin infections, swelling to the brain and birth defects.

What Happens if There’s a Varicella Case at School/Child Care

People with chickenpox can return to school or child care as soon as they are well enough to participate in normal activities, regardless of the state of the rash. Parents may be notified if someone in the classroom gets chickenpox. Follow guidance provided by Toronto Public Health, and visit Communicable Disease Information for Schools & Child Care Centres for more information.

Varicella Symptoms

  • Fever
  • Feeling tired
  • Loss of appetite
  • Headache
  • Generalized itchy rash (small red spots) turning into blisters (fluid-filled bumps) that crust and go away

How Varicella Spreads

  • Direct contact with fluid from the blisters
  • Close contact with respiratory droplets or airborne (from talking, coughing or sneezing)
  • Direct contact with contaminated objects

About the Varicella Vaccine

  • The Varicella vaccine protects against chickenpox, and the MMRV vaccine protects against measles, mumps, rubella and chickenpox
  • At 15 months of age, one dose of Varicella vaccine is given
  • At four to six years, the second dose of the Varicella vaccine is usually given in the combined MMR and Varicella (MMRV) vaccine

Meningococcal disease is a serious bacterial infection that can lead to brain infection (meningitis) or blood infection (septicemia) and possible death. There are many strains of meningococcal infection that can cause illness. Strains A, C, Y, and W-135 have a free vaccine to prevent infection.

What Happens if There’s a Meningococcal Disease Case at School/Child Care

Anyone who has meningococcal disease may have to stay home from school or child care if notified by Toronto Public Health. Close contacts may be recommended to receive antibiotics and vaccine. Follow guidance provided by Toronto Public Health.

Meningococcal Disease Symptoms

Meningococcal meningitis (brain infection):

  • Fever
  • Headache
  • Stiff neck
  • Confusion
  • Loss of appetite
  • Vomiting
  • Sore muscles and joints
  • Increased sensitivity to light
  • Seizures, convulsions
  • Skin rashes

Meningococcal septicemia (blood infection):

  • Fever
  • Feeling tired
  • Vomiting
  • Diarrhea
  • Headache
  • Rapid breathing
  • Body aches
  • Red or dark purple skin rashes

How Meningococcal Disease Spreads

  • Close or lengthy direct contact with the saliva (spit) of someone who has the bacteria.

About the Meningococcal Disease Vaccine

Haemophilus influenzae, despite its name, has nothing to do with the influenza (flu) virus. There are several types of haemophilus influenzae bacteria. Type b (also known as Hib) can cause serious and life threatening illness, especially for children under five. Before the vaccine, Hib was a common cause for meningitis in young children.

What Happens if There’s a Haemophilus Influenzae Case at School/Child Care

People with Hib must stay home from school or child care until after they have started antibiotics. Contact a health care provider if there are any concerns. Follow guidance provided by Toronto Public Health, and visit Respiratory Viruses: Caring for Someone for more information.

Haemophilus Influenzae Symptoms

  • Fever/chills
  • Feeling tired
  • Sneezing
  • Cough
  • Nausea
  • Vomiting
  • Stomach pain
  • Complications can result in trouble breathing, convulsions, seizures, and pneumonia
  • May also cause Meningitis: sudden fever, headache, confusion, stiff neck and eyes being more sensitive to light

How Haemophilus Influenzae Spreads

  • Close contact with respiratory droplets or aerosols (from talking, coughing or sneezing)
  • Can be carried in the nose and throat of people without symptoms

About the Haemophilus Influenzae Vaccine

  • Usually, one vaccine (e.g. DTap-IPV-Hib) is given to protect against diphtheria, tetanus, pertussis, polio and Hib
  • Five doses, given at two, four, six, and 18 months of age, and a booster dose at four to six years old
  • Available from a health care provider’s office (as a single vaccine or a combination vaccine such as DTap-IPV-Hib)

Pneumococcal disease is a bacterial infection that is a common complication of influenza that affects both children and adults. Very young infants and children, people 65 and older, and people with health conditions are at greater risk of complications from the disease. Besides pneumonia, the bacteria can also cause ear infections, sinus infections, meningitis and infections in the bloodstream. In severe cases, pneumococcal disease can cause hearing loss, brain damage, or death. Vaccination is the best protection.

What Happens if There’s a Pneumococcal Disease Case at School/Child Care

People with pneumococcal disease can continue to go to school or child care if they feel well enough. Complete Ontario’s self-assessment tool to learn more about what to do next. Contact a health care provider if there are any concerns. Visit Respiratory Viruses: Caring for Someone for more information.

Pneumococcal Disease Symptoms

  • Fever/chills
  • Cough
  • Shortness of breath
  • Chest pain
  • Stiff neck
  • Confusion
  • Increased sensitivity to light
  • Joint pain
  • Ear pain
  • Irritability
  • Sleeplessness

How Pneumococcal Disease Spreads

  • Close contact with respiratory droplets or aerosols (from talking, coughing or sneezing)
  • Can be carried in the nose and throat of people without symptoms

About the Pneumococcal Disease Vaccine

  • There is one Pneumococcal vaccine for children: one dose given at two, four and 12 months of age
  • Available from a health care provider’s office

In Canada, rotavirus is the most common cause of severe diarrhea in infants and young children. Most children will have at least one episode of rotavirus diarrhea before the age of five. Watch for signs of dehydration especially in babies and toddlers. Wash hands frequently especially after changing diapers.

What Happens if There’s a Rotavirus Case at School/Child Care

People with rotavirus should stay home until they have no fever for at least 24 hours and symptoms of nausea/vomiting/diarrhea are improving for at least 48 hours. Contact a health care provider if there are any concerns.

Rotavirus Symptoms

  • Fever
  • Vomiting
  • Severe watery diarrhea
  • Stomach pain

How Rotavirus Spreads

  • When contaminated stool/poop enters the mouth (fecal-oral spread)
  • Direct contact with contaminated objects or stool

About the Rotavirus Vaccine

  • Vaccine is given as oral drops at two, four, six months of age
  • Available from a health care provider’s office

Hepatitis B is a viral infection that affects the liver. The disease can be short-term (acute) but can become long-term (chronic). For some people, symptoms can take two to six months to appear, while others may not develop symptoms at all. During this time, they can spread the infection to others. Babies, young children and persons with a weakened immune system are at a greater risk of becoming chronic carriers. A person may not know they have hepatitis B infection until damage has been done to their liver.

What Happens if There’s a Hepatitis B Case at School/Child Care

People with hepatitis B can continue to go to school if they feel well enough. Contact a health care provider if there are any concerns.

Hepatitis B Symptoms

Acute hepatitis B:

  • Fever
  • Feeling tired, weak
  • Stomach pain
  • Nausea, vomiting
  • Loss of appetite
  • Yellowing of the skin and eyes

Chronic hepatitis B:

  • Serious liver disease such as scarring of the liver (cirrhosis)
  • Liver cancer

How Hepatitis B Spreads

  • Blood and bodily fluids that contain the virus enter the body of someone who is not infected (e.g. through sexual contact, contact with contaminated objects such as needles).

About the Hepatitis B Vaccine

Human Papillomavirus (HPV) is a viral infection that can cause many cancers. It can cause cancers of the genitals, cervix and head and neck. HPV is also the most common sexually transmitted disease. Approximately three out of four sexually active Canadians will be infected with HPV at some time in their life. The infection peaks in young adults, affecting both males and females.

What Happens if There’s a Human Papillomavirus Case at School/Child Care

People with Human Papillomavirus can continue to go to school if they feel well enough. Contact a health care provider if there are any concerns.

Human Papillomavirus Symptoms

  • Most people have no symptoms and can infect their sexual partner(s).
  • For some people, infections go away without treatment within a couple of years
  • Some people may develop symptoms of cancer or warts

How Human Papillomavirus Spreads

  • Spread through close physical contact with someone who has the virus.

About the Human Papillomavirus Vaccine

Influenza (flu) is a viral respiratory infection which is most severe in children six months to five years old, people over 65, people who are pregnant, and those with health conditions. Unlike the common cold, the flu can develop into more serious health problems such as pneumonia or can worsen pre-existing medical conditions such as asthma.

What Happens if There’s an Influenza Case at School/Child Care

People with influenza (flu) should stay home until they have no fever and their symptoms are improving for at least 24 hours (or 48 hours if nausea/vomiting/diarrhea) and avoid contact with others, especially those at highest risk of getting very sick. Complete Ontario’s self-assessment tool to learn more about what to do next. Contact a health care provider if there are any concerns. Visit Respiratory Viruses: Caring for Someone for more information.

Influenza Symptoms

  • Fever/chills
  • Sore throat
  • Feeling tired
  • Sneezing
  • Cough
  • Watery eyes
  • Loss of appetite
  • Nausea
  • Vomiting
  • Muscle pain
  • Complications can result in trouble breathing, convulsions, seizures, and pneumonia

How Influenza Spreads

  • Close contact with respiratory droplets or aerosols (from talking, coughing or sneezing)
  • Touching something with the virus on it, then touching your mouth, nose or eyes before washing your hands

About the Influenza Vaccine

  • Everyone six months and older can get a flu vaccine
  • One dose of the influenza vaccine given every year during “flu season”

COVID-19 is a viral respiratory illness similar to the flu. Some people can get very sick and may require hospitalization. Long COVID (when symptoms last for months) is a condition that some people can get after having a COVID-19 infection.

What Happens if There’s a COVID-19 Case at School/Child Care

People with COVID-19 should stay home until they have no fever and their symptoms are improving for at least 24 hours (or 48 hours if nausea/vomiting/diarrhea). Complete Ontario’s self-assessment tool to learn more about what to do next. Notify your close contacts to help stop the spread of COVID-19. Contact a health care provider if there are any concerns. Visit Respiratory Viruses: Caring for Someone for more information.

COVID-19 Symptoms

  • Fever/chills
  • Cough
  • Sore throat
  • Runny nose
  • Loss of taste or smell
  • Nausea, vomiting, diarrhea
  • Difficulty breathing
  • Headache
  • Dizziness
  • Feeling tired
  • Weakness (or falls)
  • Muscle aches
  • Some children can get an unusual inflammatory condition that needs medical attention: rash, long lasting fever, pink eyes and/or swelling in the hands and feet

How COVID-19 Spreads

  • Close contact with respiratory droplets or aerosols (from talking, coughing or sneezing)
  • Touching something with the virus on it, then touching your mouth, nose or eyes before washing your hands

About the COVID-19 Vaccine

  • Everyone six months and over is encouraged to get a COVID-19 vaccine and stay up-to-date with vaccinations
  • Everyone can get the COVID-19 vaccine at the same time as most vaccines (except for the RSV and MPOX vaccines)

For more information about COVID-19 vaccines for infants, children & youth, visit:

Vaccines given with a needle can be painful and frightening for a child. Parents play an important role in supporting their children during immunizations. It is important to share information in an age-appropriate way with your child about vaccines and the diseases they protect against.

Visit Tips to Improve Your Child’s Immunization Experience to learn more.