Recreational Camp Guide

For Infection Prevention and Control

Introduction

The Recreational Camp Guide is provided to you by the North Bay Parry Sound District Health Unit's (NBPSDHU) Communicable Disease Control (CDC) Program. This guide contains information on the role of Public Health in managing illnesses due to diseases of public health significance (DOPHS) in recreational camps, the role of Public Health in managing and controlling outbreaks in the community, and some information on ticks and tick-borne diseases.

Illness in Recreational Camps

Public Health works to help reduce the occurrence of specific communicable diseases through investigation and management of reported cases. Specific cases of diseases are to be reported to the NBPSDHU according to as per Ontario Regulation 135/18 and amendments under the Health Protection and Promotion Act, R.S.O. c.H.7. These cases and any contacts of cases are managed on an individual basis. Your assistance may be required for collection of information throughout the course of the investigation and for management of these cases and contacts.

According to the Ontario Camp Association Standards, "camps must have a policy for the management of outbreaks and communicable diseases. Camps must obtain and post a list of reportable and non-reportable diseases from the Public Health Unit Department (PH). A process and delegated person for reporting all reportable diseases to PH must be in place."

Due to close living and sleeping quarters, camps provide a favorable environment for the spread of communicable diseases. For this reason, it is important to remember that sick children and/or staff should remain at home or be excluded from having contact with the other children and/or staff, not only to recover, but also to prevent spreading illness to others. See the Diseases page for more information on common communicable diseases and recommendations for exclusion from camp.

There should be procedures in place at camps to manage potential outbreaks and/or manage communicable diseases. According to the Ontario Camp Association Standards, "written procedures should include: infection prevention and control practices, a process for early identification of communicable disease, methods of isolation/management, and communication with public health department, parent/guardian(s), and senior camp staff".

Understanding the Spread of Infection

See the Understanding the Spread of Infection webpage.

Outbreaks

Role of the Health Unit in an Outbreak

Public Health Inspectors and Public Health Nurses at the NBPSDHU work with the owner/operator of the recreational camp to assist in controlling the spread of illness, which will benefit the health and enjoyment of campers and staff. Services that may be provided as soon as possible after the outbreak has been reported to the Health Unit include:

Onsite visit to conduct inspection of food preparation and handling.
Onsite visit to speak to the camp director, camp nurse/healthcare providers, custodial staff, or counselors to reinforce basic infection and prevention control measures.
Daily communication via phone/fax/email to support documentation and answer questions related to outbreak management.
Statistical analysis of data collected about ill campers and/or staff to monitor the effectiveness of outbreak control measures and to identify sources of infection.
Arrangement for the pickup and testing of environmental samples (food, water) and clinical specimens (stool specimens).

The NBPSDHU staff are available to answer any questions or concerns that you may have about infection prevention and control, whether or not you are in outbreak.

Enteric Outbreak

Definition

An enteric outbreak is suspected whenever there are a greater than expected number of cases with similar signs and symptoms in the same location, for example, two or more cases experiencing diarrhea and/or vomiting within a 48-hour period. Enteric refers to an illness that affects the gastrointestinal tract (stomach and intestines) and results in symptoms such as nausea, vomiting, and/or diarrhea. Many bacteria and some viruses and parasites can produce enteric illness in people.

Steps to take when you have a suspected outbreak

Notify the NBPSDHU CDC Program of a known or suspected outbreak. It is the responsibility of the NBPSDHU, in consultation with the camp, to decide if an outbreak is going to be declared.
Start separate line listings, one for staff and one for campers, who have presented with symptoms that may be associated with the outbreak.
Exclude ill campers and staff to stop the spread of infection to others.
Implement outbreak control measures to stop the spread of infection, as recommended by the NBPSDHU.

Managing an enteric outbreak

Staff at the recreational camp will:

Develop a case definition for the outbreak with the NBPSDHU. This may change, depending on presenting symptoms, throughout the outbreak.
Review outbreak control measures, including exclusion recommendations, with the NBPSDHU (also faxed or emailed when the outbreak is declared).
Review cleaning and disinfection recommendations with the NBPSDHU during an outbreak.
Discuss cleaning and sanitizing of food preparation/handling areas with a Public Health Inspector from the Environmental Health Program at the NBPSDHU.
Continue to monitor and exclude all staff and campers who meet the case definition, for the appropriate exclusion period, as determined by the NBPSDHU and the camp. In some instances, staff and/or campers may be sent home to recover. The return of staff and/or campers is based on the specific exclusion guidelines for the outbreak.
Update the line listing(s) daily with all new campers and staff that develop symptoms during the outbreak. Fax the line listing(s) daily (including weekends and holidays) to the NBPSDHU at 705-482-0670 by 11:00 am. Line listing(s) may also be emailed to the NBPSDHU via password protection or encryption; discuss options with the Outbreak Manager.
Obtain an order from the camp physician/nurse practitioner to collect stool samples (NBPSDHU to provide kits upon request) from campers and/or staff with the most recent onset of enteric symptoms. (Helpful Hint: A pre-existing medical directive from the camp physician/nurse practitioner, for the purposes of an outbreak, would ensure timely collection of samples). Usually, the maximum number of specimens collected during an enteric outbreak is 5. Ensure that each specimen is appropriately labeled. All specimens must be placed in the bag provided with the kit.
Once specimens are collected and bagged, place on ice or refrigerate, but do not freeze. Contact the NBPSDHU to arrange pick-up and delivery to the Public Health Laboratory.
Any food or environmental specimens will be coordinated by an Environmental Health Public Health Inspector.
Inform all staff of the outbreak status and provide education on how to stop the spread of infection.
Educate all campers on stopping the spread of infection.
Inform parent(s)/guardian(s) of campers that an outbreak has been declared at camp.
Post appropriate signage at entrances and exits of camp to inform visitors than an outbreak has been declared and what precautions they should take to stop the spread of infection.

Respiratory Outbreak

Definition

A respiratory outbreak is suspected whenever there is a greater than expected number of cases with similar respiratory illness signs and symptoms in the same location. Respiratory refers to an illness that affects the respiratory tract and results in symptoms such as cough, runny nose, sneezing, sore throat, abnormal lung sounds, hoarseness, difficulty swallowing, headache, chills, loss of appetite, and/or fever. Many viruses and bacteria can produce respiratory illness in people. Public Health presently has a minimal role in the management of respiratory outbreaks in recreational camps, unless there is an outbreak of a Disease of Public Health Significance, or the illness experienced by campers and/or staff is severe, unusual, or there are hospitalizations. In these situations, please contact the NBPSDHU's CDC Program for further directions. The CDC program is always available to answer questions and provide information/support regarding infection control practices.

Managing a respiratory outbreak

Staff at the recreational camp will:

Exclude ill campers and staff to stop the spread of infection to others. See our Diseases webpage.
Implement Infection Prevention and Control recommendations for stopping the spread of infection. Contact the NBPSDHU's CDC Program with any questions or concerns.
Inform all staff, campers, and parent(s)/guardian(s) of the outbreak and provide education on how to stop the spread of infection. See Template Letter for Parents/Staff.
Inform visitors to the camp facility of the increase in respiratory symptoms, so they may take appropriate precautions upon entering and leaving camp. See Appropriate Signage.

Resources

Gastroenteritis

See the Gastroenteritis webpage.

Hand Hygiene

See our Hand Hygiene webpage.

Outbreak Control Measures

Outbreak Line Listing Forms: Campers/Staff

Outbreak Line Listing Form for printing only

How to Collect a Stool Sample

Template Letter for Parents/Staff

Appropriate Signage

Post appropriate signage at entrances and exits of the camp to inform visitors that an outbreak has been declared.

How to Reach Us

Health Unit Programs and Services

References

Canadian Digestive Health Foundation. (2023). Is my Poop Healthy/Normal? Retrieved from the Canadian Digestive Health Foundation webpage.

Health Protection and Promotion Act, R.R.O., 1990, Regulation 568 for Recreational Camps, Section 5. Retrieved from Ontario Laws

Ministry of Health (MOH¹). (2024). Recommendations for Outbreaks Prevention and Control in Institutions and Congregate Living Settings. Retrieved from Recommendations for Outbreaks Prevention and Control in Institutions and Congregate Living Settings (ontario.ca)

Ministry of Health (MOH²). (2024). Lyme Disease. Government of Ontario. Retrieved from Ontario Government webpage.

Ministry of Health (MOH³). (2022). Appendix 1: Case Definitions and Disease, Specific Information Disease: Gastroenteritis Outbreaks in Institutions and Public Hospitals. Toronto, Canada: Queen's Printer for Ontario. Retrieved from Ministry of Health website

Ministry of Health (MOH⁴). (2023). Appendix 1: Case Definitions and Disease Specific Information Disease: Respiratory Infection Outbreaks in Institutions and Public Hospital. Toronto, Canada: Queen's Printer for Ontario. Retrieved from Ministry of Health website

Ministry of Health (MOH⁵). (2023). Covid-19. Government of Ontario. Retrieved from Covid-19/Ontario

Ontario Camps Association. (2024). 2024 Standards. Retrieved from Ontario Camps Association website

Public Health Ontario (PHO¹). (2021). Gastroenteritis - Stool Viruses. Laboratory Services. Retrieved from Public Health Ontario website

Public Health Ontario (PHO²). (2020). Enteric Outbreak Kit Order #:390036. Laboratory Services. Retrieved from Public Health Ontario website

Public Health Ontario (PHO³). (2020). IPAC Core Competencies - Risk Assessment and Chain of Transmission. Retrieved from Public Health Ontario website

Public Health Ontario (PHO⁴). (2014). Best Practices for Hand Hygiene in All Health Care Settings, 4^th edition. Provincial Infectious Diseases Advisory Committee. Retrieved from Public Health Ontario website

Shope, Timothy R., Hashikawa, Andrew N. (2023). Managing Infectious Diseases in Child Care and Schools - A Quick Reference Guide (6^th ed.). American Academy of Pediatrics.

Last updated: June 2024, by CDC