Based on current evidence indicating that acquired immune deficiency syndrome is not transmitted through casual person-to-person contact, the federal Centers for Disease Control has recommended that most children with the disease be allowed unrestricted access to schools, child-care facilities, and foster-home settings.
But the centers also suggested, in a set of recommendations released late last month, that decisions on individual cases should involve the careful weighing of health and environmental factors and should be made by “teams” including physicians, public-health and school officials, and parents and guardians.
The CDC recommendations represent the first national guidelines on educating children with AIDS. (See text of guidelines below.)
Though the guidelines reflect the CDC’s belief that the risk of developing AIDS from casual contact is minimal, they also advise caution in school and child-care settings to “minimize exposure of other children to blood and other body fluids.”
Those making decisions on whether to allow aids-infected children to attend classes with other children, the CDC states, should4"weigh the risks and benefits both to the infected child and others in the setting.”
“For most infected school-age children, the benefits of an unrestricted setting would outweigh the risks of their acquiring potentially harmful infections in the setting and the apparent nonexistent risk of transmission,” the guidelines state.
However, for preschool children and for neurologically handicapped youths who may lack adequate control of their bodily functions, the CDC recommends a restricted environment “until more is known about transmission in these settings.”
Because the “hygienic practices” of children with AIDS may improve or deteriorate as they mature or as their disease worsens, the centers recommend regular evaluations to assess the need to restrict access to group settings.
Routine Procedures
The guidelines also encourage all schools and day-care facilities, regardless of whether children with AIDS are enrolled, to adopt routine procedures for handling blood and body fluids. Such precautions are not only warranted by the fact that other infectious agents may be present in such fluids, the CDC says, but will be a safeguard against the possible presence of the virus thought to cause AIDS--Human T-Lymphotropic Virus Type III/Lymphadenopathy-Associated Virus (HTLV-III/LAV).
Available scientific data on AIDS do not warrant “mandatory screening as a condition for school entry,” according to the guidelines. But physicians are advised to consider testing at-risk children, such as those whose mothers have AIDS, to protect them against potential medical problems and to enable parents and others to make informed decisions on their care and schooling.
Development of the guidelines follows consultation by the CDC with representatives from various health, education, and legal groups, including the National Association of Elementary School Principals and the National Congress of Parents and Teachers. Pediatricians familiar with AIDS and a legal adviser to a state education department also contributed to the guidelines’ formulation.
The agency says the nonbinding recommendations are meant to “assist state and local health and education departments in developing guidelines for their particular situations and locations.” They take into consideration, CDC officials say, the scope of the problem, children’s education-related civil rights, the issue of patient confidentiality, and the increased susceptibility of children with AIDS to other diseases because of their weakened immune systems.
CDC statistics show that, as of late August, 183 of the 12,599 reported cases of AIDS in the United States were among children under age 18. The agency predicts that number will double in the next year.
Children with the incurable disease have been reported in 23 states, the District of Columbia, and Puerto Rico, according to the CDC, with 75 percent residing in California, Florida, New Jersey, and New York.
To date, the agency notes, none of the identified cases of AIDS in the United States are known to have been transmitted in school, day-care, or foster-care settings, or through other casual person-to-person contact.
New Jersey, New York
In related developments:
- The New Jersey Department of Health has recommended that most children with AIDS be allowed to attend classes, but will leave it up to local school districts to make initial admissions decisions.
To date, 22 children with AIDS have been reported in the state; at least five of them are seeking to enroll in public schools this month, according to health officials.
Two days before the New York City guidelines were issued, Mayor Koch said that, in his opinion, no child suffering from AIDS should attend New York City schools. At least seven children with the disease were expected to be evaluated by the panel before school opened Sept. 9.
