The federal and state governments use schools as the vehicle to enforce various public health laws directed at children. States have customarily required proof of immunization for childhood diseases for school admission. Some states are mandating that schools screen children for personal health problems. State laws also provide schools with the authority to screen and exclude students to prevent the spread of communicable diseases. The controversies over school children with HIV have sensitized the public to communicable diseases in schools. This has forced school physicians to become a front line force in community disease control.

All states require that physicians report communicable diseases to the public health department. Most also require reporting of outbreaks of any disease that may be caused by infection, infestation, or environmental hazards, particularly if they occur in a school. School physicians have personal responsibility for seeing that the reports are made. Normally, the school nurses will do the actual tallying and reporting of routine cases such as influenza or chicken pox. They should report unusual disease problems to the school physician immediately.

Every school needs a detailed, written policy on the management of students with communicable diseases. Schools have the right and duty to screen and restrict students infected with diseases that pose a risk to other students, but they cannot use this power to remove students who pose a political problem rather than a communicable disease problem. For example, a student with asymptomatic HIV infection does not pose a risk to other students. This student must be allowed to stay in school without restrictions unless the student is violent due to dementia or has a secondary disease, such as infectious tuberculosis.