06 H1N1 Flu Schools FAQs (General Information)
The student should be kept isolated from others while at school, where possible, while waiting to go home with a parent or responsible adult as soon as practical.
There is no notification requirement for single cases of flu at a school or day care center. If there is an outbreak situation with many students becoming ill, the school administrators should contact their medical advisers and their local public health department for further advice. The County Health Officer usually has the authority to close a school after discussions with school officials if an outbreak is severe. If considered necessary, these local officials will contact the California Department of Education and the California Department of Public Health to consider regional or state issues. If you are inquiring for a school, the CDC has provided template materials for schools, including letters to parents. These can be accessed online at http://www.ImmunizeCA.org.
Current recommendations, while vaccine supplies are limited, target people that have a higher risk of influenza-related complications or death. Once vaccine supply exceeds prioritized demand, the vaccine will be available to all people who want it, on a first come first served basis. Due to vaccine production issues, delivery dates are fluid.
Teachers and staff who have chronic health conditions, like diabetes or asthma, are at higher risk of flu complications if they do catch the flu. These at risk people are prioritized to be given the vaccine as soon as it is available. They should check with their doctor or clinic or check in the local media to find out when prioritized groups and for healthy adults should go for H1N1 vaccine.
The new CDC (and CDPH) K-12 and child care guidance applies to any influenza (flu) virus circulating during the 2009-2010 school year, including the regular seasonal flu and the H1N1 flu. The new guidance recognizes the need to balance the risks of illness among students and staff with the benefits of keeping students in school. It offers specific steps for school staff, parents, and students to take given the current flu conditions as well as for more severe flu conditions. The new guidance also provides information for making decisions at the community level about when to use these strategies aimed at schools.
In addition, this guidance recommends that, based on current flu conditions, students and staff with flu-like illness stay home until at least 24 hours after they no longer have a fever or signs of a fever without the use of fever-reducing medications (any medicine that contains ibuprofen or acetaminophen). This is a shorter time period from the previous guidance, which recommended that sick students and staff stay home 7 days after symptoms begin. The 7 day period away from school for sick students and staff would still be recommended under more severe flu conditions. In addition, this longer period should be used in healthcare settings and in any place where a high number of high-risk people may be exposed, such as schools for children with muscular dystrophy, asthma, diabetes or childcare facilities for children younger than 5 years of age.
More information is available on line at CDC, CDE, CDPH and AAP (American Academy of Pediatrics) web sites (http://www.cdc.gov, http://www.flu.gov, and http://www.aap.org).
Students are at high risk for getting the H1N1 flu. Children and adolescents are efficient spreaders of this kind of flu. Students are packed close to each other in classrooms so schools may act as a point of spread, where students can easily spread flu to other students and their families. If many people are in a small space, social distance is low. Spread is reduced if social distance can be increased. So far, with H1N1 flu, the largest number of cases has been in people between 5 and 24 years of age.
School officials should think creatively about ways to increase the space between people, but still keep students in school. Not every option listed below will be possible for all communities, but it is important to consider some ways to increase social distancing if schools are going to remain open, which officials now suggest if possible. Some options are:
rotating teachers between classrooms while keeping the same group of students in one classroom,
canceling classes that bring students together from multiple classrooms,
holding classes outdoors,
postponing class trips,
discouraging use of school buses and public transit,
dividing classes into smaller groups,
moving desks farther apart, and
moving classes to larger spaces to allow more space between students. Three feet apart is better than less, 6 feet apart is probably better than 3 feet apart.
Anyone can get influenza (the flu), even healthy people, and serious problems from the flu can happen at any age. But, people who are more likely to have complications (negative effects) from the flu include:
Children under 5 years of age;
People of any age with chronic medical conditions (such as pulmonary disease, including asthma, diabetes, neuromuscular disorders or heart disease); and
people 65 years of age and older.
CDC and other public health agencies are monitoring local, regional, national, and international data on the ages, conditions, and number of people who seek care for flu-like illness, the number of hospitalizations; and deaths.
CDC will also look at the geographic spread of flu-like illness and will look for changes in the characteristics of the virus. By comparing data on a weekly basis with seasonal flu trends and trends from the H1N1 flu during the spring, CDC will provide advice to state and local agencies on what steps to take depending on circumstances, which will change as time goes on. Public Health officials now agree that schools should be kept open, if at all possible. However, if too many staff are out sick, then schools may have to close. States and local communities can expect the impact of flu in their area to be different from that seen in other parts of the country.
States, communities, and schools should consider:
Who needs to be involved in the decision-making process and include those people in regular communications;
The severity of flu and the impact in the community and in the schools; and
The goals, feasibility, educational, social and economic consequences, and community's acceptability of the action steps being considered.
Food needs of children on free and reduced lunch programs if schools are dismissed.
Creative methods to assure that students continue with their education if schools are dismissed.
Alternatives available for child care if parents must continue working, if schools are dismissed. Congregating in child care or in malls helps no one avoid spreading the flu.
The effect of decisions on children with special needs.
Families, students, and school staff can keep from getting sick with influenza (flu) in three ways:
1. Get vaccinated. CDC recommends that you get both the seasonal flu and H1N1 vaccine. Vaccination is especially important for people at high risk of complications from the flu.
2. Take everyday preventive actions. This includes:
practicing good hand hygiene. Students and staff members should wash their hands often with soap and water, especially after coughing or sneezing. Alcohol-based hand cleaners are also effective.
practicing respiratory etiquette. The main way that the flu spreads is from person to person in the droplets produced by coughs and sneezes, so it's important to cover your mouth and nose with a tissue when you cough or sneeze. Throw the tissue away and clean hands after sneezing and coughing. If you don't have a tissue, cough or sneeze into your elbow or shoulder, not into your hands.
staying home if you're sick. Keeping sick students at home means that they keep their viruses to themselves rather than sharing them with others.
3. Take flu antiviral drugs if your doctor recommends them. Antiviral drugs can treat the flu. They can make illness milder and shorten the time you are sick. They may also prevent serious flu complications.
Students, staff, and their families must take personal responsibility for helping to slow the spread of the virus by practicing these steps to keep from getting sick with flu and protecting others from getting the flu.
Institutions of higher education can keep students, faculty, and staff healthy and can protect them from the H1N1 flu and other flu illnesses by taking the following steps:
Separate people who are sick from those who are well, as soon as possible.
Encourage good hand hygiene and respiratory etiquette through:
Providing alcohol based hand cleaners and tissues all over campus.
Direct education on how to keep hands clean and respiratory secretions from spreading;
Communication materials such as posters and flyers; and
Other methods including e-mail, text messaging, or phone calls.
Establish a method for maintaining contact with students who are sick. If resources permit, student affairs staff, housing staff, or health care providers could be assigned to make daily contact with each student.
Encourage sick people to stay at home or in their residence (dorm) except to talk with a healthcare provider about whether they have flu; appropriate treatment; and what actions to take if they have severe symptoms.
Encourage students, faculty, and staff living off campus to stay at home if they are sick with flu-like illness. They should stay home until they are free of fever for at least 24 hours without medicine to control fever.
Advise students, staff and administration to:
Avoid kissing, hand shaking, illicit drug use, smoking and alcohol consumption.
Get enough sleep, exercise, and eat a well balanced diet.
Pay attention to your own mood and the adjustment of others. Take action to solve behavioral problems once identified.
Get involved in helping others, especially if the student has recovered from the flu.
Pay attention to maintaining social contacts with family and friends using phone, e-mail, networking, etc
Discourage visitors with flu-like illness from attending institution-sponsored events until they are free of fever for at least 24 hours without medicine to control fever.
Examine and revise, as necessary, current flu (or crisis) response plans and procedures, and update contact information.
Communicate with vendors who supply critical products and services, including hygiene supplies, food service, and personal protective equipment for staff, to address the continuation of these products and services throughout the flu season.
Encourage any students, faculty, and staff who want protection from flu to get vaccinated for seasonal flu.
Encourage students, faculty, and staff who are at higher risk for flu complications from H1N1 flu to receive the H1N1 vaccine. People at higher risk for H1N1 flu complications include pregnant women and people with chronic medical conditions (such as asthma, heart disease, or diabetes). For more information about priority groups for H1N1 vaccination, visit CDC's H1N1 website.
Encourage all child care staff to get vaccinated for seasonal influenza (flu) and H1N1 flu. Most staff who work in child care settings are in the priority group for vaccination. Also encourage parents to get their children vaccinated. Visit the CDC website to learn more about priority groups for vaccination.
Encourage child care staff to stay at home if they are sick with flu-like illness. Ask parents to keep children home if they are sick. Staff and children should stay home until they are free of fever (100 degrees Fahrenheit or 38 degrees Celsius) for at least 24 hours, without the use of fever-reducing medicines.
Conduct a daily health check of children and staff. Watch children and staff for signs of illness, take their temperatures, and ask about symptoms.
Move children and staff who become sick at the child care program to a separate room until they can be sent home. Limit the number of staff who take care of the sick person and provide a surgical mask to sick staff members to wear if they can tolerate it. Visit the CDC website to learn more about caring for someone who is sick.
Encourage respiratory (breathing tract) etiquette by providing staff and children with education and reminders about covering coughs and sneezes, and easy access to tissues and no-touch trash cans.
Remind staff and children to practice good hand hygiene and provide the time and supplies for children and staff to wash their hands or use alcohol hand cleaners under adult supervision when needed.
Routinely clean surfaces and items that children frequently touch with their hands, mouths, and body fluids. Use cleaning agents that are usually used in these areas. Additional disinfection beyond routine cleaning is not recommended.
Communicate and instruct staff and parents of children in child care programs to get medical care for themselves or for their children immediately if they get sick and are at higher risk of flu complications (health problems), are concerned about their illness, or develop severe symptoms. Early treatment can prevent hospitalizations and deaths.
Consider closing the child care program if flu transmission (spread) is high in the community. Work closely with child care medical staff and local public health officials to decide if the child care program should be closed temporarily (for a short period of time).
Child care programs should perform a daily health check for all children and staff upon or soon after arriving at the facility. The purpose of the daily health check is to observe and assess the child's overall health. Trained and experienced child care providers can be a valuable resource to parents, especially new parents who may not recognize that their child is ill and should be examined by a pediatric health care provider. Young children may not be able to communicate that they are not feeling well.
The daily health check should consist of watching the child and talking with parent and child. During the daily health check, the child care provider should look for:
A change in the child's behavior (crankiness, unusual crying, decreased appetite, or a lack of interest in playing);
A report of illness in the child or a family member;
A report of a recent visit to a health care provider by the child or a family member; and
Any signs or symptoms of influenza (flu) (feeling warm to the touch, fever, coughing, sneezing, runny nose, sore throat).
A note from a doctor's office or health care provider is not needed for a child to return to a child care program. Health care facilities may be very busy during influenza (flu) season and it will be hard to provide these notes. Under current flu conditions, if a child has symptoms of flu they should stay home until they are free of fever (100 degrees Fahrenheit or 38 degrees Celsius) for at least 24 hours, without the use of fever-reducing medicines.
Under more severe flu conditions, children with symptoms of flu should stay home for at least 7 days, even if symptoms go away sooner. People who are still sick after 7 days should continue to stay home until at least 24 hours after symptoms have gone away.
Parents should make plans for alternate child care in case their usual child care programs are closed due to influenza (flu) if the parents must go to work. Alternate child care may include care by:
Parents should check with their employers to find out if they can be allowed to work from home or to have different work hours to be able to stay home and take care of their children. Temporary (for a short time) alternate child care should keep the child in small groups (less than 6 children). Parents might also check with faith based or social community organizations on ways they can get emergency child care for their children if child care programs close during a severe flu outbreak.
California Department of Public Health, Office of Public Affairs
Reviewed by CDPH 10/24/09
Posted by H1N1 Web Team 11/3/09