Public Health Idaho North Central District, 215 10th Street, Lewiston, ID 83501
Asotin County Health District, 431 Elm Street, Clarkston, WA 99403
May 5, 2009
GUIDANCE FOR SCHOOLS REGARDING THE CONTROL OF NOVEL INFLUENZA A (H1N1) IN JURISDICTIONS OF ACHD AND INCD
Background
Over the past week, consistent with guidance from CDC, public health officials in several Washington counties had been recommending temporary closure of schools when there was a student with a confirmed or suspected case of novel influenza A (H1N1). At the onset of this outbreak of a previously unknown influenza virus, it was prudent to close affected schools while we learned more about the characteristics of this new disease and the strategy for community measures to prevent illness. The closures may have helped to decrease spread of infection in the schools and have provided valuable time for us to gather information about this new novel influenza A (H1N1)in our community. Because Asotin and Nez Perce County schools have not yet had a confirmed or suspected case, no schools have been closed in our health districts.
Based on information we have gathered from national, state and local officials, Asotin County Health District and Idaho North Central District are issuing this revised guidance for responding to the novel influenza A (H1N1) in schools and day care. We will not be routinely recommending the closure of individual schools or districts based on diagnosis of novel influenza A (H1N1) cases in students or staff. Although decisions will be made on a school-by-school basis, we expect that we will recommend a policy that focuses on keeping all students/staff with symptoms of influenza out of school during their period of illness and recuperation (typically seven calendar days), when they are potentially infectious to others. This change in policy is an enhanced version of the approach used during the yearly influenza season. Again, special circumstances in an individual school (such as a large spike in absenteeism from flu like illness) may result in closure, but this is not the default recommendation based on the first few suspected or confirmed cases. All closure decisions will be made by local Public Health officials through active collaboration with school officials.
Recommendations for disease control measures in the community, including schools, are driven by what we know about the illness and its spread, and the practicality and consequences of the measures, including personal, family and community disruption.
Two important points stand out:
- Epidemiological information from case investigations and surveillance (statewide and nationally) suggests that this new virus has spread more widely in communities and will continue, at least for a time, to be transmitted from person to person, including children.
- Available information from health care providers, emergency departments and hospitals, as well as information from other states, suggests that so far the severity of illness from novel influenza A (H1N1) is not greater than the typical seasonal influenza that circulates in our community every year.
Widespread school closure makes less sense at this time in the outbreak given what we are observing about disease transmission and the severity of illness currently associated with novel influenza A (H1N1). Public health authorities are acutely aware of the educational and economic disruption caused by school closure, and are committed to using that approach only when truly necessary. At the same time, public health officials are continuing to monitor the situation and will alter policies as needed as the situation changes. Our priority continues to be the protection of our community’s health.
Recommendations for Management of novel influenza A (H1N1) in Schools and Day Care
- Each morning, all parents/caregivers should assess all family members and especially all school-age children for symptoms of influenza (fever and cough or sore throat) or other symptoms that might be influenza.
- Each morning all school faculty should assess themselves for symptoms of influenza.
- Students or faculty with influenza-like illness (fever and cough or sore throat) should stay home and not attend school. All sick students and faculty should stay out of school for at least 7 days even if their symptoms resolve sooner. Students and faculty who are still sick at 7 days should continue to stay home from school until at least 24 hours after they have completely recovered.
- If a child or adult is ill with other symptoms, they should stay home at least one day to observe how the illness develops and until completely well for 24 hours. A few cases of novel influenza A (H1N1) begin as a gastro-intestinal illness.
- Schools should screen students and staff for visible signs of possible influenza illness upon arrival at school.
- Students and staff who appear ill at arrival or become ill at school should be promptly isolated and sent home.
- Persons who are ill should stay home and not go into the community unless they need medical care. Ill students should not attend alternative child care.
- As always, situations can be individualized and school authorities may close school at their discretion. Parents may use their judgment regarding the risk and benefits of sending their children to school during this influenza outbreak as they would during a seasonal influenza outbreak.
- As is the practice with seasonal influenza, schools may be closed if larger numbers of students or faculty become ill and school functioning becomes disrupted.
It is important to remember that even “routine” seasonal influenza can be a severe disease. Each year in the United States more than 200,000 people are hospitalized for flu-related complications; and about 36,000 people die from flu-related causes. Given this fact, unfortunately, as in every influenza season, we need to be prepared for the possibility of additional cases including severe cases and deaths. Preventing the spread of influenza requires all of us – schools, families, businesses, and government – to cooperate and work together.