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Novel Influenza A (H1N1) Virus: Review of Current School Guidance
Presentation to SHACSeptember 16, 2009Esther M. Walker, Assistant Director of Patient Care ServicesDouglass O’Neill, Coordinator, Safety And Environmental Health
History of Influenza Pandemics
Three pandemics in the 20th century 1918 (H1N1) – 40 million deaths
young people most affected
1957 (H2N2) – 2 million deaths children most affected
1968 (H3N2) – 700,000 deaths all ages affected
Outbreaks tend to occur in two or three waves over a period of a year or more
Severity of subsequent waves can change
H1N1 “swine flu” Pandemic: Activity Update
Disease outbreaks of influenza occurring on every continent and over 70 countries
Worldwide - 162,380 cases 1154 deaths U.S.A – 43,771 cases and 302 deaths Virginia -349 cases and 2 deaths Fairfax County – 75 cases and no deaths
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
Current H1N1 Pandemic Update
Virus appears to be more contagious than seasonal influenza
A younger age group has been affected than seen during seasonal influenza
Presenting with spectrum of illness Most cases seem to be mild and self-limited
Tendency to cause more severe and lethal infections in people with underlying medical conditions
Potential severity of virus remains uncertain; current severity is unchanged from Spring 2009
H1N1 Vaccine
Matches isolated virus- manufactured using same process as seasonal flu vaccines
Currently in clinical trails Available for use mid-October Possibly 2 doses 21-28 days apart First group to receive vaccine will be
high risk group as defined by CDC
CDC/ACIP Target Groups for Vaccine
Target Group (159 M) Priority if needed (40 M)
HCW and Emergency Medical Services
HCW and EMS with direct exposure or work with samples
Pregnant Pregnant
Household contacts of infants <6 months of age
Household contacts of infants <6 months of age
Individuals 6 mos. to 24 years of age
Individuals 6 mos. to 4 years of age
25-64 years with chronic medical conditions
5 years to 18 years with chronic medical conditions
Hospitalizations From Novel H1N1 Influenza
Prevalence, Hospitalized H1N1 Patients Prevalence, General US Pop
8%
15%
14%
16%
7% 7% 6%
8%
4%
6%
7% 5% 1%
28%
0%
5%
10%
15%
20%
25%
30%
Asthma
COPD
Diabetes
Chronic C
VD*
Morbid O
besity **
Neurocognitiv
ie Dz
Neuromuscular D
z
Pregnant
April 1 – May 30st (n=268)
Possible Vaccine Delivery Models
Traditional providers in the community
Public Health Response Push model to community partners School based vaccination clinics Mass vaccination clinics for the general
population
FCPS providing free seasonal flu shots for employees
Human Resources coordinating Expected to be available in
September Highly encouraged to receive
seasonal flu shots
Seasonal Flu Vaccine
Current Planning Education and Information
KIT messages to community High risk individuals should begin dialogue with
primary care provider Internal and public websites, videos, posters,
morning school announcements, community messaging via Insight and Channel 21
FCPS and FCHD continue ongoing meetings If severity increases guidance will come
through FCHD and FCPS if other interventions are needed Number of strategies available
Town Hall Meetings
Principal meeting August 11, 2009 HD-SIMS Cleaning protocols—routine is adequate Hand washing emphasized Health curriculum in first 2 weeks of school Respiratory/Cough Etiquette and Hand Washing Posters
delivered to every school and center. Surgical masks delivered to every school and center. Notification to employees with information on high risk
groups Kilmer, Key, Bryant and Mountain View briefing already
held with administrators
Preventive Measures
Recommendations for Schools: Outbreak similar to the Spring Hand Hygiene/Respiratory etiquette
Work with school administrators to make access to hand washing (soap/paper towels) easier and tissues available. Guidance on antiseptic towellettes and hand sanitizers.
Reinforce the classroom based instruction with the student and staff
Getting seasonal flu vaccine All children aged 6 months to 19th birthday should
get seasonal flu vaccine H1N1 Vaccine when available for persons in priority group Keeping ill students home
Influenza
Symptoms Fever, cough, sore throat, runny nose,
headache, muscle aches, extreme weakness, tiredness
Definition Influenza-Like-Illness (ILI) is defined as
having a fever (>100) plus cough and/or sore throat
Stay at home if ill Stay home until 24 hours after fever has ended
Students present ILI symptoms at school Isolated and supervised. FCPS principals to start identifying
isolation areas and non-high risk staff to supervise students. Parental contact for pickup—emergency contact info Wear a surgical mask, if tolerable Reinforce the exclusion period with the families when they are
called and again when they pick up the child Children do not necessarily need to seek medical care unless the
severity of their illness requires that Students will not require a medical note to come back to school
Protocol for Students
Stay home if ill—24 hour rule
No doctor note required
Staff who present ILI symptoms Sent home If unable to leave immediately, self isolate
and wear surgical mask if tolerable
Protocol for Staff
Recommendations for Schools: Exclusion period
Staff and students with ILI should stay home for at least 24 hours after fever (most contagious period) without the use o fever reducing medications 3-5 days in most cases Avoid close contact with others Medical note not required to return to school
When they return to school after fever resolves, they should continue to wash hands and cover coughs and sneezes
CDC recommends schools try to stay open Recognition of social and economic impacts of closures
Local decision Populations, individual schools or division wide Close consultation with FCHD Epidemiological basis Operational capability basis
Recommendations for Schools: School Closures
Recommendations for Schools: School Closures
Widespread school closures not anticipated Will use strategies based on the severity of the
illness and local flu activity Alternatives to school closures
Stepping up basic good hygiene practices Keeping sick students and staff away from school Helping families identify their children who are at high-
risk for flu complications Benefit from early evaluation from their physician if they
develop the flu Review your medical flag lists and discuss these kids with
their parents in advance Routine Cleaning
Updated FCPS Pandemic Emergency Operations Plan
Continuity of Operations component
Daily student & staff absentee data to be provided to VDH
Closure notifications to CDC/U.S. Dept of Ed
Emergency Management Issues
School Blackboard sites kept up-to-date
Blackboard pandemic function ready Keep on Learning
Packets for distribution, when needed
Academic Continuity
Individual and Family Preparedness
Encourage students, staff and school community Get an emergency kit Make a family plan Stay informed Stop germs from spreading
Wash hands often Cover coughs and sneezes Stay home when sick