Guidance for School Responses to Influenza

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1 Guidance for School Responses to Influenza West Virginia Department of Education and West Virginia Department of Health and Human Resources August 19, /19/2009 1

2 Purpose To provide local school and health officials with guidance for school responses to influenza during the school year with the goal of: Decreasing the spread of flu among students and staff, Decreasing risk of hospitalization and death, and Minimizing disruption of day-to-day social, educational, and economic activities 8/19/2009 2

3 Conference Call Agenda Welcome and Overview Status Update on H1N1 Virus Outbreak School Guidance and Support Documents Status Update on Planning for H1N1 Vaccination Question and Answer Session 8/19/2009 3

4 Current H1N1 (Swine Flu) Status Novel H1N1 currently predominant flu virus in US and WV Symptoms - like seasonal flu: fever, cough, sore throat, weakness, runny nose, muscle aches, etc. Younger age groups more impacted than with seasonal flu No evidence virus is changing at present. US: 7511 hospitalizations (23 WV) and 67 deaths (0 WV) Impact varies across localities. Some with heavy impact, yet overall flu-like-illness is at baseline in US and WV. Over summer in WV, outbreaks have been seen in camps, daycares, businesses, sports teams, etc. 8/19/2009 4

5 Graph A: Novel H1N1 Confirmed and Probable Case Rate in the United States, By Age Group 8/19/2009 5

6 Novel H1N1 U.S. Deaths, By Age Group 8/19/2009 6

7 Collaborative Planning and Response State level efforts strive to reduce the spread and minimize the effects of Influenza in West Virginia through collaborative planning and coordinated response Efforts are based on guidance, tools and resources provided by federal agencies. All guidance and technical assistance is predicated on the belief that the same collaborative effort should be practiced at the local level. 8/19/2009 7

8 Collaboration (Continued) Schools Examine and revise current plans and procedures Collaborate with Local Health Department and WVDE Communicate with families and communities about: What the school is doing to decrease exposure Roles of families and communities to reduce exposure and keep schools open Things families can do now to reduce work and educational disruption should short term dismissal be necessary. Local Health Departments Provide up to date guidance and information to schools Collaborate with school officials to jointly make H1N1 and seasonal flu prevention and management decisions related to the school setting 8/19/2009 8

9 Collaboration (continued) Students, staff, and families Take personal responsibility for behaviors that will protect them and their communities, such as staying home when ill and practicing good hand and respiratory hygiene Stay informed Local businesses Examine leave policies to ensure they enable employees to feasibly stay home when they or their children are ill (can employee maintain income? Is job protected?) Community-based and faith-based organizations can provide critical support Small group child care, if school dismissed Information dissemination 8/19/2009 9

10 August 2009 CDC Guidance for School Responses to Influenza Major Changes from Spring 2009 Guidance Recommends specific interventions for use during school year Suggests interventions for use under conditions of greater severity and impact Provides rationales, instructions, and caveats for use Provides decision-making guidance 8/19/

11 Access CDC Guidance Document and Technical Report at: Guidance: Technical Report: Communication Toolkit: 8/19/

12 Summary A combination of interventions based on spring 2009 influenza activity, severity, and virulence A menu of additional interventions to consider Decisions will differ across communities and should be based on local goals, epidemiology, health care system capacity, feasibility, and acceptability Interventions determined through collaborative decision making involving education and public health agencies, parents, and the community CDC may recommend pre-emptive school dismissals in the future based on changes in virulence, severity, and impact 8/19/

13 Recommended Interventions for school year Respiratory Etiquette Cover nose and mouth to cough or sneeze Discard tissue after use Hand Hygiene Students and staff should be encouraged to wash hands often especially after coughing or sneezing Time, facilities and materials should be provided for students to wash hands as needed Alcohol-based hand cleaners are also effective If not allowed, other hand sanitizers may be useful 8/19/

14 Recommended Interventions (Continued) Exclusion period Individuals with ILI should remain home for at least 24 hours after they are free of fever or feverishness without the use of fever-reducing medications 3 to 5 day exclusion period in most cases Stay home until the end of this period and avoid contact with others Can shed virus for more than 24 hours after fever goes away Upon returning to school continue to follow Hand hygiene Respiratory etiquette 8/19/

15 Recommended Interventions (Continued) Exclusion (Continued) Exclusion recommended regardless of antiviral drug use Decisions about extending period should be made at community level, in conjunction with local and state health officials Longer exclusion period may be appropriate for people returning to a setting with high-risk persons 8/19/

16 Recommended Interventions (Continued) Routine Cleaning Viruses may spread when persons touch respiratory droplets on hard surfaces and objects then touch their mouth, nose, or eyes Not necessary to disinfect beyond routine cleaning Regularly clean areas and items likely to have frequent hand contact Clean when visibly soiled Use detergent-based cleaners or EPA-registered disinfectants. 8/19/

17 Recommended Interventions (Continued) Designate isolation room for ill persons Move students and staff with ILI symptoms to isolation room immediately until they can be sent home Have them wear surgical masks when near others Staff with limited interactions with students and other staff should be designated to care for ill persons Use appropriate personal protective equipment for school nurses and other designated staff when caring for persons with ILI Suggest high-risk students and staff discuss antiviral post-exposure prophylaxis and early treatment with their health care provider 8/19/

18 Supply List for Recommended Interventions ) Tissues for each classroom Soap and paper towels Alcohol-based hand sanitizer Masks and gloves for school nurses and other designated staff caring for persons with ILI Thermometers (disposable recommended) Detergent-based cleaners or EPA-registered disinfectants 8/19/

19 Additional Interventions Based on Increased Severity and Impact Specific measures being defined Increased virulence High rates of severe complications, hospitalizations, deaths Pronounced surge in demand for healthcare services Feasibility and acceptability will vary across communities Other than school dismissal, not scientifically evaluated in community settings 8/19/

20 Additional Interventions for Severe Conditions (Continued) Extended exclusion period Remain at home for at least 7 days. If still sick after 7 days, stay home until at least 24 hours after symptoms resolve. Permit high risk students and staff to stay home Decide with health care provider Decrease exposure in other ways School and school board should consider ways to allow people to stay home Schools should plan for continuing education for home-bound students 8/19/

21 Additional Interventions for Severe Conditions (Continued) Institute active fever and symptom screening Sick students and staff should stay home Ask all students about symptoms at beginning of day Expanded illness definition Be vigilant throughout the day Students and staff who appear ill should be further screened by school nurse Home quarantine of well siblings Remain home and monitored for at least 5 days from onset of illness in household member Follow exclusion guidance for household members who becomes ill during this period 8/19/

22 Additional Interventions for Severe Conditions (Continued) Increase social distance within the school Half day schedules Outdoor classes Rotating teacher between classrooms, rather than students Postponing class trips that bring students together from multiple locations 8/19/

23 Additional Interventions for Severe Conditions (Continued) School dismissal Collaborative decision-making Clearly state reason for dismissing students and type of dismissal being implemented Selective dismissal Based on population and outbreak characteristics of schools Local decision Reactive dismissal Based on excessive absenteeism, illness at school, inability to maintain school functioning May reduce burden on health care system Local decision 8/19/

24 Additional Interventions for Severe Conditions (Continued) School dismissal (Continued) Pre-emptive dismissal Goal is to decrease spread of influenza virus or reduce demand on health care system Use early and in conjunction with other community interventions Consider mixing of students across schools and districts and work collaboratively to prevent Length of dismissal will vary depending on type of dismissal, severity and extent of illness but should be at least seven days and regularly reassessed 8/19/

25 Additional Interventions for Severe Conditions (Continued) School dismissal (Continued) Plan early to address possible secondary effects Allow school staff continued use of school facilities May allow teachers to develop and deliver lessons and materials Continue to follow infection control practices Report dismissals to CDC, the U.S. Department of Education at 8/19/

26 Additional Interventions for Severe Conditions (Continued) Cancel school-based mass gatherings Sporting events, performances If held, strongly advise the ill and high risk persons to stay away and Provide hand washing and hand sanitizer Provide tissues Provide medical assessment and onsite care Provide alternative participation options and venues 8/19/

27 Deciding on a Course of Action CDC recommends that schools act to decrease exposure by using the most appropriate combination of interventions, based on local information, and in close collaboration with local and state health officials CDC, WVBPH, and your LHD will monitor data trends and make recommendations States and local communities can expect to see variability from national picture Should consider proactive use of more intensive interventions based on other parts of the country 8/19/

28 Deciding on a Course of Action (Continued) Are the appropriate decision-makers and stakeholders involved? What is the epidemiology of the influenza virus in your community? Does your health care community have the capacity to manage the current outbreak? What is your main goal? How feasible are the interventions under consideration? How acceptable are the interventions you are considering? 8/19/

29 Current Status of H1N1 Vaccine Distribution & Administration Planning Seasonal flu vaccine first; novel H1N1 vaccine to follow H1N1 time frame: likely starting by mid-october WVBPH and Local Health Departments are the lead for H1N1 Vaccine Administration Planning Target groups include all individuals age 6 mos. through 24 years (thus emphasis on working with schools). 8/19/

30 Current Status of H1N1 Vaccine, cont. Collaboration from the Health Care Provider Community and Schools will be critical School Based H1N1 Vaccine Clinics will be a key part of strategy for administering vaccine Several models will be presented Planning tools being developed and practitioner tested distribution of tools expected in early September 8/19/

31 Recommended Activities Related to Flu Vaccine Encourage seasonal flu vaccine as soon as available!! Watch for H1N1 vaccine planning materials (working through schools to increase flu vaccination of school age children) Link with your LHD and community partners to plan best approach for your district / schools Serve as an information resource for students and parents, in conjunction with your LHD 8/19/

32 CDC Guidance on Planning and Operating Large Scale Influenza Vaccination Clinics elocal/settingupclinics.htm 8/19/

33 Questions, Comments, Discussion If you have comments, questions or other input after this conference call, please send contact: Melanie Purkey Rebecca King The Office of Healthy Schools (WVDE) Telephone: /19/

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