After much speculation about swine flu (H1N1 influenza) and the disruption the closing of schools would cause in the USA, HHS Secretary Kathleen Sebelius, Education Secretary Arne Duncan, Homeland Security Secretary Janet Napolitano, and CDC Director Thomas R. Frieden, M.D., M.P.H., in a joint statement announced the publication of CDC guidelines which leave the decision to state and local public health and school officials.

The guidelines offer state and local authorities a list of options on how to respond to H1N1 flu in schools – the thrust of the recommendations focuses on the severity of the influenza in local areas and measures to stem the spread of infection.

The CDC writes that the guidance is aimed at reducing exposure to seasonal flu as well as 2009 H1N1 flu while “…limiting the disruption of day-to-day activities and the vital learning that goes on in schools.” It encourages people to be vaccinated and take other precautions to avoid infection.

As the number of seasonal flu cases typically rises during the autumn and winter months the CDC anticipates more cases of illness after the school year starts.

HHS Secretary Sebelius said:
“We’re going to continue to do everything possible to keep our children – and all Americans – healthy and safe this fall. But all Americans also have a part to play. The best way to prevent the spread of flu is vaccination. A seasonal flu vaccine is ready to go, and we should have one for the 2009 H1N1 flu by mid-October.”

Homeland Security Secretary Napolitano said:
“The federal government continues to coordinate closely with state and local governments, school districts and the private sector on H1N1 preparation as we head into the fall flu season – and the upcoming school year. Readiness for H1N1 is a shared responsibility, and the guidance released today provides communities with the tools they need to protect the health of their students and teachers.”

Included in the guidelines is the recommendation of basic good hygiene, such as hand washing. Schools must make sure students and staff have time to wash their hands whenever they need to, especially after coughing/sneezing into their hands, before meals, and after using the restroom. It is crucial that there is an adequate supply of soap, paper towels, and sanitizers. If necessary, schools should consider providing supervision to students as they wash their hands in rest rooms. Students, families, and staff should be educated about the importance of good hand hygiene to help curb the spread of infection, as well as how to clean your hands properly.

Pupils and members of staff who develop flu-like symptoms should remain at home until at least 24 hours after fever symptoms have disappeared without medication. In the guideline the CDC refers to a fever as 100° F (37.8° C) or greater.

Education Secretary Duncan said:
“We can all work to keep our children healthy now by practicing prevention, close monitoring, and using common sense. We hope no schools have to close. But if they do, we need to make sure that children keep learning.”

Schools and local authorities have been asked to set up plans for dealing with infections outbreaks in schools. If a child or member of staff develops flu-like symptoms they should be isolated as soon as possible until they can be sent home.

Every school should have plans for providing education for students who are away sick. This should include homework packets, telephone calls, lessons via the internet, and some other approaches. Contingency plans should be in place in every school to fill key positions, such as school nurses.

Should H1N1 influenza cause very high rates of severe illness, hospitalizations and deaths, the guidelines say school officials should be ready to respond more intensely. Parents would need to be told to check their children every morning for signs and symptoms of flu, and to keep them at home if they have an elevated temperature (fever). Students and staff at high risk of complications from flu may consider staying at home if influenza transmission is high in their community, or if they or their families are worried about the risks of becoming infected. Those at higher risk of complications include people 65 years and older, children under 5, pregnant women, and people with certain chronic medical conditions of any age.

The guideline asks all schools to start actively screening students as they arrive and sending those with symptoms home promptly. Students should stay at home if a member of their household is sick with flu and not return until at least five days after symptoms began, the guideline adds.

CDC Director Dr. Frieden said:
“Influenza can be unpredictable, so preparation and planning are key. We can’t stop the tide of flu, but we can reduce the number of people who become very ill by preparing well and acting effectively.”

In the USA there are approximately:

  • 130,000 public and private schools
  • 55 million students
  • 7 million staff working in schools

Written by Christian Nordqvist