Impact of H1N1 on School Facilities: An Outlook for the Future. Daniel LaHart, CIH Environmental Issues Program Manager Operations Division Anne Arundel County Public Schools 410-360-0138 Edward L. Van Oeveren, M.D., M.P.H. Health Officer, Anne Arundel County Department of Health. Outline.
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Daniel LaHart, CIH
Environmental Issues Program Manager
Anne Arundel County Public Schools
Edward L. Van Oeveren, M.D., M.P.H.
Health Officer, Anne Arundel County Department of Health
A type of virus that causes respiratory infection with systemic S/S
Two types of influenza viruses cause epidemic human disease:
Influenza A: Categorized into subtypes on the basis of 2 surface antigens:
Two distinct genetic lineages: Yamagata and Victoria
Not categorized into subtypes
Seasonal vs. pandemic influenza
Virus changes slightly most years (antigenic drift)
Season usually October through May
~200,000 persons hospitalized
Influenza virus to which most of population lacks immunity
Spread to at least two regions in the world
Antigenically and genetically distinct from other human influenza A (H1N1) viruses in circulation since 1977
Inappropriately referred to as “swine” flu because the virus is related to influenza viruses that affect pigs.
The most affected group of persons is under age 24 years.
Has spread to all regions of the
in June 2009.
Respiratory droplets from an infectious individual—coughing and sneezing
Can travel up to 3 feet in the air
Contaminates another person close by
Lands on surfaces (fomites), e.g., doorknobs, computer keyboards, faucet handles
Infection begins when the virus is introduced to the nose or mouth (mucous membranes)
Respiratory illness with systemic signs & symptoms:
Fever (100°F or greater), cough, sore throat
Nasal congestion, muscle aches, headache, chills, fatigue
Diarrhea, vomiting (seen with novel H1N1)
Usually abrupt onset
Typical time to recover is 4 days to one week in healthy people
Immune system disorders
HIV, transplant, chemotherapy, etc.
Elderly, infants, pregnant women
Other medical problems:
Drink plenty of liquids
Avoid drinking alcohol or smoking
Use over-the-counter medications
Labeled “cold and flu” remedies
In some situations, use antivirals
Oseltamivir (Tamiflu), zanamivir (Relenza)
Initiate within 48 to 72 hours of first symptoms for optimal effectiveness
Clean hands often
Soap and water
Alcohol-based hand sanitizers
Cover your cough/sneeze
Use a tissue or your sleeve
Avoid close contact with sick people
Practice healthy behaviors
Don’t smoke, eat a healthy diet, exercise
Use antiviral medication if prescribed
Trivalent inactivated influenza vaccine (TIV) (injectable)
Live, attenuated influenza vaccine (LAIV) (nasal spray)
Safety (known for seasonal vaccine)
Shot: arm soreness, redness, swelling, low grade fever, mild muscle aches, fatigue
Nasal spray: low grade fever, runny nose, headache, sore throat, fatigue
DOES NOT CAUSE THE FLU!!
Protection takes at least 10 days
Still important this year
Novel H1N1 vaccine
First shipments anticipated ~mid-October
Target and priority groups initially
If available, everyone for whom medically appropriate may be vaccinated over the next 6 months
Health care and emergency medical workers
People who live with or care for children <6 months old
Persons 6 months through 24 years
Adults 24 through 64 years with high risk health conditions
Health care workers with direct patient contact
People who live with or care for children <6 months old
Children 6 months through 4 years
People 5 through 18 years with high risk health conditions
High Priority Groups
CDC. MMWR Early Release. 2009;58 (August 21, 2009).
Majority of those affected do not require hospitalization and recover without complications.
So far, H1N1 flu appears similar to seasonal flu except for different high-risk groups.
Antivirals still generally effective.
Vaccine is developed, studies ongoing.
Prevention measures work!
What’s going on simultaneously
Family member ill (flu symptoms)
Recently returned from Mexico
Children exposed @ home
Children come to school
School notified, etc
Health Department directs school system
“Pandemic” flu announced
Media news bites clips focus on people wearing protective masks
H1N1Vaccine not ready yet
Worst is yet to come
Anxiety - probably
Panic – not yet but….
With Teachers and Admin.
With Custodial Staff
In consultation w/HD who, in turn, are following CDC:
Family children sent home
Meet w/teachers and staff
Advise cleaning protocols
Promote good hygiene in classroom & home
Letter sent home
School will stay open
School custodial staff backed up with extra volunteers to clean & disinfect classroom
Provided training on virus, disinfection cleaning techniques, overview of disinfectant, and MSDS
Provided gloves, masks, rags, spray bottles, pump sprayers
Team cleaning approach
Disinfectant sprayed on
Wipe and rinse
Parents swamp phone lines
Some kids stay home
Many are sick
Another child suspected of H1N1
School to close 5-7 days per H.D.
News helicopters, TV reporters & cameras, etc.
Gear up for full school disinfection; desks, chairs, hallways. Lockers, basically all surfaces, handles, sinks, knobs etc.
TV Crews see inside school to see crews with masks, etc.
National news show same scenario in a NY high school.
A federal agent who traveled to Mexico with President Obama this month probably contracted swine flu and infected several members of his family in Anne Arundel County, prompting assurances yesterday from the White House that the President was safe.
Parents and government officials are debating whether to close schools where suspected cases of swine flu have been discovered. What should officials do?
Keep schools open. Schools should be cleaned and sick children kept home, but closings go too far.39%
Close schools. School officials should take every step possible to protect children from the flu.57%
Other solution. Write your answer in the comments below.2%
Total Votes: 2,648
The word came so late in the school day yesterday that officials couldn't send a letter to parents, so they resorted to e-mails and phone calls: A student at Folger McKinsey Elementary School in Severna Park was one of six probable cases of swine flu in Maryland.
At a news conference last night, President Obama recommended that schools with suspected cases of swine flu strongly consider closing. But a spokesman for Gov. O'Malley said afterward that Maryland schools would remain open. "At this point it doesn't appear that it's necessary given the probable cases in Maryland," spokesman Shaun Adamec said.
School & Health Department
On a national conference call, CDC states that any school with even a single case of H1N1 influenza should close for 5-7 days (possibly as long as 14 days).
In conformity with CDC guidance, School and Health Department close school.
Reopened in 3-4 days
School returns to routine
Vast expenditure of manpower and equipment
Lots of overtime
Decision to dismiss students should:
Be made locally
Balance the goals of:
Morbidity and mortality from influenza with
Minimizing social disruption and safety risks to children sometimes associated with school dismissal.
Based on the experience and knowledge gained in jurisdictions that had large outbreaks in spring 2009, the potential benefits of preemptively dismissing students are often outweighed by negative consequences, including:
Students being left home alone
Health workers missing shifts when they must stay home with their children
Students missing meals, and
Interruption of students’ education.
*American Academy of Pediatrics’ Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 2nd Edition (2009) for guidance on cleaning and sanitizing in schools. (http://aapredbook.aappublications.org/resources/midsheets.dtl)
The EPA provides a list of EPA-registered products effective against flu: http://www.epa.gov/oppad001/influenza-disinfectants.html
National Clearinghouse for Educational Facilities (National Institute of Building Sciences), Resource List for School-Based Health Facilities--http://www.edfacilities.org/rl/health_centers.cfm
The Center for Health and Health Care in Schools--http://www.healthinschools.org/static/states/MD-guidelines.aspx