Novel Influenza A (H1N1) Virus: Review of Current School Guidance

1. Novel Influenza A (H1N1) Virus: Review of Current School Guidance Presentation to SHAC September 16, 2009 Esther M. Walker, Assistant Director of Patient Care Services Douglass O’Neill, Coordinator, Safety And Environmental Health

2. 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

3. H1N1 “swine flu” Pandemic: Activity Update • Disease outbreaks of influenzaoccurring 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.

4. 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

6. 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

7. CDC/ACIP Target Groups for Vaccine

8. April 1 – May 30st (n=268) 30% 25% 28% 20% 15% 16% 15% 14% 10% 8% 8% 5% 7% 7% 7% 6% 6% 5% 1% 4% 0% Pregnant COPD Asthma Diabetes Morbid Obesity ** Chronic CVD* Neuromuscular Dz Neurocognitivie Dz Prevalence, Hospitalized H1N1 Patients Prevalence, General US Pop Hospitalizations From Novel H1N1 Influenza

9. 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

10. Seasonal Flu Vaccine • FCPS providing free seasonal flu shots for employees • Human Resources coordinating • Expected to be available in September • Highly encouraged to receive seasonal flu shots

11. 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

12. Preventive Measures • 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

13. Respiratory/Cough Etiquette and Hand Washing Posters

14. 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

15. 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

16. Protocol for Students • 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

17. Protocol for Staff • 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

18. 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

19. Recommendations for Schools: School Closures • 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

20. 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

21. Emergency Management Issues • 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

22. Academic Continuity • School Blackboard sites kept up-to-date • Blackboard pandemic function ready • Keep on Learning • Packets for distribution, when needed

23. 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

24. H1N1 Resources • FCPS http://www.fcps.edu/news/swineflu.htm • FCHD http://www.fairfaxcounty.gov/hd/flu/