Wednesday, September 2, 2009

Back To School-Prepare For Swine Flue

Parents might be feeling more anxious than usual as they send their children back to school this fall. After all, the previous academic year ended with a wave of school closings across the country, the declaration of an influenza pandemic, and fears that H1N1 (swine flu) would return with a vengeance this season.

But here’s the good news: Health and education officials at the local, state, and federal levels have spent the summer preparing for whatever the upcoming flu season may bring. And experts believe that H1N1 (swine flu) will not be any more potent than the seasonal flu we deal with every year. “I think the swine flu is going to be much milder than the regular flu,” says Dr. Kent Holtorf, M.D., of Holtorf Medical Group in Torrance and Foster City, Calif. “Likely there’s a lot more scare than there is substance.”

For now, the Centers for Disease Control and Prevention is taking a wait-and-see approach. In a new set of guidelines released in early August, the CDC recommends that schools not rush to close their doors if some students have the flu. Rather, they are urged to carefully weigh the potential benefits of school dismissal against the social disruption it can cause. The recommendations are based on severity of the flu season — whether conditions are similar to or more severe than the conditions observed in spring 2009 H1N1 outbreak.

A vaccine for H1N1 is undergoing clinical trials and is tentatively scheduled to be available in mid-October. “I think the good news is that by the time the question really comes up in school season, there will be a vaccine out — and a large proportion of the population will have already gone through the disease,” says Dr. Stephen Berger, M.D., founder of the Global Infectious Disease and Epidemiology Network and director of geographic medicine at Tel Aviv Medical Centre in Israel. “Not all flu is susceptible to drugs, but this one is.”

In the meantime, here are a few steps you can take to help keep your children healthy and prepare for the season ahead.

Healthy Practices to Prevent Swine Flu

  • Review good hygiene practices with your children. Remind them to wash their hands frequently and thoroughly, and to cough or sneeze into a tissue or the crook of their arm. Equip them with a travel-size bottle of hand sanitizer to take to school.
  • The CDC recommends getting your family vaccinated for both seasonal flu and H1N1(they are separate vaccines). Priority groups for the H1N1 vaccine — different than those for the seasonal flu — include people ages 6 months to 24 years and people who take care of or live with children under 6 months old. Priority groups include people ages 6 months to 24 years, as well as caretakers of children under 6 months old. NOTE: Multi-dose vials of H1N1 vaccine will contain thimerosal, an antibacterial additive that contains mercury and is believed by some to be harmful to children. Single-dose syringes and inhaler vaccine products will be thimerosal-free and are recommended for young children and pregnant women.
  • If your child is sick, keep him home for at least 24 hours after the fever has subsided without the use of fever-reducing medication.

If Flu Conditions Become More Severe

  • Keep a child sick with flu at home for at least seven days, even if he or she feels better sooner. Those who are still sick after seven days should continue to stay home until at least 24 hours after symptoms have completely disappeared.
  • If someone in your household is sick with the flu, keep all school-aged children home for five days from the time that person became sick. Monitor the children for signs of fever and other flu symptoms.

Contingency Plans in Case of School Closings

  • Stay up-to-date on your school district’s pandemic or emergency plan.
  • Determine whether your school plans to offer Web-based lessons or other forms of distance learning during an extended closure, and plan accordingly.
  • Plan activities to keep your children engaged at home in the event of school closings. Create a stockpile of games, books, DVDs, craft projects, etc.
  • Check with your employer ahead of time to find out if you will be able to stay home to care for sick family members or children who have been dismissed from school. If you can’t work from home, arrange for other child care.

source :Everyday Health

Recommended school responses for the 2009-2010 school year

Under conditions with similar severity as in spring 2009

* Stay home when sick:
Those with flu-like illness should stay home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. They should stay home even if they are using antiviral drugs. (For more information, see CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others.)

* Separate ill students and staff:
Students and staff who appear to have flu-like illness should be sent to a room separate from others until they can be sent home. CDC recommends that they wear a surgical mask, if possible, and that those who care for ill students and staff wear protective gear such as a mask.

* Hand hygiene and respiratory etiquette:
The new recommendations emphasize the importance of the basic foundations of influenza prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).

* Routine cleaning:
School staff should routinely clean areas that students and staff touch often with the cleaners they typically use. CDC does not believe any additional disinfection of environmental surfaces beyond the recommended routine cleaning is required.

* Early treatment of high-risk students and staff:
People at high risk for influenza complications who become ill with influenza-like illness should speak with their health care provider as soon as possible. Early treatment with antiviral medications is very important for people at high risk because it can prevent hospitalizations and deaths. People at high risk include those who are pregnant, have asthma or diabetes, have compromised immune systems, or have neuromuscular diseases.

* Consideration of selective school dismissal:
Although there are not many schools where all or most students are at high risk (for example, schools for medically fragile children or for pregnant students) a community might decide to dismiss such a school to better protect these high-risk students.

Under conditions of increased severity compared with spring 2009

CDC may recommend additional measures to help protect students and staff if global and national assessments indicate that influenza is causing more severe disease. In addition, local health and education officials may elect to implement some of these additional measures. Except for school dismissals, these strategies have not been scientifically tested. But CDC wants communities to have tools to use that may be the right measures for their community and circumstances.

* Active screening:
Schools should check students and staff for fever and other symptoms of flu when they get to school in the morning, separate those who are ill, and send them home as soon as possible. Throughout the day, staff should be vigilant in identifying students and other staff who appear ill.

* High-risk students and staff members stay home:
People at high-risk of flu complications should talk to their doctor about staying home from school when a lot of flu is circulating in the community. Schools should plan now for ways to continue educating students who stay home through instructional phone calls, homework packets, internet lessons, and other approaches.

* Students with ill household members stay home:
Students who have an ill household member should stay home for five days from the day the first household member got sick. This is the time period they are most likely to get sick themselves.

* Increase distance between people at schools:
CDC encourages schools to try innovative ways of separating students. These can be as simple as moving desks farther apart or canceling classes that bring together children from different classrooms.

* Extend the period for ill persons to stay home:
If influenza severity increases, people with flu-like illness should stay home for at least 7 days, even if they have no more symptoms. If people are still sick, they should stay home until 24 hours after they have no symptoms.

* School dismissals:
School and health officials should work closely to balance the risks of flu in their community with the disruption dismissals will cause in both education and the wider community. The length of time schools should be dismissed will vary depending on the type of dismissal as well as the severity and extent of illness. Schools that dismiss students should do so for five to seven calendar days and should reassess whether or not to resume classes after that period. Schools that dismiss students should remain open to teachers and staff so they can continue to provide instruction through other means.

Reactive dismissals might be appropriate when schools are not able to maintain normal functioning for example, when a significant number and proportion of students have documented fever while at school despite recommendations to keep ill children home.

Preemptive dismissals can be used proactively to decrease the spread of flu. CDC may recommend preemptive school dismissals if the flu starts to cause severe disease in a significantly larger proportion of those affected.
Deciding on a course of action

CDC and its partners will continuously look for changes in the severity of influenza-like illness and will share what is learned with state and local agencies. However, states and local communities can expect to see a lot of differences in disease burden across the country.

Every state and community has to balance a variety of objectives to determine their best course of action to help decrease the spread of influenza.
Decision-makers should explicitly identify and communicate their objectives which might be one or more of the following:
  1. protecting overall public health by reducing community transmission;
  2. reducing transmission in students and school staff; and
  3. protecting people with high-risk conditions.

Some strategies can have negative consequences in addition to their potential benefits. In the particular case of school dismissals, decision-makers also must consider and balance additional factors:
(a) how to ensure students continue to learn;
(2) how to provide an emotionally and physically safe place for students; and
(3) how to reduce demands on local health care services. The following questions can help begin discussions and lead to decisions at the state and local levels.

source: CDC H1N1

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