H1N1 SCHOOL GUIDANCE
8/19/2009
West Virginia Department of
Education and
West Virginia Department of
Health and Human Resources
August 19, 2009
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8/19/2009
H1N1 SCHOOL GUIDANCE
To provide local school and health officials with guidance for school responses to influenza during the
2009-2010 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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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H1N1 SCHOOL GUIDANCE
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.
8/19/2009
Over summer in WV, outbreaks have been seen in camps, daycares, businesses, sports teams, etc.
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H1N1 SCHOOL GUIDANCE
Graph A: Novel H1N1 Confirmed and Probable Case Rate in the United States, By Age Group
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8/19/2009
H1N1 SCHOOL GUIDANCE
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H1N1 SCHOOL GUIDANCE
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.
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H1N1 SCHOOL GUIDANCE
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.
8/19/2009
• 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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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H1N1 SCHOOL GUIDANCE
Major Changes from Spring 2009
Guidance
• Recommends specific interventions for use during
2009-10 school year
• Suggests interventions for use under conditions of greater severity and impact
• Provides rationales, instructions, and caveats for use
• Provides decision-making guidance
8/19/2009 10

H1N1 SCHOOL GUIDANCE
8/19/2009
Guidance: http://www.flu.gov/plan/school/schoolguidance.html
Technical Report: http://www.flu.gov/plan/school/k12techreport.html
Communication Toolkit: http://www.flu.gov/plan/school/toolkit.html
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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H1N1 SCHOOL GUIDANCE
8/19/2009
Recommended Interventions for 2009-
2010 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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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8/19/2009
H1N1 SCHOOL GUIDANCE
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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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.
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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8/19/2009
H1N1 SCHOOL GUIDANCE
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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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
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8/19/2009
H1N1 SCHOOL GUIDANCE
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
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8/19/2009
H1N1 SCHOOL GUIDANCE
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 http://www.cdc.gov/h1n1flu/schools/dismissal_form/index.htm
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8/19/2009
H1N1 SCHOOL GUIDANCE
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
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8/19/2009
H1N1 SCHOOL GUIDANCE
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
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H1N1 SCHOOL GUIDANCE
8/19/2009
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?
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H1N1 SCHOOL GUIDANCE
8/19/2009
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).
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H1N1 SCHOOL GUIDANCE
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
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H1N1 SCHOOL GUIDANCE
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
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8/19/2009
H1N1 SCHOOL GUIDANCE
http://www.cdc.gov/h1n1flu/vaccination/stat elocal/settingupclinics.htm
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H1N1 SCHOOL GUIDANCE
8/19/2009 input after this conference call, please send contact:
Melanie Purkey mpurkey@access.k12.wv.us
Rebecca King rjking@access.k12.wv.us
The Office of Healthy Schools (WVDE)
Telephone: 304-558-8830
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