Novel Influenza A (H1N1) Virus: Review of Current School Guidance Presentation to SHAC September 16, 2009 Esther M. Walker, Assistant Director of Patient.

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

Presentation to SHACSeptember 16, 2009Esther M. Walker, Assistant Director of Patient Care ServicesDouglass O’Neill, Coordinator, Safety And Environmental Health

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

H1N1 “swine flu” Pandemic: Activity Update

Disease outbreaks of influenza occurring 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.

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

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

CDC/ACIP Target Groups for Vaccine

Target Group (159 M) Priority if needed (40 M)

HCW and Emergency Medical Services

HCW and EMS with direct exposure or work with samples

Pregnant Pregnant

Household contacts of infants <6 months of age

Household contacts of infants <6 months of age

Individuals 6 mos. to 24 years of age

Individuals 6 mos. to 4 years of age

25-64 years with chronic medical conditions

5 years to 18 years with chronic medical conditions

Hospitalizations From Novel H1N1 Influenza

Prevalence, Hospitalized H1N1 Patients Prevalence, General US Pop

8%

15%

14%

16%

7% 7% 6%

8%

4%

6%

7% 5% 1%

28%

0%

5%

10%

15%

20%

25%

30%

Asthma

COPD

Diabetes

Chronic C

VD*

Morbid O

besity **

Neurocognitiv

ie Dz

Neuromuscular D

z

Pregnant

April 1 – May 30st (n=268)

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

FCPS providing free seasonal flu shots for employees

Human Resources coordinating Expected to be available in

September Highly encouraged to receive

seasonal flu shots

Seasonal Flu Vaccine

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

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

Preventive Measures

Respiratory/Cough Etiquette and Hand Washing Posters

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

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

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

Protocol for Students

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

Protocol for Staff

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

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

Recommendations for Schools: School Closures

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

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

Emergency Management Issues

School Blackboard sites kept up-to-date

Blackboard pandemic function ready Keep on Learning

Packets for distribution, when needed

Academic Continuity

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

H1N1 Resources

FCPS http://www.fcps.edu/news/swineflu.htm

FCHD http://www.fairfaxcounty.gov/hd/flu/

Public Health Challenge

•http://www.coughsafe.com/ •http://www.healthmap.org/nejm/