If a flu pandemic breaks out in the United States, as many as four in 10 school-age children will become sick, according to the U.S. Department of Health and Human Services, which released a comprehensive plan last week on how it would deal with such an outbreak.
The nearly 400-page plan says the department would consider measures such as closing schools early in a pandemic to help control its spread, especially before a vaccine was available or while it was in short supply. School closings would accompany other measures, such as restricting travel, screening people from affected areas, and isolating infected persons.
Though school health experts caution against overreaction, they agree that preparedness is paramount. They say that districts need to begin work now to ensure they are not caught sleeping.
“If I were the superintendent [of a school district], I would go to the public-health department and say, what are you doing about this, and we don’t want to have our first conversation after the bird flu has been discovered in humans,” said Julia Graham Lear, the director of the Center for Health and Healthcare in Schools at George Washington University in Washington.
The federal plan, issued amid worries about avian flu, places children low on the list of groups that would have priority for receiving vaccines because, it says, they generally have been at a low risk for hospitalization and death in prior pandemics and during the annual flu season. But it also says anecdotal reports suggest the spread of a pandemic can be better controlled when schools are closed early in an outbreak. It advises school districts to come up with their own plans on how to respond to an influenza pandemic.
Scientists are keeping a close eye on the avian flu caused by the H5N1 virus, which has spread through bird populations in Asia and is now in Europe. The bird flu has sickened 115 people who have come in contact with infected birds in Asia, killing half of them, including several children. Although it is still primarily an animal virus, experts say it could mutate into a form that spreads from person to person, triggering a pandemic, which is an epidemic over a wide region or worldwide.
Early Transmitters?
President Bush last week outlined a national strategy for a flu pandemic and asked Congress to appropriate $7.1 billion, including money to help detect and contain outbreaks, to develop new vaccines, and to stockpile flu vaccines.
“Scientists and doctors cannot tell us where or when the next pandemic will strike or how severe it will be, but most agree at some point we are likely to face another pandemic,” Mr. Bush said on Nov. 1 at the National Institutes of Health, located in Bethesda, Md.
If that happens, the Health and Human Services Department predicts, 25 percent to 30 percent of the U.S. population—as many as 90 million people—could become sick during a six- to eight-week outbreak. The pandemic could kill between 209,000 and 1.9 million Americans, the federal plan says.
Regular flu remains a more immediate concern, Ms. Lear of George Washington University said.
“Right now, there is not a problem with the bird flu,” she said. “Right now, the big issue parents face is the regular flu.”
In the case of bird flu, public-health officials say that it is difficult to predict whether children would be more likely to become infected than adults because the epidemiology of a human bird-flu virus is not yet known. But children could more easily spread the disease, they say.
“We know children may not be the best hand-washers, and they could be early transmitters of the pandemic,” said Dr. Jean Taylor, an epidemiologist with the Maryland Department of Health and Mental Hygiene.
For the annual flu, children with conditions like asthma or diabetes, as well as children between 6 and 23 months of age, and those with family members who have high-risk conditions for influenza, are considered priority groups for vaccines. The HHS pandemic plan also places children in these categories higher in the priority group for vaccines.
Henry Bernstein, a member of the committee on infectious diseases at the American Academy of Pediatrics, advised that everyone should exercise caution while traveling abroad, especially to areas where the avian flu has emerged.
“They need to be careful how they handle any poultry, for instance,” he said. “At a marketplace, they want to avoid contact with any birds or contaminated surfaces,” he said.
President Bush has proposed $583 million for pandemic preparedness, including $100 million for states to complete and test their plans before a pandemic strikes. The Health and Human Services Department’s plan also leaves much preparation to state and local government agencies, asking them to come up with measures like monitoring absenteeism at schools, for instance.
States Plan
The HHS plan also advises state and local governments to investigate laws and procedures for ordering the closure of schools as part of their preparedness plans.
In a conference call with reporters, Secretary of Health and Human Services Michael O. Leavitt said that local preparation was a “critical part of the plan.”
He pointed out that while catastrophic events such as Hurricane Katrina have been limited to a particular geographic region, “a pandemic would be occurring in as many as 1,000 or more different locations around the country and many beyond that in the world.”
Several states have already drawn up their own plans to combat a potential flu pandemic. Such plans call for monitoring absenteeism in schools in the early stages of the pandemic, and the possible closure of schools. Health officials in some states have also begun talking with their local school officials to guide them in preparing for a pandemic.
According to a draft flu-preparation plan developed this year by the Texas Department of Health, local health agencies would monitor attendance at schools. Immunizing children in schools and at child-care centers early on can also help reduce the spread of the disease, the plan says.
Dr. Bernstein agrees that immunizing children early on can play an important role in controlling the flu, be it the annual flu or a pandemic.
Plans from the Maine and Vermont state health departments propose introducing screening systems that would pick out students with abnormally high body temperatures before they could enter schools in case of a pandemic.
In Maryland, state health officials met with school health personnel from all of the state’s 24 school districts to brief them about the bird-flu virus and play out scenarios for a pandemic.
Dr. Taylor, the epidemiologist, said the exercise was intended to identify and explore how Maryland schools and public health agencies would respond to a flu pandemic. Officials discussed, for example, identifying when to make a decision about closing schools.
“We want to identify indicators that would be important for making decisions on school closure, like staff absentee levels [and] sickness thresholds,” Dr. Taylor said.
In Fairfax County, Va., where school health officials last year conducted extensive exercises on dealing with a potential smallpox outbreak, public school officials said they were prepared to cooperate fully with local health authorities in case of a pandemic.
“We are ready to go,” said Paul Regnier, a spokesman for the 166,000-student Fairfax County school district. “We are prepared to cooperate with the county health department and anybody else that needs to be involved with this.”
