Published Online: August 13, 2009

Flu Guidelines Offer Districts More Flexibility

Swine flu didn’t hit the 3,700-student Burlington, Vt., school district until just before the most recent school year ended—but fearful parents still considered pulling their children from classes with a day or two to go, recalls Superintendent Jeanne Collins.

Now, thanks to new guidelines from the Centers for Disease Control and Prevention in Atlanta, Ms. Collins and other school administrators have clear directions for how to handle the cases of H1N1 flu virus that are all but certain to appear in schools this fall. First among them: Closing school is not always necessary.

The Atlanta-based CDC now believes this strain of flu is comparable in severity to what schools would encounter with a typical seasonal flu, which does not usually force school closures. In most cases, students and employees can return to school when they’ve been fever-free for 24 hours, according to Dr. Thomas R. Frieden, the CDC’s director.

The guidelines also stress personal hygiene as a prevention measure and recognize that local officials may decide to close if high numbers of absentees make staying open impractical.

Such advice is likely to be welcomed by district administrators, who were forced to make decisions last spring on how to respond to H1N1 cases even as federal health officials were working to get a handle on how much of a threat the flu strain posed. ("Swine Flu Disruption Has School Officials Looking for Lessons," May 13, 2009.)

Some early cases of the H1N1 flu in the United States were clustered in schools. There were also concerns that young people were particularly susceptible to the illness.

But federal experts have come to believe that school closures are a less effective control measure and, though young people are more susceptible to the illness, their symptoms are generally mild.

“The more that we can get guidance in writing from the CDC, the more we can allay the fears of parents,” Ms. Collins said.

The latest guidance was released during an Aug. 7 news conference in Washington that included Dr. Frieden as well as the secretaries of education, health and human services, and homeland security. The point that federal officials were trying to get across, they said, is that the government is speaking in a united voice on the topic.

Though decisions to close schools are made at the local level, “it is now clear the closure of schools is rarely indicated, even if H1N1 is in the schools,” said Dr. Frieden, who before his CDC appointment in May, was the health commissioner in New York City. That city’s school system saw thousands of swine flu cases last school year and, in some situations, closed schools. “Maybe we would have closed fewer if we knew what we know now,” he said.

The widow of a New York City assistant principal who died after contracting the H1N1 flu virus has announced her intention to file a $40 million wrongful death suit, saying that the city didn’t control the outbreak and didn’t let her husband know that he had come into contact with people who had tested positive for swine flu.

Advice to Parents

The new guidance from the federal government comes with a “toolkit” that offers templates that administrators can use when they send letters home to parents.

One letter is intended for schools where swine flu cases have been diagnosed, reminding parents of the importance of keeping sick children home from school, frequent handwashing, and covering one’s mouth when coughing or sneezing.

Another letter offers similar guidelines, but is geared toward schools where swine flu cases are more numerous. In those cases, schools might choose to allow high-risk students, such as those who are pregnant, immuno-compromised or who have other health problems, to stay home.

There also are fact sheets for school personnel and a question-and-answer sheet for administrators. Ms. Collins said she appreciated having medical advice to use in response to school employees who want bleach in every classroom, or antibacterial soap. Neither item is considered necessary to fight the spread of the virus. “Having an official agency, not just the local school officials, saying things is very helpful to administrators,” she said.

Amy Garcia, the executive director of the National Association of School Nurses, said that the fact that all the government agencies are working together is useful.

“It’s one consistent set of messages that can be shared with communities, and can be reinforced,” she said.

Hundreds of schools were disrupted last spring when officials closed them on the basis of federal recommendations that were eventually modified. Ms. Garcia said that she understood the rationale for shifting advice now that more about the virus has become known.

“We had a novel virus,” Ms. Garcia said. “As a nurse, that kind of mid-course correction is very logical, even if it is frustrating to some in the educational community. We’ve got to operate on the best-known science of the moment.”

Vaccine Recommendations

The CDC also is recommending that people between the ages of 6 months and 24 years old be among the groups to be vaccinated for the H1N1 virus. That vaccine is expected to be a two-dose regimen separated by at least three weeks, and will not replace the regular seasonal-flu vaccine. The vaccine is expected to be generally available by mid-October.

U.S. Secretary of Education Arne Duncan has said schools could serve as vaccination sites. Local school and health officials would make that decision. Ms. Collins, the superintendent in Vermont, said that’s already under consideration. Her district is also reviewing plans for distance learning if schools have to close, and how to provide meals to students and the elderly if the swine flu is present.

Despite recommendations that schools can stay open, state officials say that closure is still a possibility.

“If the absentee rate is more than 25 or 30 percent, then the only way to disrupt [the spread of flu] may be to close a school temporarily,” said Oklahoma epidemiologist Dr. Kristy Bradley said.

“H1N1 is not behaving like a normal flu virus,” Dr. Bradley said. “When kids got together during summer camps, there were multiple outbreaks. We are expecting the same thing to occur with the start of school.”

She said parents need to make plans to stay home from work if someone in the family becomes ill.

Steve Lindley, the spokesman for the 18,790-student Putnam City district, in Oklahoma, said administrators updated the district’s plans this summer and purchased precautionary items such as masks and hand sanitizer.

“Our thought was we needed to be prepared, not panicked,” Lindley said

Vol. 29, Issue 1

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