Published Online: August 25, 2009
Published in Print: August 26, 2009, as Administrators Willing to See Schools as Site For Flu Inoculations

Administrators Willing to See Schools as Site for Flu Inoculations

View Voiced Amid New CDC Guidelines on H1N1 Virus

Even as they brace for the start of the school year—and the flu season—most school leaders say they are ready to offer their facilities as a location of swine-flu vaccination clinics if requested, recent surveys show.

Decisions will be made on a state-by-state basis about when and where to hold vaccination clinics for the H1N1 virus, expected to resurface this fall. In a survey conducted by the National School Boards Association in Alexandria, Va., close to 75 percent of 485 superintendents said they would be willing to offer the vaccines in their buildings.

The American Association of School Administrators in Arlington, Va., surveyed members of its executive and governing boards in late July and found that of the 61 members who responded, about 70 percent said they would be interested in hosting the clinics.

In both surveys, some respondents indicated they would want to know more about liability issues. But the fact that many were willing to participate if asked was not a surprise to Anne L. Bryant, the executive director of the NSBA.

“Schools can play a critical role” both in controlling the disease and providing information to parents, she said.

U.S. Secretary of Education Arne Duncan has said schools could serve as vaccination sites. Local school and health officials would make the call.

Changing Advice

The U.S. Centers for Disease Control and Prevention, based in Atlanta, is recommending that people between the ages of 6 months and 24 years be among the groups to be vaccinated for the H1N1 virus. The vaccine is expected to be generally available by mid-October.

The CDC is also suggesting that school districts don’t have to engage in widespread closures. School leaders should generally be able to handle outbreaks by stressing good hygiene and urging sick children and employees to stay home.

That’s in contrast to advice offered earlier this year, when the illness was first seen in the United States and hundreds of schools closed in response. 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.

Richard A. Middleton, the superintendent of the 63,000-student North East school district in San Antonio, received advice from county health officials not to close schools when students were ill last year. In contrast, a neighboring county decided to close down its schools for several days.

For the first few days, parents in North East were suggesting that the district should follow the lead of its neighbor. “But by about Wednesday of that week, they said, ‘oh, thank goodness we stayed open,’ ” Mr. Middleton said.

The CDC 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 recognize that local officials may decide to close schools if high numbers of absentees make staying open impractical.

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. But federal experts have come to believe that school closures are a less effective control measure, though young people tend to get the flu, 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.

However, 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, claiming that the city didn’t do enough to control the outbreak.

The new guidance for schools from the federal government comes with a “tool kit” 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 hand washing, 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 usein response to school employees who want bleach or antibacterial soap in every classroom. 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 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.

Ms. Garcia said she understood the reasons behind the shifting advice from the government.“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.”

Closure Possible

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 Dr. Kristy Bradley, the state epidemiologist in Oklahoma.

“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, Okla., district, 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,” Mr. Lindley said.

Vol. 29, Issue 01, Pages 12-13

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