MMS Flu Advisory: Updated Guidance for Schools and Child Care Settings

As of 11:00 a.m. today, the Massachusetts Department of Public Health (MDPH) is reporting a total to date of 193 confirmed cases of H1N1 (swine flu). Charts produced by DPH reveal the majority (70%) of cases are occurring in patients aged 6 – 20 years old. Eight percent of cases have required hospitalizations. For details, see today’s updated case count report on the MDPH website.

Several schools across the state have had high rates of absenteeism due to influenza like illness. Yesterday, the Massachusetts Department of Public Health (MDPH) provided updated guidance for schools and child care settings. Guidance may continue to change in the upcoming weeks as the situation changes, and as more information becomes available. 

The updated May 19 guidance document is available on the DPH website, and is copied below:

The guidance document provides information in three categories:

• Surveillance and Prevention Measures for ALL Schools and Child Care Facilities
• Enhanced Surveillance and Prevention Measures for Schools with Cases of Influenza-like Illness (ILI)
• Factors to Consider with Regard to School Closings

Recommendations for Surveillance and Prevention of Swine-Origin Influenza A H1N1 in Massachusetts Schools and Child Care Settings

The following recommendations apply to all schools in the Commonwealth, regardless of whether or not they are experiencing higher than usual rates of absenteeism. They are designed to help prevent the spread of ILI in school and child-care settings.

• Emphasize to students and parents, the importance of proper hand washing and cough etiquette in preventing the spread of diseases. Educational materials, posters, etc. are available on the MDPH website, www.mass.gov/dph/swineflu.
• Inform parents and caregivers that they should assess all family members (and especially all school-age children) for symptoms of influenza before sending them to school.  ILI may include fever plus cough, sore throat or runny nose.  It may also include other symptoms, such as vomiting or diarrhea. A Flu Symptoms Checklist is on the DPH website at www.mass.govdph/swineflu.
• All school staff should assess themselves for symptoms of influenza before reporting to work, and should stay home if they are symptomatic.
• Schools should consider screening students and staff for visible signs of possible influenza illness upon arrival at school.
• Students or staff who appear ill with influenza-like illness should be promptly isolated and sent home.  All such students and staff should stay out of school for at least 7 days even if their symptoms resolve sooner. Students and faculty who are still sick at 7 days should continue to stay home from school until at least 24 hours after they have completely recovered.
• If a child or adult is ill with other symptoms, they should stay home at least one day to observe how the illness develops and until completely well for 24 hours.  This period of exclusion can be shortened if it is found that the child is unlikely to have influenza, for example if an alternative diagnosis, such as strep throat, is made.
• School nurses and student health centers should report higher than normal absenteeism to your local health department or to the MDPH at 617-983-6800.

Recommendations for Enhanced Surveillance and Prevention of Swine-Origin Influenza A H1N1 in Massachusetts Schools and Child Care Settings

If cases of influenza-like illness are identified, schools/child care facilities should consider increasing their surveillance and infection control measures to limit the further spread of illness in their facilities.  These measures are enhancements of what schools/child care facilities do during flu season to prevent illness in children and staff.

Because CDC and MDPH recommend testing only those who are seriously ill, or who have underlying conditions which put them at increased risk for complications from influenza for H1N1, schools should consider implementing these enhanced measures when they see an increase in absenteeism due to influenza-like illness. They do not need to await confirmation of H1N1.

• Monitor absenteeism in students and staff and follow up to determine if absence is due to influenza-like illness. School nurses and student health centers should report higher than normal absenteeism to your local health department and to the MDPH Epidemiology Program at 617-983-6800.
• Screen students and staff as they enter school, during home room, or other appropriate times to identify anyone with fever and symptoms of influenza-like illness.  Any child that appears to have ILI should be isolated and sent home.  If the ill student or staff member has a cough, as well as fever, he/she should wear a mask (if available) until leaving the school to decrease the spread of the virus.If there are an unexpected number of absences in a particular class room or grade, screen the children in that class or grade to identify any that may have symptoms of ILI.
• Place hand sanitizer in each classroom to facilitate regular hand hygiene.  Encourage younger students to use the sanitizer before snacks and lunch.  Encourage older students that change classrooms to use hand sanitizer each time they change classes.
• Ask teachers or school nurses to demonstrate proper hand washing and cough etiquette in each class, and to explain why it’s important.  Educational materials, posters, etc., are available on the MDPH website, www.mass.gov/dph/swineflu.
• Send hand washing or other flu control educational materials home to parents and ask for their assistance in reinforcing these messages with their children.
• Distribute the Flu Symptom Checklist to families and ask that parents use it if they are unsure if their child is well enough to go to school.
• Consider increasing routine cleaning of classroom surfaces likely to be touched.  This should be considered only as an adjunct to the efforts to increase hand washing, improve cough etiquette and keep ill children and staff home, because cleaned surfaces can easily become re-contaminated during the day.

Preparedness Planning: Schools and childcare facilities should prepare for the possibility of school or childcare facility closure before facing this decision.  This includes asking teachers, parents, and officials in charge of critical school-associated programs (such as meal services) to make contingency plans.

Parent and Staff Reassurance

Parents, faculty and staff may need to be reassured that the school/child care facility is taking appropriate steps to limit the spread of illness.

Concerned parents, faculty and staff can be reminded that illness caused by swine-origin influenza A H1N1 is similar to that caused by seasonal flu, so our responses should be what they would be for seasonal flu.

Influenza is highly likely to be in the school or community, whether or not there is a confirmed case.    Parents and staff should assume that they could be exposed to this new flu at school, at work or anywhere else in the community.  Therefore, it is very important for everyone to continue to protect themselves with hand washing, cough etiquette, etc.

Special Populations

Some children or staff may be at greater risk for complications from any flu – seasonal or swine.  These include:

• Children less than 2 years old
• Persons aged 65 years or older
• Pregnant women
• Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy who might be at risk for experiencing Reye’s syndrome after influenza virus infectionAdults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders
• Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV infection)

Staff or parents of children who fit any of the above criteria should discuss their specific situation with their doctor, just as they do when regular flu season starts.

Source: Massachusetts Department of Public Health (May 20, 2009)