The U.S. Department of Health has declared a health emergency. On June 9, 2009 the World Health Organization has raised the global Pandemic warning level to level 6 indicating that a global Influenza A H1N1 (aka Swine Flu) pandemic is underway. Pandemic does not mean that the Novel A H1N1 influenza is particularly dangerous, but rather that there is no immunity to this flu and that it is therefore highly contagious and has already been spreading across a wide geographic area. Historically pandemic flu has occurred in waves of outbreaks over a 1-2 year period. Though the current outbreak of April-June 2009 appears to be waning, CDC and WHO expect a second wave of infection in the fall and winter seasons for the next two years coinciding with the regular seasonal flu season.
What About Severity?
At this time, WHO considers the overall severity of the influenza pandemic to be moderate. This assessment is based on scientific evidence available to WHO, as well as input from its member states on the pandemic’s impact on their health systems, and their social and economic functioning.
The moderate assessment reflects that:
- Most people recover from infection without the need for hospitalization or medical care.
- Overall, national levels of severe illness from influenza A(H1N1) appear similar to levels seen during local seasonal influenza periods, although high levels of disease have occurred in some local areas and institutions.
- Overall, hospitals and health care systems in most countries have been able to cope with the numbers of people seeking care, although some facilities and systems have been stressed in some localities.
WHO is concerned about current patterns of serious cases and deaths that are occurring primarily among young persons, including the previously healthy and those with pre-existing medical conditions or pregnancy.
Large outbreaks of disease have not yet been reported in many countries, and the full clinical spectrum of disease is not yet known.
Like most flu, there is a significant risk of respiratory complications, particularly pneumonia that may result in death. The high fever from flu can also cause death. In normal seasonal flu, it is children and senior citizens that are most at risk. In pandemic flu, including the current AH1N1 flu, healthy young adults (college age) are also highly vulnerable and often suffer the highest mortality rates due to an over-aggressive immune response to the unique flu virus.
Institute Preparation and Response for a Local Novel Influenza A H1N1 Outbreak
Since schools are a gathering place where individuals are in close proximity, it is very important that all institutes have a plan in place to protect its students, staff and faculty from the spread of this highly contagious virus.
- Pray daily for our national and local health care leaders and providers as they combat the spread of this flu. Pray also for protection for your state and community and school.
- It is important to weekly monitor your local news and your state’s Department of Health and Department of Education websites to know if you area needs to take immediate protective actions. Once school is in session in the fall, also corresponding to the anticipated time of the second wave of the flu pandemic, this monitoring should become daily.
- Though the CDC initially recommended school closures when a confirmed case of A H1N1 flu occurred locally, they have modified their recommendation based upon the currently moderate severity of this flu. The CDC currently recommends that schools remain open, but that any student or staff member displaying flu like symptoms be quarantined at home for seven days or until they have been symptom-free for 24 hours, whichever is longer. This recommendation may change again if the flu changes in its severity, so it is important to closely monitor the CDC and WHO websites. If a situation arises where the scope or severity of an outbreak in your area gets to the level that the state calls for local schools or colleges to shut down temporarily, we ask that you also take the same action to protect your school population.
- If there is a person at your school with flu like symptoms such as fever higher than 100 degrees, sore throat, sneezing or coughing, body ache, (and sometimes with nausea, vomiting or diarrhea) send them home immediately and ask that they get medical attention immediately. This flu responds well to antiviral medications if treated within the first two days of onset, so quick medical attention is very important to avoid the more severe complications of this flu. Ask them to remain at home for at least seven days or until they have been symptom-free for 24 hours, whichever is longer.
- In the meantime, it is good to remind all school personnel to practice good hygiene measures to avoid spreading germs: Cover the mouth and nose when sneezing or coughing, wash hands frequently with soap and water or alcohol hand cleaner, disinfect high contact surfaces such as doorknobs and telephones frequently, and avoid touching your eyes or nose with your fingers. Pregnant person or persons with weak immune systems, may be encouraged to wear facemasks to prevent accidental exposure to the flu.
Also please review the emergency preparedness manual sections on pandemic flu on pages 3.105-107 of the Institutes Handbook. If there are variations between the Handbook recommendations and more recent CDC recommendations, always defer to the most current instructions from CDC.
CDC Interim Recommendations for Institutions of Higher Education: May 11, 2009
Exerpted from (www.cdc.gov/h1n1flu/guidance/guidelines_colleges.htm)
- CDC is not currently recommending that institutions cancel or dismiss classes or other large gatherings.
- If confirmed cases of novel influenza A (H1N1) virus infection or a large number of cases of influenza like illness (ILI) (i.e. fever with either cough or sore throat) occur among students, faculty, or staff or in the community, institutions officials should consult with state and local health officials regarding an appropriate response.
- Because the spread of novel influenza A (H1N1) within a health professions school may pose special concerns, school administrators are strongly encouraged to contact their state and local public health authorities if they suspect that cases of ILI are present on their campuses.
- Students, faculty or staff who live either on or off campus and who have ILI should self-isolate (i.e., stay away from others) in their dorm room or home for seven days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer.
- If possible, persons with ILI who wish to seek medical care should contact their health care provider or campus health services to report illness by telephone or other remote means before seeking care. Institutions should assure that all students, faculty and staff receive messages about what they should do if they become ill with ILI, including reporting ILI to health services.
- If persons with ILI must leave their home or dorm room (for example, to seek medical care or other necessities) they should cover their nose and mouth when coughing or sneezing. A surgical loose-fitting mask can be helpful for persons who have access to these, but a tissue or other covering is appropriate as well. (See Interim Guidance for H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home).
- Roommates, household members, or those caring for an ill person should follow guidance developed for caring for sick persons at home. (See Interim Guidance for H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home).
- Persons who are at high risk of complications from novel influenza A (H1N1) infection (for example, persons with certain chronic medical conditions, children less than 5 years, persons 65 years or older, and pregnant women) should consider their risk of exposure to novel influenza if they attend public gatherings in communities where novel influenza A virus is circulating. In communities with several reported cases of novel influenza A (H1N1) virus infection, persons who are at risk of complications from influenza should consider staying away from public gatherings.
On the basis of what is currently known about the ongoing spread of novel influenza A (H1N1) and, as a means to prevent the further spread of disease on and off campus, institutions should encourage persons with ILI to stay home and away from large gatherings. Persons who are sick should be instructed to limit their contact with other people as much as possible and to stay home for seven days after their symptoms begin or until they have been symptom-free for 24 hours, whichever is longer. In addition, they should be reminded to use appropriate respiratory and hand hygiene. (See H1N1 Flu and You). Gatherings may include graduations and commencement activities, concerts, sporting events, and other gatherings where close contact is likely among a large number of attendees.
Large public gatherings offer a good opportunity for officials and event organizers to deliver key educational messages about measures attendees can take to help protect themselves and their family members from novel influenza A (H1N1) infection, including active promotion of good hygiene practices. (See H1N1 Flu and You)
Institutions should consider the following in preparation for possible outbreaks of novel influenza A (H1N1):
- Establishing a relationship with their state and local health departments.
- Keeping informed regarding the evolving situation through regular visits to the CDC’s H1N1 Flu website.
- Developing educational messages in a variety of formats regarding the illness and how to reduce the spread of influenza. (See H1N1 Flu and You).
- Alternative educational delivery such as distance learning, web-based learning, or other ways to increase social distancing.
- Planning for assistance for students with ILI, including provision for meals, medications and other care.
- Developing contingency plans for how to reduce exposure of non-ill students, staff and faculty to ill students, staff and faculty.
For more information, see: H1N1 Flu Guidance
Groups at Higher Risk for Severe Illness from Novel Influenza A (H1N1) Infection
Exerpted from (www.cdc.gov/h1n1flu/masks.htm)
Groups of people at higher risk for severe illness from novel influenza A (H1N1) infection are thought to be the same as those people at higher risk for severe illness from seasonal influenza. These groups include:
- Children younger than 5 years old.
- Persons aged 65 years or older.
- Children and adolescents (younger than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection.
- Pregnant women.
- Adults and children who have asthma, chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders such as diabetes.
- Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV)
- Residents of nursing homes and other chronic-care facilities.