Transcript Novel Influenza A (H1N1) Virus - Fairfax County Public Schools

Novel Influenza A (H1N1) Virus:
Review of Current School
Guidance
Presentation to SHAC
September 16, 2009
Esther M. Walker, Assistant Director of Patient Care Services
Douglass O’Neill, Coordinator, Safety And Environmental Health
History of Influenza Pandemics
 Three pandemics in the 20th century
 1918 (H1N1) – 40 million deaths
 young people most affected
 1957 (H2N2) – 2 million deaths
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children most affected
 1968 (H3N2) – 700,000 deaths
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all ages affected
 Outbreaks tend to occur in two or three waves
over a period of a year or more
 Severity of subsequent waves can change
H1N1 “swine flu” Pandemic:
Activity Update
 Disease outbreaks of influenza occurring on
every continent and over 70 countries
 Worldwide - 162,380 cases 1154 deaths
 U.S.A – 43,771 cases and 302 deaths
 Virginia -349 cases and 2 deaths
 Fairfax County – 75 cases and no deaths
*Given that countries are no longer required to test and report individual
cases, the number of cases reported actually understates the real
number of cases.
Current H1N1 Pandemic Update
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Virus appears to be more contagious than seasonal
influenza
A younger age group has been affected than seen
during seasonal influenza
Presenting with spectrum of illness
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Most cases seem to be mild and self-limited
Tendency to cause more severe and lethal infections
in people with underlying medical conditions
Potential severity of virus remains uncertain; current
severity is unchanged from Spring 2009
H1N1 Vaccine
 Matches isolated virus- manufactured
using same process as seasonal flu
vaccines
 Currently in clinical trails
 Available for use mid-October
 Possibly 2 doses 21-28 days apart
 First group to receive vaccine will be
high risk group as defined by CDC
CDC/ACIP Target Groups for
Vaccine
Target Group (159 M)
Priority if needed (40 M)
HCW and Emergency Medical HCW and EMS with direct
Services
exposure or work with
samples
Pregnant
Pregnant
Household contacts of infants Household contacts of infants
<6 months of age
<6 months of age
Individuals 6 mos. to 24
years of age
Individuals 6 mos. to 4 years of
age
25-64 years with chronic
medical conditions
5 years to 18 years with
chronic medical conditions
Hospitalizations From Novel H1N1 Influenza
April 1 – May 30st (n=268)
30%
28%
25%
20%
1%
Prevalence, General US Pop
6%
7%
7%
Prevalence, Hospitalized H1N1 Patients
5%
7%
4%
6%
8%
0%
8%
5%
16%
10%
14%
15%
15%
Possible Vaccine Delivery Models
 Traditional providers in the
community
 Public Health Response
 Push model to community partners
 School based vaccination clinics
 Mass vaccination clinics for the general
population
Seasonal Flu Vaccine
 FCPS providing free seasonal flu shots
for employees
 Human Resources coordinating
 Expected to be available in
September
 Highly encouraged to receive
seasonal flu shots
Current Planning
 Education and Information
 KIT messages to community
 High risk individuals should begin dialogue with
primary care provider
 Internal and public websites, videos, posters,
morning school announcements, community
messaging via Insight and Channel 21
 FCPS and FCHD continue ongoing meetings
 If severity increases guidance will come
through FCHD and FCPS if other
interventions are needed
 Number of strategies available
 Town Hall Meetings
Preventive Measures
Principal meeting August 11, 2009
HD-SIMS
Cleaning protocols—routine is adequate
Hand washing emphasized
Health curriculum in first 2 weeks of school
Respiratory/Cough Etiquette and Hand Washing Posters
delivered to every school and center.
 Surgical masks delivered to every school and center.
 Notification to employees with information on high risk
groups
 Kilmer, Key, Bryant and Mountain View briefing already
held with administrators
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Respiratory/Cough Etiquette and Hand Washing Posters
Recommendations for Schools:
Outbreak similar to the Spring
 Hand Hygiene/Respiratory etiquette
 Work with school administrators to make access to
hand washing (soap/paper towels) easier and
tissues available. Guidance on antiseptic
towellettes and hand sanitizers.
 Reinforce the classroom based instruction with the
student and staff
 Getting seasonal flu vaccine
 All children aged 6 months to 19th birthday should
get seasonal flu vaccine
 H1N1 Vaccine when available for persons in priority
group
 Keeping ill students home
Influenza
 Symptoms
 Fever, cough, sore throat, runny nose,
headache, muscle aches, extreme
weakness, tiredness
 Definition
 Influenza-Like-Illness (ILI) is defined as
having a fever (>100) plus cough and/or
sore throat
Protocol for Students

Stay at home if ill
 Stay home until 24 hours after fever has ended
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Students present ILI symptoms at school
 Isolated and supervised. FCPS principals to start identifying
isolation areas and non-high risk staff to supervise students.
 Parental contact for pickup—emergency contact info
 Wear a surgical mask, if tolerable
 Reinforce the exclusion period with the families when they are
called and again when they pick up the child
 Children do not necessarily need to seek medical care unless the
severity of their illness requires that
 Students will not require a medical note to come back to school
Protocol for Staff
 Stay home if ill—24 hour rule
 No doctor note required
 Staff who present ILI symptoms
 Sent home
 If unable to leave immediately, self isolate
and wear surgical mask if tolerable
Recommendations for Schools:
Exclusion period
 Staff and students with ILI should stay home
for at least 24 hours after fever (most
contagious period) without the use o fever
reducing medications
 3-5 days in most cases
 Avoid close contact with others
 Medical note not required to return to school
 When they return to school after fever
resolves, they should continue to wash hands
and cover coughs and sneezes
Recommendations for Schools:
School Closures
 CDC recommends schools try to stay open
 Recognition of social and economic impacts of closures
 Local decision
 Populations, individual schools or division wide
 Close consultation with FCHD
 Epidemiological basis
 Operational capability basis
Recommendations for Schools:
School Closures
 Widespread school closures not anticipated
 Will use strategies based on the severity of the
illness and local flu activity
 Alternatives to school closures
 Stepping up basic good hygiene practices
 Keeping sick students and staff away from school
 Helping families identify their children who are at highrisk for flu complications
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Benefit from early evaluation from their physician if they
develop the flu
Review your medical flag lists and discuss these kids with
their parents in advance
 Routine Cleaning
Emergency Management Issues
 Updated FCPS Pandemic Emergency Operations
Plan
 Continuity of Operations component
 Daily student & staff absentee data to be
provided to VDH
 Closure notifications to CDC/U.S. Dept of Ed
Academic Continuity
 School Blackboard sites kept up-todate
 Blackboard pandemic function ready
 Keep on Learning
 Packets for distribution, when needed
Individual and Family Preparedness
 Encourage students, staff and school
community
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Get an emergency kit
Make a family plan
Stay informed
Stop germs from spreading
 Wash hands often
 Cover coughs and sneezes
 Stay home when sick
H1N1 Resources
 FCPS
http://www.fcps.edu/news/swineflu.h
tm
 FCHD
http://www.fairfaxcounty.gov/hd/flu/