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Guidance for Colleges and Universities during Outbreak of Novel Influenza A (H1N1) virus

posted May 11, 2009, 1:50 PM by Santa Clara County Public Health Dept   [ updated May 11, 2009, 1:51 PM ]

May 6, 2009

Background on the outbreak

The outbreak of novel influenza A (H1N1) virus, which has been reported widely in the news, now affects 19 countries and 38 states. As of May 5, 2009, Santa Clara County has reported a total of 17 probable and confirmed cases, most of whom have not traveled to Mexico or other affected communities. There is evidence of human-to-human transmission within our community. Although seasonal human influenza continues to circulate in the community, anyone with an influenza-like illness might potentially have novel influenza A (H1N1) virus.

Influenza-like illness (ILI) is defined as fever >37.8°C [100°F] AND at least two of the following: runny nose or nasal congestion, sore throat, or cough.

How Influenza A H1N1 is spread

Flu viruses are generally spread from person to person through coughing or sneezing of people with influenza. In addition, sometimes people may become infected by touching something with flu viruses on it and then touching their mouth, nose, or eyes. A person with influenza is contagious beginning one day before the onset of symptoms until seven (7) days after illness onset, or until all symptoms have resolved, whichever is longer.

Measures to control the spread of influenza and other contagious diseases

Students and staff at colleges and universities should be encouraged to observe the following measures to reduce the spread of influenza and other contagious diseases:

  • Cough or sneeze into the sleeve or cover the nose and mouth with a tissue when coughing or sneezing. Throw tissues in the trash after use.
  • Wash hands often with soap and water, especially after coughing or sneezing. Alcohol-based hand cleaners are also effective.
  • Avoid touching eyes, nose or mouth. Germs spread this way.
  • Well persons should try to avoid close contact with sick people.

Students and staff who are feeling ill should stay home (or in the dormitory) at least one day to observe how the illness develops and until completely well for 24 hours.

What to do with students and staff who have influenza-like illness

If a student or staff person develops an influenza-like illness (ILI), they should stay home or in the dormitory and not attend classes or school functions where they might expose others, for at least seven (7) days following the onset of illness or until all symptoms have resolved, whichever is longer. During this time, they should limit contact with healthy people. The document “What to do if you’re home with the Flu” on Santa Clara County Public Health Department’s website www.sccphd.org may be applied to the dormitory setting.

If students or staff persons with ILI must enter public areas (e.g., common living areas in a dormitory), they should wear a surgical mask. Use of the surgical mask should continue for at least the seven (7) days following the onset of illness, and until all symptoms have resolved.

Guidance for care at home for patients with influenza, including reasons to contact a medical provider for evaluation and treatment, can be found at: http://www.cdc.gov/swineflu/guidance_homecare.htm, and on the Santa Clara County Public Health Department’s website at http://www.sccphd.org/swine_flu_update.html (click on the link to the Home Care Guide on the right side of the page).

Testing for Novel Influenza A (H1N1) virus

At this time, the Santa Clara County Public Health Department is NOT recommending testing for novel influenza A (H1N1) virus in university students or staff with influenza-like illness.

Current local recommendations for testing for novel influenza A (H1N1) virus are available at www.sccphd.org – please look for the most recent Health Alert for these recommendations.

Treatment for Novel Influenza A (H1N1) virus

Treatment with influenza antiviral medications is not routinely recommended, even for patients with novel influenza A (H1N1) virus, except under certain circumstances. Guidelines for identifying and treating patients with novel influenza A (H1N1) virus can be found at http://www.cdc.gov/h1n1flu/identifyingpatients.htm and http://www.cdc.gov/h1n1flu/recommendations.htm. Additional guidance is available in the most recent Health Alert at www.sccphd.org. This is a dynamic and evolving situation. Clinicians are advised to stay informed and use the most up-to-date guidance from the CDC.

Individuals at high risk for complications of influenza should be advised to contact their medical providers early in the course of an influenza-like illness (ILI) in order to determine the best course of treatment. These individuals include:

  • persons aged ≥ 50 years of age;
  • children < 5 years of age;
  • pregnant women;
  • persons with chronic diseases such as diabetes mellitus, asthma, heart disease (excluding hypertension), kidney diseases, severe anemia, cancer, and weakened immune systems due to immunosuppressive medications (corticosteroids, anti-TNF alpha medicines, etc.) or HIV infection;
  • children aged six months to 18 years who are on long-term aspirin therapy;
  • persons with any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration;
  • residents of nursing homes and other chronic care facilities

If student health services or other health care providers cannot obtain access to antiviral medications through a commercial pharmacy, they may order these medications through the Santa Clara County Public Health Pharmacy. To order antiviral medications, go to www.sccphd.org and select “Click Here for Physician & Provider Information.”

Further questions

Current information on the status of the outbreak at the local, state, and national levels may be found at the following websites:

Santa Clara County Public Health Department: http://swineflu.sccgov.org/
State of California: http://ww2.cdph.ca.gov/Pages/default.aspx
Centers for Disease Control and Prevention: http://www.cdc.gov/h1n1flu/

For further questions, please contact the Public Health Department Emergency Operations Center during regular business hours at 408-794-0700. After hours and on weekends, healthcare providers (but not the general public) may call County Communications at 408-998-3438 and ask to speak with the public health officer on call.

Updated Guidance for School and Childcare Closures for Santa Clara County

posted May 11, 2009, 1:49 PM by Santa Clara County Public Health Dept   [ updated May 11, 2009, 1:49 PM ]

Santa Clara County Public Health Department
May 6, 2009

Over the last week and up until last evening, and consistent with guidance from California Department of Public Health and the Centers for Disease Control, Santa Clara County Public Health Department closed schools and daycares if a probable or confirmed case of swine influenza (influenza A H1N1) was identified in that setting. As you know, this outbreak has been evolving and with each day we learn more about the virus, the severity of illness that it causes, and how easily it spreads. The closures have helped to decrease the spread of infection in the schools and have provided valuable time for us to gather information about this new H1N1 influenza strain in our community.

Information gathered over the last week in Santa Clara County and elsewhere in the country show that most U.S. cases have not been severe and are comparable in severity to seasonal influenza.

What will be the new policy and guidance?
Based on our local information, as well as new draft guidance issued by CDC today, we are now modifying our approach. Rather than continuing to close individual schools and childcare centers based on the diagnosis of influenza A H1N1 in students or staff, we will instead implement a county-wide policy that focuses on keeping all students and staff with symptoms of influenza out of school or childcare during their period of illness and recuperation, when they are potentially infectious to others. The new recommendation guidance to decrease spread of influenza A H1N1 in Santa Clara County schools and childcare settings is as follows:

  • Each morning, all parents/caregivers should assess all ill family members and especially all school-age children for symptoms of influenza (fever and cough or sore throat) or other early symptoms that might be influenza.
  • Each morning, all school faculty should assess themselves for symptoms of influenza.
  • Students or faculty with influenza-like-illness (fever and cough or sore throat) should stay home and not attend school. All sick students and faculty 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 symptoms (even if they don’t have all the symptoms or influenza), they should stay home at least one day to observe how the illness develops and until completely well for 24 hours.
  • Schools should screen students and staff for visible signs of possible influenza illness upon arrival to school.
  • Students and staff who appear ill at arrival or become ill at school should be promptly isolated and sent home.
  • Persons who are ill should stay home and not go into the community unless they need medical care. Ill students should not attend alternative child care or congregate in settings other than school.
  • As always, situations can be individualized and school authorities may still close a school at their discretion. Parents may use their judgment regarding the risk and benefits of sending their children to school during this influenza outbreak as they would during a seasonal influenza outbreak.
  • Schools will not longer be routinely ordered closed by Santa Clara County Public Health Department on the basis of a probable case of swine influenza. As is our practice with seasonal influenza, schools may be closed if larger numbers of students or faculty would become ill and school functioning becomes disrupted.

What information is informing this policy change?
Epidemiological information from our case investigations and surveillance systems suggests that this new strain has spread widely in our community and will continue to be transmitted from person to person, including children. Available information (from local, state and national sources) suggests that the severity of illness from the new influenza A H1N1 strain is not greater than the typical seasonal influenza that circulates in our community every year.

What will the policy be for schools and daycares that have already closed?
Schools and childcare centers that have been closed over the last week may re-open, and should be especially diligent about following the guidance above.

We thank the school nurses and health clerks who have diligently been reporting cases of influenza-like-illness to us. As of today, we no longer need those reports as we will no longer be following up on individual students with influenza like illness. However, if you note an unusual number of absences from influenza-like-illness and need assistance in deciding what measures to take, you may consult the “school liaison” at Santa Clara County Disease Prevention and Control Program at (408) 885-4214.

If you have questions about this change in guidance or its implementation, please call (408) 794-0700 and ask to speak with the Medical Group Supervisor.

We have tremendous respect and appreciation for the superintendents, principals, teachers and other staff in schools and daycare who have worked so closely with us, and the parents and students who have been so patient with our actions. As you know, this has been a very dynamic and rapidly evolving situation, and your cooperation and partnership have been invaluable.

Thank You

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