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School Closures May Not Be Necessary When Swine Flu Strikes

But that could change if fall outbreak proves more severe, government says

FRIDAY, Aug. 7 (HealthDay News) -- The school closures that swept across the United States last spring during the emergence of the H1N1 swine flu needn't be repeated this fall, according to new guidelines issued Friday by federal health officials.

However, the same guidelines noted that everything could change if the outbreak suddenly turns severe.

"New guidance for schools from the [U.S.] Centers for Disease Control and Prevention will help schools prepare and respond to the H1N1 flu as kids get ready for school in the upcoming days," Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, said during a Friday morning news conference.

"Schools must have clear guidance about how to minimize the spread of H1N1," Janet Napolitano, Secretary of the U.S. Department of Homeland Security, added during the same news conference.

"The decisions to close schools is a local one," she said. "Once you close a school, as we saw last spring, that causes a very significant ripple effect, because children need to stay home [and] that means parents need to be thinking about their own plans."

"The guidance we are providing today will give school officials the tools they need to make informed decisions about how to decrease exposure to the flu while limiting the disruption of day-to-day learning in schools," Napolitano added.

"What we don't know is whether or when H1N1 will return," said Dr. Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention. "It's quite possible that it will come back when schools reopen. It is also possible that it will not."

As far as school closings go, the new guidelines offer a "range of options." According to the CDC, more than 55 million students and 7 million staffers head to the nation's 130,000 schools each weekday during the school year. In essence, the recommendations balance the need to contain the spread of the H1N1 swine flu against the disruption to education and inconvenience to parents that school closures can bring.

Among the recommendations:

  • Students and school staff should exercise good flu hygiene, such as hand washing and covering noses and mouths with tissue when sneezing or coughing (use a shirt sleeve if tissue is unavailable).
  • If flu is suspected, the affected person should contact a health-care worker as soon as possible. People at high risk (due to pregnancy, or medical conditions such as asthma or diabetes) should take antiviral medication immediately to reduce risk of prolonged or dangerous illness.
  • Schools should have an action plan for flu outbreaks, including a room set aside for people suspected of coming down with flu, as they wait to be transported home. Schools should also have a contingency plan should important personnel, such as school nurses, fall ill.
  • The CDC recommends the use of surgical masks for ill students or staff and those caring for them.
  • The education of students who are ill at home with the flu should be continued, using phone calls, homework packets and Web-based learning.
  • Any ill student or staff member should stay home for an additional 24 hours after flu symptoms such as fever have ended, even if they are using antiviral drugs such as Tamiflu.
  • Select schools with high populations of high-risk students (for example, schools for "medically fragile" students) may want to consider closure.

However, these guidelines may need to be revisited and revised should the swine flu prove more dangerous this fall, health officials said. Under those conditions:

  • Parents should check their children each morning for flu symptoms and keep them home if they have a fever. Students should also be screened for flu symptoms upon arrival at the school.
  • If any family member of a student becomes ill with the flu, the respective student should stay home for five days from the day symptoms arise, the experts advised.
  • Increase distances between students by spreading desks further apart or canceling classes that bring students from different classes together.
  • Extend the stay-at-home period for sick students to seven days, even after symptoms have subsided.
  • Close schools after careful weighing of the risks and benefits to students and the community. Schools should be closed for five to seven calendar days, and then officials should reassess the advisability of re-opening the school.
  • Even during a school closure, teachers and staff should have access to the school so they can continue to provide instruction via the Web and other means. Speaking at the news conference, Arne Duncan, Secretary of the U.S. Department of Education, said that "realistically, some schools will close this fall. If they do, it is important to us that students continue to learn."

"Only schools with high numbers of high-risk students or students getting the flu should actually consider closure," Napolitano said.

Health officials may have another tool in their arsenal, as well: a swine flu vaccine.

"The best way to prevent the spread of the flu is vaccination, and our scientists are working hard to have a vaccine ready for consumption by mid-October," Sebelius said. According to the CDC's Frieden, "the vaccine will most likely, at least for children, require two doses separated by about three weeks or more."

"Because not a lot of kids get vaccinated against flu in a regular flu season, it's going to be challenging to get lots of kids vaccinated," he noted.

When the H1N1 vaccine is available, "we hope all providers and venues where flu vaccine can be given will be used. That includes, wherever possible, school-located vaccine clinics," Frieden said. "It's a great way to get all the kids vaccinated."

One expert called the new recommendations "sensible and reasonable," but noted that certain illnesses other than flu can cause sudden fever.

"My only concern is that people who dont have flu, I think they are recommending that anyone with a sign of fever has to be out of school for a week," said Dr. Stuart E. Beeber, attending physician at Northern Westchester Hospital and a pediatrician in private practice in Chappaqua, N.Y. "You could have a strep throat or gastroenteritis or something, and that's overkill for those people and a hardship on the families, working parents -- providing babysitters and so on for someone who has strep throat and is treated with penicillin and is ready to go back to school in a day or two."

Beeber noted that it is relatively quick and easy to identify strep throat, however, and the flu does have a distinctive set of symptoms. "To me, there are certain things - if you tell me you have chills, aches, you feel like someone hit you over the head with a sledgehammer, you've got the flu," he said.

More information

Find out the latest on H1N1 flu at the CDC.

SOURCES: Stuart E. Beeber, attending physician, Northern Westchester Hospital, and pediatrician, private practice, Chappaqua, N.Y.; Aug. 7, 2009, news conference with: Kathleen Sebelius, U.S. Department of Health and Human Services Secretary; Janet Napolitano, U.S. Department of Homeland Security Secretary; Arne Duncan, U.S. Department of Education Secretary; and Thomas R. Frieden, M.D., director, U.S. Centers for Disease Control and Prevention; Aug. 7, 2009, CDC Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza during the 2009-2010 School Year

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