Alabama Adopts Guidelines For Schools Regarding H1N1
The Alabama Department of Public Health recommends a change on how to respond if a child with influenza A H1N1 (swine flu) is identified in a school or day care center. The Centers for Disease Control and Prevention has modified its guidance on closing schools and day care facilities in communities having cases of influenza A H1N1. The available data do not indicate that the H1N1 virus is causing unusually severe illness at this time.
The reasons for the change in the recommendations are: 1) disease is already widespread; 2) the proportion of clinical illness that is severe is relatively low, potentially approximating that seen in seasonal influenza; 3) school closure is disruptive given the current severity of illness; and 4) warm weather may bring relief.
Dr. Donald Williamson, state health officer, said, “I am grateful that the A H1N1 illness is mild enough that school dismissal up to 14 days is no longer thought to be necessary. It is important that ill persons not go to school or day care facilities for at least seven days after the onset of illness, including one full day of being well before returning to class.”
He added, “If the disease becomes more severe, school dismissal might be recommended again in the future. Furthermore, school authorities might close schools if absenteeism is so high that it interferes with education.”
CDC now recommends implementation of measures that focus on keeping all students, faculty and staff with symptoms of influenza out of schools and child care facilities during their period of illness when they are potentially infectious to others.
Students and faculty with influenza-like illness should stay home and not attend school or go into the community except to seek medical care for at least seven days, even if symptoms resolve sooner. The child should return to school or day care only after being well for at least 24 hours. Students or staff who appear to have influenza-like illness at arrival or become ill during a school day should be isolated promptly in a room separate from other students and sent home.
As of noon, May 5 the health department had identified four confirmed and 14 probable cases of influenza A H1N1. The total of 18 cases were identified in Madison, Montgomery, Jefferson, Pike and Shelby counties. The most recent cases include three children in Madison County and one child in Shelby County. The department has been in contact with local school officials. Local school officials have announced the reopening of schools in Madison County.
The Alabama Department of Public Health does not recommend cancelling large group events based on concerns of H1N1 influenza. Individuals should try to curtail the spread of influenza by realizing the virus is circulating in the population. Individuals who are ill should not attend group events to avoid spreading the virus to others. Persons with underlying medical conditions which would put them at greater potential risk are also advised to avoid group events. Prescription antiviral drugs such as Tamiflu and Relenza provide effective treatment and should be taken within the first 48 hours of illness.
All persons are reminded to follow these precautions:
• Cover your cough or sneeze with a sleeve or tissue.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand sanitizers are also effective.
• Avoid touching your mouth, eyes and nose with your hands.
• Try to avoid close contact with sick people.
• If you get sick, stay home from work or school and limit contact with others to avoid infecting them. Patients experiencing severe symptoms, such as difficulty breathing, should call their health care provider.
Those with underlying medical conditions may want to avoid large group gatherings. Individuals control their own individual risk of acquiring infection. At-risk groups of persons with medical complications of A H1N1 infections include:
• Children less than 5 years old;
• Persons aged 65 years or older;
• Children and adolescents (less 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 chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders;
• Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);
• Residents of nursing homes and other chronic-care facilities.
The symptoms of H1N1 influenza are similar to the symptoms of traditional influenza and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with H1N1 influenza. Ill persons should voluntarily isolate themselves from others for seven days after they experience symptoms. Close contacts should limit their contact with others for a period of seven days from the time they were exposed.
The incubation period from the moment of exposure to H1N1 influenza until symptoms develop is two to seven days. Individuals are infectious to others one day before until seven days after symptoms develop. Persons who develop symptoms of respiratory illness should contact their medical provider who can arrange for tests to determine whether the disease is due to H1N1 flu.