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Guidance for School Administrators to Help Reduce the Spread of Seasonal Influenza in K-12 Schools during the 2010-2011 School Year

This document from the Centers for Disease Control and Prevention (CDC), an agency of the U.S. Department of Health and Human Services, provides guidance to help reduce the spread of seasonal influenza (flu) among students and staff in K-12 schools during the 2010-2011 school year. This guidance replaces the Guidance for State and Local Health Officials and School Administrators for School Responses to Flu during the 2009-2010 School Year. Recommendations are based on CDC's current knowledge of flu in the United States. CDC will continue to monitor flu activity and update this guidance as needed.

For the purpose of this guidance, "schools" will refer to both public and private institutions providing grades K-12 education to children and adolescents in group settings.

Background Flu seasons are unpredictable in a number of ways. Although epidemics of flu occur every year, the timing, severity, and length of the epidemic depend on many factors, including what flu viruses are spreading, how well the flu vaccine is matched to the flu viruses that are causing illness, and the number of people who are susceptible to the circulating flu viruses. The timing of flu can vary from season to season. In the United States, seasonal flu activity most commonly peaks in January or February, but flu viruses can cause illness from early October to late May. In 2009-2010, a new and very different flu virus (called 2009 H1N1) spread worldwide, causing the first flu pandemic in more than 40 years. During the 2010-2011 flu season, CDC expects the 2009 H1N1 virus to cause illness again, along with other influenza viruses.

Flu viruses are thought to spread mainly from person to person through coughs and sneezes of infected individuals. People may also become infected by touching something with flu virus on it and then touching their mouth, nose, or eyes.

Many respiratory infections spread from person to person and cause symptoms similar to those of flu. Therefore, the non-pharmaceutical recommendations in this document might help reduce the spread of not only flu, but also respiratory syncytial virus (RSV), rhinovirus, and other viruses and bacteria that may cause respiratory illness.

Each day, about 55 million students and 7 million staff attend the more than 130,000 public and private schools in the United States. By implementing the recommendations in this document, schools can help protect one-fifth of the country's population from flu. Collaboration is essential; CDC, the U.S. Department of Education, state/local public health and education agencies, schools, staff, students, families, businesses, and communities should work together to reduce the spread of flu and other respiratory infections.

See Current Flu Season Information and Key Facts about Influenza (Flu) and Flu Vaccine.

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High-Risk Groups People of all ages get sick with flu. School-aged children are the group with the highest rates of flu illness. Groups at highest risk for severe flu-related illness, including being hospitalized or dying from flu, include:

  • Children younger than 5, but especially children younger than 2 years of age
  • Adults 65 years of age and older
  • Pregnant women
  • American Indians/Alaskan Natives
  • People younger than 19 years of age who are receiving long-term aspirin therapy
  • People who have certain medical conditions, including:
    • Asthma
    • Other chronic lung diseases (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
    • Neurological and neurodevelopmental conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle, such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, and spinal cord injury).
    • Heart disease (such as congenital heart disease, congestive heart failure, and coronary artery disease)
    • Blood disorders (such as sickle cell disease)
    • Endocrine disorders (such as diabetes mellitus)
    • Kidney disorders
    • Liver disorders
    • Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
    • Weakened immune systems due to disease or medication (such as HIV/AIDS, cancer, and use of chronic steroids)
    • Morbid obesity (body mass index [BMI] of 40 or greater)
See People at High Risk of Developing Flu-Related Complications.

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Symptoms and Emergency Warning Signs The symptoms of flu can include:

  • Fever (although not everyone with flu has a fever)
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Body aches
  • Headache
  • Chills
  • Tiredness
  • Sometimes diarrhea and vomiting
Emergency warning signs that indicate a person should get medical care right away include:

  • In young children:
    • Fast breathing or trouble breathing
    • Bluish skin color
    • Not drinking enough fluids
    • Not waking up or not interacting
    • Being so irritable that the child does not want to be held
    • Flu-like symptoms improve but then return with fever and worse cough
    • Fever with rash
  • In adults:
    • Difficulty breathing or shortness of breath
    • Pain or pressure in the chest or abdomen
    • Sudden dizziness
    • Confusion
    • Severe or persistent vomiting
    • Flu-like symptoms that improve but then return with fever and worse cough
See The Flu: What to Do If You Get Sick.

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Recommendations Below are recommendations to help reduce the spread of flu in schools.

  • Encourage students, parents, and staff to take the time to get a yearly flu vaccine.
    • Teach students, parents, and staff that the single best way to protect against the flu is to get vaccinated each year. See Key Facts about Seasonal Flu Vaccine.
      • Seasonal flu vaccination is recommended for everyone 6 months of age and older unless they have a specific contraindication to flu vaccine. See Persons Who Should Not Be Vaccinated.
      • The 2010-2011 seasonal flu vaccine protects against an influenza A H3N2 virus, an influenza B virus, and the 2009 H1N1 virus that caused so much illness last season.
      • There are two types of seasonal flu vaccines. One type is the "flu shot," an inactivated (killed) vaccine (TIV for "trivalent inactivated influenza vaccine") that is given with a needle, usually in the upper arm. This vaccine can be given to anyone 6 months or older, including pregnant women and people with existing medical conditions. The second type is the nasal spray vaccine (FluMist® or LAIV for "live attenuated influenza vaccine"), a vaccine made with live, weakened flu viruses that do not cause flu. This vaccine is approved for use in people 2-49 years of age who are not pregnant and who do not have health problems.
      • Flu vaccines have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines. The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness, or swelling where the shot was given. See Adverse Events after Receipt of TIV (Flu Shot) and Adverse Events after Receipt of LAIV (Nasal Spray Vaccine).
      • Vaccination efforts can start as soon as vaccination becomes available (usually in September) and should continue as long as flu viruses are spreading and causing illness in the community.
    • Consider setting up a seasonal flu vaccination clinic at school. These clinics are an option for vaccinating many school-aged children against flu in a short period of time. Contact your local and state public health departments for more information about your local flu situation and how to set up a vaccination clinic. See CDC Guidelines for Large-Scale Influenza Vaccination Clinic Planning.

    See Preventing Seasonal Flu with Vaccination.
  • Encourage students, parents, and staff to take everyday preventive actions to stop the spread of germs.
    • Encourage respiratory etiquette among students and staff through education and the provision of supplies. See Cover Your Cough.
      • Teach students and staff to cover coughs and sneezes with a tissue or their arm. If they use a tissue, they should put the used tissue in the trash can and wash their hands.
      • Provide adequate supplies within easy reach, including tissues and no-touch trash cans.
    • Encourage hand hygiene among students and staff through education, handwashing time, and the provision of supplies. See Clean Hands Save Lives.
      • Teach students and staff to wash hands often with soap and water for 20 seconds, dry hands with a paper towel, and use the paper towel to turn off the faucet. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer containing at least 60% alcohol may be used.
      • Include handwashing time in student schedules.
      • Provide adequate supplies, including clean and functional handwashing stations, soap, and alcohol-based hand sanitizer.
    • Encourage students and staff to keep their hands away from their nose, mouth, and eyes.

    See Good Health Habits for Preventing Seasonal Flu and
    Everyday Preventive Actions That Can Help Fight Germs, Like Flu Adobe PDF file.
  • Encourage students and staff to stay home when sick through education and policy.
    • Teach students, parents, and staff the importance of staying home when sick until at least 24 hours after they no longer have a fever (usually defined as 100 degrees Fahrenheit or 37.8 degrees Celsius, measured by mouth) or signs of a fever (chills, feeling very warm, flushed appearance, or sweating) without the use of fever-reducing medicine.
    • Review school policies, and consider revising those that make it difficult for students and staff to stay home when sick or when caring for others who are sick. Avoid the use of perfect attendance awards. Cross-train staff so others can cover for co-workers who need to stay home.
  • Encourage routine surface cleaning through education, policy, and the provision of supplies.
    • Each day, routinely clean surfaces and objects that are touched often, such as desks, countertops, doorknobs, computer keyboards, hands-on learning items, faucet handles, and phones. Empty trash cans frequently.
    • Use general cleaning products that you normally use on surfaces to clean (remove germs) and disinfect (kill germs). Always follow label directions on cleaning products and disinfectants. Additional disinfection beyond routine cleaning is not recommended.
    • Provide adequate supplies, including general EPA-registered cleaning products, gloves, disinfecting wipes, and no-touch trash cans.
    • Place disinfecting wipes in classrooms, and encourage students and staff to wipe down frequently-touched surfaces and objects before each use.
    • Most studies have shown that the flu virus can live and potentially infect a person for only 2 to 8 hours after being deposited on a surface. Therefore, it is not necessary to close schools to clean or disinfect every surface in the building to slow the spread of flu.

    See How to Clean and Disinfect Schools to Help Slow the Spread of Flu.
  • Educate students, parents, and staff on what to do if someone gets sick.
    • Teach students, parents, and staff the signs and symptoms of flu, emergency warning signs, and high-risk groups. See lists at the beginning of this document.
      • Those who get flu-like symptoms at school should go home and stay home until at least 24 hours after they no longer have a fever or signs of a fever without the use of fever-reducing medicine. Those who have emergency warning signs should get immediate medical care. See The Flu: What to Do If You Get Sick.
      • Those who get flu-like symptoms and are at high risk of severe flu illness should ask a doctor or other health-care provider if they should be examined. See People at High Risk of Developing Flu-Related Complications.
    • Separate sick students and staff from others until they can be picked up to go home. When feasible, identify a "sick room" through which others do not regularly pass. The sick room should be separated from areas used by well students for routine health activities, such as picking up medications. Caregivers should be limited in number and should not be at high risk for severe illness if they get sick.
    • Encourage students, parents, and staff to take antiviral drugs if their doctor or other health-care provider prescribes them. See Treatment (Antiviral Drugs).
      • Antiviral drugs, called Relenza® and Tamiflu®, are drugs that can be prescribed by doctors or other health-care providers to treat the flu. These drugs can reduce the number of days that a person is sick, but not everyone needs to be treated.
      • Antiviral drugs work best when started within the first 2 days of illness, but they may also help reduce the risk of severe illness even after 2 days for persons who are hospitalized.
      • Although most people will recover from flu without treatment, antiviral drugs may be most important for treating people who have an illness requiring being in the hospital; a progressive, severe, or complicated illness; or at high risk of severe flu because of an underlying medical condition or their age.
      • People at high risk of severe flu illness who get flu-like symptoms should speak with their doctor or other health-care provider to determine if they need treatment.
  • Establish relationships with state and local health officials so that you can take action quickly if flu conditions become more severe in your community.
  • Follow your local flu situation through close communication with state and local health officials.
  • Although school dismissal and closure are not recommended for the control of seasonal flu, work with state and local health officials to determine if and when you should dismiss students based on the severity of disease in your community. Some schools may decide to close based on local considerations, such as high student and staff absenteeism.
  • Update emergency plans so they are in place before an outbreak occurs.

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