CDC scales back school-closure advice

May 5, 2009 (CIDRAP News) – The Centers for Disease Control and Prevention (CDC) today revised its novel H1N1 influenza (swine flu) guidance for schools, urging schools and parents to identify and isolate sick children rather than close schools when cases are identified or suspected.

The new recommendations are based on a new understanding of disease severity, which is now seen as less than originally thought and appears to be more in line with that of seasonal influenza, the CDC said today in its guidance. However, the CDC's recommendations allow for local flexibility, particularly when many student and faculty absences interfere with school functioning.

Health and Human Services (HHS) Secretary Kathleen Sebelius said at a CDC media briefing today that the guidance was developed in close collaboration with the Department of Education. It seeks to balance the importance of school attendance with the safety and security of students, she said.

Isolating sick kids, relieving closure burdens
According to the updated guidance, students, faculty, and staff who have influenza-like illness (fever with a cough or sore throat) should stay home, except for seeking medical care, for at least 7 days, even if symptoms have already resolved. Those who appear ill at the beginning of or during the school day should be isolated and sent home.

The initial guidance, issued May 1, advised schools with confirmed or suspected cases to close for up to 14 days, depending on the scope and severity of illness.

The number of school closures as of today is relatively small, the Department of Education said today on its blog—726 of the nation's more than 100,000 schools. "Still, this has been a significant disruption for hundreds of thousands of students at those schools, their families, teachers and school leaders," the department said. "Following CDC’s guidance, those schools may reopen as soon as possible, and most of those students will be able to return to class."

"Hopefully, this will alleviate some of the burden on workers and parents," Sebelius said. However, she added that changing the school closure recommendations isn't an indication that health officials know what course the novel virus will take. "There are aggressive efforts underway to learn more," she said.

Some jurisdictions—including Minnesota and the Seattle—recently revised their school closure policies to reflect the new strain's apparent similarity to seasonal flu. And yesterday, Richard Besser, MD, acting CDC director, hinted at a media briefing that the CDC might change its recommendation.

The rationale for softening the school-closure guidance was that the previous policies weren't practical or effective because the virus is already circulating widely in the community and because many people with mild illnesses aren't seeing their doctors or being diagnosed with the new strain.

IDSA supports CDC response
The Infectious Diseases Society of America (IDSA) today praised the CDC's overall response to the swine flu epidemic, including its guidance on school closings, and defended the agency from criticism.

In a statement, IDSA President Anne Gershon, MD, said, "We are hearing some Monday-morning quarterbacking about whether it was right to raise alarms, close schools, and gear into pandemic mode. But the Infectious Diseases Society of America thinks the . . . CDC has been correct in ramping up the nation’s response—and it's equally appropriate that CDC is re-evaluating some of the guidance as we learn more about the current behavior of this novel virus."

Noting that influenza is unpredictable, she continued, "When you are facing a possible pandemic, you cannot set the course from day one—you have to revise and reassess your strategy at every turn, just as CDC has done. Given the notorious history of influenza, the initial response has to be appropriate for what could be a worst case."

Gershon said the CDC has been consulting appropriately with clinicians and local public health officials, checking supplies of drugs and masks, and evaluating possible disruptions from closing schools and canceling events. "Officials are appropriately weighing the benefits and costs," she asserted.

"Revisions in recommendations are an indication that aswe learn more about the behavior of the virus and its evolutionary changes, we are successfully coping with it," she added. "Changes in our approach are unavoidable, necessary, and should be expected when we use science to drive our response."

See also:

May 5 HHS press release

May 4 CIDRAP News story "CDC, states weigh usefulness of school closures"

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