Academic institutions receive updated H1N1 guidance for fall

Aug 20, 2009 (CIDRAP News) – Federal education and health officials today unveiled updated guidance to help colleges, universities, and other institutions prepare for the return of the novel H1N1 influenza virus to campuses this fall, where school administrators may face difficult challenges.

Young people up through age 24 have been among the hardest hit by the virus, which recently led the US Centers for Disease Control and Prevention's (CDC's) vaccine advisory group to include them among the first groups to receive the pandemic H1N1 flu vaccine. At the group's Jul 29 meeting, some members raised concern about virus circulation in crowded dormitory and apartment settings and the risk of students transmitting the virus to the wider community through off-campus jobs.

Pandemic planners at many of the nation's colleges have spent the past several years putting together detailed plans that center around a severe event that would send students home, but many are now struggling with how to handle a more moderate scenario where sick students are more likely to stay on campus.

The updated guidance was released today during a press teleconference hosted by the secretaries of the US Department of Education and the US Department of Health and Human Services (HHS). It appears on the government's pandemic flu Web site and includes a communication toolkit and technical report.

Education secretary Arne Duncan told reporters that the guidance includes commonsense actions, including having students clean their own frequently used items such as computer keyboards, asking students to stay home when they're sick, and removing barriers to faculty and staff staying home when sick.

Kathleen Sebelius, HHS secretary, said college students—known for not seeing their doctors regularly—should be encouraged to take care of themselves and to receive the novel H1N1 vaccine when it becomes available. She urged colleges to make use of social networking tools such as Twitter and Facebook to communicate flu news and prevention steps to their students.

Dr. Beth Bell, deputy director of the CDC's National Center for Immunization and Respiratory Diseases, said the guidance includes several suggestions for isolating sick students, such as having those who live relatively close to school return home to recover so that roommates are not exposed to the virus. The guidelines also suggest that sick students enlist roommates or friends to help take care of them by bringing meals and medications.

She advised university administrators to act now to review and revise their pandemic response plans as needed. Each school's situation will be different, based on resources, housing situation, student population, and circulation of the virus in the local area. Though some schools might consider setting up temporary housing for sick students, the strategy might be not be manageable for other schools.

If the pandemic becomes more severe, the guidance recommends permitting high-risk students, faculty, and staff to stay home when the virus is circulating in the community. It also suggests increasing the self-isolation period for sick people to at least 7 days after the onset of symptoms. Those sick longer than 7 days should stay home 24 hours after symptoms resolve.

Suspending classes may be needed if absences impair the school's normal functioning, the guidance states. The CDC said it might recommend preemptive class suspension if the virus starts causing severe illnesses in the college-aged population.

Dr. Anita Barkin, director of student health services at Carnegie Mellon University in Pittsburgh, listened to today's teleconference and praised the guidance, saying it reflects the CDC's close involvement of colleges in its H1N1 pandemic response. "This is a wise approach, given that we don't have a vaccine yet," she told CIDRAP News. Barkin also chairs the American College Health Association's (ACHA's) Emerging Public Health Threats and Emergency Response Coalition, which is producing a white paper on pandemic H1N1 response for higher education institutions.

The CDC guidance suggests a host of options and leaves room for schools to implement what works best for their location. "Schools are going to have to do some creative thinking," Barkin said.

She acknowledged that many schools have planned for a 1918-like pandemic scenario and have focused on what would trigger sending students home so that campuses aren't put in a position to care for large numbers of gravely ill patients. The fact that the H1N1 cases now circulating are generally of moderate severity makes evacuations less likely, leading school administrators to revisit their thinking, she added.

"We have not faced this type of disease in the absence of a vaccine on a college campus since 1968—we're out of practice," Barkin said.

How to isolate sick students in a congregate setting is "an incredible educational challenge," she noted. At many schools, residence halls are filled to capacity, with no flexibility to offer sick rooms for students with the flu.

Some schools are already thinking of ways to support student self-isolation, she said. For example, some university dining halls are developing menus of meals that can be packaged and delivered to sick students. In many ways, schools are relieved that the H1N1 virus seems to be mild, because many pandemic plans included provisions for food stockpiling in anticipation of large numbers of stranded students and shaky supply chains.

College students are always a challenge to reach with seasonal vaccine messages, and this year colleges and universities will be rolling out their seasonal flu vaccine campaigns early, in advance of the pandemic H1N1 campaign expected later this fall, Barkin said.

However, if the virus severity ramps up in the fall, she predicts students will be eager to receive the vaccine. "Students are very driven to complete their academic responsibilities. If there are illnesses, they'll miss classes," she said. "They may be more likely not to want to interrupt their classes."

Barkin said the ACHA's pandemic white paper is due out early this fall and will discuss the rationale behind many of the actions spelled out in today's CDC guidelines.

See also:

Aug 20 CDC flu guidance for higher education institutions

Flu communication toolkit for higher education institutions

Higher education institution flu guidance technical report

American College Health Association Web site

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