CDC advises against closing schools during H1N1 outbreaks

Aug 7, 2009 (CIDRAP News) – Federal officials recommended today that schools should not close down during novel H1N1 influenza outbreaks, though they emphasized that the advice is a guideline and that decisions should be made based on local conditions.

The guidelines, composed by the Centers for Disease Control and Prevention (CDC) and released at a press briefing by the Department of Health and Human Services, build on revised guidance that the CDC issued in May. Early in the pandemic's spring wave, schools were told to close for up to 2 weeks, but the CDC changed its advice shortly afterward to say that schools should focus on keeping sick students and staff out of school.

The new advice is being issued because "once you close a school, as we saw last spring, that creates a very significant ripple effect" on parents and businesses, Janet Napolitano, secretary of the Department of Homeland Security, said during the briefing.

However, the officials said, some schools will be justified in closing if they have a high rate of infection or large numbers of students with the underlying conditions that make the virus more dangerous. "We hope no schools will have to close, but realistically, some schools will close this fall," Department of Education Secretary Arne Duncan said.

The advice affects the approximately 55 million students and 7 million staff who work in the more than 130,000 public and private K-12 schools in the United States. Separate advisories for colleges and universities, and for pre-kindergarten and early-childhood programs, are expected to be issued in the next few weeks.

More than 700 schools closed when H1N1 flu first struck in April and May. About 50 were in New York City, where the local outbreak was at least 800,000 cases. As New York City health commissioner, Dr. Thomas Frieden oversaw those closings. But today, speaking as new director of the CDC, he said that additional information about the behavior of the novel virus has made school closings a choice rather than a necessity.

"We know from the spring that where there was H1N1 there were very large explosive outbreaks in schools," Frieden said in the briefing. "[But] we know more now about how it behaves; we know more about how to control it. It is now clear that closure of schools is rarely if ever indicated."

Schools can reasonably consider closing if they have large numbers of students who are medically frail or pregnant, or are in an area where the local outbreak is especially intense, or if the virus begins to cause more severe illness, he said. Otherwise, schools will need to rely on parents to keep children at home if they are feverish. But he cautioned that some of the spring closings in New York City were driven by children showing up to school with fever because their parents did not or could not keep them at home.

Because closings may yet happen, school should prepare by getting temporary home-schooling plans ready, Duncan warned.

Along with the advice on closings, which were published today on the CDC's H1N1 flu Web page, the guidelines include new advice on when to allow ill students and staff to return to school: when 24 hours have passed with no fever, whether or not the person is taking antiviral drugs. Previously, federal guidance required flu patients to stay home for 7 days.

The guidelines also advise:

  • Sending ill students and staff home, and holding them in rooms separate from the main student body until they can leave
  • Emphasizing hand-washing and covering coughs with tissues or shirt-sleeves
  • Regularly cleaning surfaces in schools with regular cleansers (bleach is not advised)
  • Making sure that students and staff with high-risk conditions see healthcare professionals as soon as possible after they show symptoms

If the fall flu wave involves more severe disease than what was seen in the spring, the guidelines also call for (among other steps):

  • Conducting active screening for fever and other symptoms as students and staff enter school each morning
  • Asking students and staff with underlying conditions to stay home when flu is circulating locally
  • Asking students and staff with ill family members to stay home for 5 days after the first household member falls ill

See also:

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
http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm

Technical Report for State and Local Public Health Officials and School Administrators on CDC Guidance for School (K-12) Responses to Influenza during the 2009-2010 School Year
http://www.cdc.gov/h1n1flu/schools/technicalreport.htm

May 5 CIDRAP News story
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/may0509schools-br.html

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