CDC issues advice for battling flu in child care settings

Sep 4, 2009 (CIDRAP News) – Federal health officials provided updated guidelines today for responding to novel H1N1 and seasonal influenza in child care settings, recommending that providers conduct daily health checks on all children and staff, among other steps.

The recommendations from the Centers for Disease Control and Prevention (CDC) generally match guidance issued a month ago for K-12 schools, emphasizing vaccination, keeping children and staff home when sick, separating sick children and staff from others, promoting hand hygiene and respiratory etiquette, and encouraging early antiviral treatment for children and staff at high risk for complications.

The guidelines do not put much emphasis on closures as a prevention tool but suggest that child care centers consider temporary closures if local flu transmission is high.

"Children less than 5 years old are at high risk for complications from the flu," said US Health and Human Services (HHS) Secretary Kathleen Sebelius in releasing the guidance at a press conference this morning. "We know that this [novel H1N1] is a young person's flu. Tragically, children do die, whether it is H1N1 or seasonal. Children spread infection quickly."

The guidelines were written for all programs for preschool children, including home-based and other day care centers and Head Start programs. The nation has about 360,000 child care programs, Education Secretary Arne Duncan said at the press conference.

The CDC guidance document notes that controlling infections in child care programs poses tough challenges because of the vulnerable population, close contact, shared toys, and children's limited ability to understand and practice good hand respiratory hygiene. Completely preventing flu transmission in such settings is impossible, the agency says.

The agency offered two sets of recommendations today—one based on the assumption that flu severity this fall and winter will be similar to what has been seen in the past several months, and another to use if a more severe season occurs.

For the first set of recommendations, vaccination for both seasonal and novel H1N1 flu leads the list of measures the CDC recommends for child care programs.

"Vaccination is our best barrier against a new virus strain and against the seasonal flu," said Sebelius. She advocated "getting parents ready to agree to have their children vaccinated" and making sure that child care workers, particularly those who work with infants, get vaccinated.

The CDC document notes that infants less than 6 months old are vulnerable because they can't receive flu immunizations, and therefore those who care for them are a priority group for vaccination. Other primary groups targeted for vaccination are pregnant women, healthcare and emergency medical services (EMS) personnel, people aged 6 months to 24 years, and nonelderly adults with chronic medical conditions. (If vaccine supplies don't meet the demand, the target groups will be narrower, as adults with medical conditions will be excluded and the children-and-youth category will include only (1) children aged 6 months through 4 years and (2) those 5 through 18 years with risk factors for flu complications. Also, only those health and EMS workers who have direct contact with patients will be included.)

"All children and many staff will fall within these groups and should be among the first to receive the 2009 H1N1 flu vaccine," the guidance states. In response to a question, Sebelius said today that child care staff members who are healthy and work with children older than 6 months are not targeted for vaccination.

The CDC further recommends that children and caregivers should stay home if they have the flu. That means staying home until they are free of fever for 24 hours without the help of fever-reducing drugs. Sebelius said child care providers should plan for ways to cover for absent staff members and parents should figure out who can stay with their child if he or she must stay home.

This past spring, most H1N1 flu patients who were not hospitalized had a fever for 2 to 4 days, which would mean staying home for 3 to 5 days in most cases, the CDC says. But child care programs, parents, or local health officials may chose to require longer periods.

A third measure is for child care programs to conduct daily health checks, with fever as a key symptom to look for. "Providers should do a daily health check, look at children, talking with them, talking with their guardians and looking for signs of illness, so children with signs of illness can be separated from well people as soon as possible," Beth Bell, associate director of science in the CDC's National Center for Immunization and Respiratory Diseases, said at the press conference.

Sick children and staff should be further screened by taking their temperature, the guidance states. It offers a link for more information on how to conduct health checks.

Here are other steps the CDC recommends for child care programs:

  • Separate sick children and staff from others until they can be sent home. Staff members who get sick at work should wear a surgical mask when near other persons if possible.
  • Encourage hand hygiene and respiratory etiquette for both the well and the sick. Sebelius suggested that providers show children the HHS video featuring the "Sesame Street" character Elmo demonstrating respiratory etiquette.
  • Keep environmental surfaces clean, especially toys and plays areas. But the CDC does not think additional disinfection beyond routine cleaning is needed.
  • Encourage early antiviral treatment for children and staff at high risk for flu complications.
  • Consider selective child care program closures. "The decision to selectively close should be made locally in partnership with pubic health officials and should balance the risks of keeping children in early childhood programs with the social and economic disruption that can result from closing these programs."

The CDC calls for considering a number of further measures if assessments show that the H1N1 virus is causing more severe disease than it has so far:

  • Permit high-risk staff to stay home.
  • Look for ways to increase social distance between children, such as separating them into small groups.
  • Encourage children with sick household members to stay home.
  • Extend the time that sick people stay home.

The 6-page CDC guidance is accompanied by a longer technical report that explains the recommended strategies further and offers information on how to use them.

See also:

CDC Guidance on Helping Child Care and Early Childhood Programs Respond to Influenza during the 2009-2010 Influenza Season

Aug 7 CIDRAP News story on guidelines for K-12 schools

Newsletter Sign-up

Get CIDRAP news and other free newsletters.

Sign up now»


Unrestricted financial support provided by

Bentson Foundation 3MAccelerate DiagnosticsGilead 
Grant support for ASP provided by

  Become an underwriter»