Public health planning group develops resources to help schools respond to H1N1

Following the first wave of H1N1, the New Hampshire Department of Health and Human Services (NH DHHS) formed six planning groups to prepare for a second wave of the pandemic in fall 2009. These planning groups addressed essential target capabilities: surveillance and laboratory, clinical guidance, medical surge, continuity of operations, risk communication, and countermeasure administration.

The surveillance and laboratory planning group comprised infectious disease investigation, surveillance, and public health laboratory staff. Due to the expected significant impact of influenza-like illness (ILI) activity in the school-age population, one of the primary activities of the surveillance and laboratory planning group was to develop tools for school nurses to monitor ILI activity, coordinate reporting of school absenteeism, and respond to increases in ILI. The group quickly identified an audience of community and school-based partners, particularly school nurses, when developing strategies for a response to H1N1.

School nurses became, in effect, mini-epidemiologists, said Darlene Morse, RN, MEd, CHES, Public Health Nurse Program Manager of the Infectious Disease Investigation Section at NH DHHS. Initial planning involved creating documents that would allow the school nurses not only to identify illness in their own schools but also to help them develop plans to mitigate the spread of ILI in their schools and communities. As a result, the planning group developed what would later be called the School Nurse Toolbox and the Web-based School Absenteeism Reporting Tool.

The toolbox had several components, including: 1) an introductory cover letter; 2) guidelines about how to recognize and follow an outbreak of acute respiratory illness in the school setting; 3) NH DHHS recommendations for school nurses; 4) an absentee tracking form; 5) a respiratory illness line list form; 6) posters for promoting hand and cough hygiene; 7) H1N1 and seasonal influenza fact sheets; 8) a sample parent letter; and 9) the current New Hampshire reportable disease list. The toolbox was well received by nurses because it made pandemic response resources available in August 2009 before the start of the school year.

At the same time the toolbox was under development, the planning group worked with the New Hampshire Department of Information Technology and the New Hampshire Department of Education to develop and distribute a Web-based tool for voluntary daily reporting of general absenteeism and ILI-related absenteeism. The Web-based reporting tool was a new concept for schools in New Hampshire. After an initial implementation period, the schools used the tool to follow the percentage of students absent and the number of students out with ILI. Data were analyzed daily and maps of absenteeism in each School Administrative Unit were posted twice weekly on the NH DHHS website. The map allowed school systems to see their status as compared to other school systems in the state and allowed NH DHHS to identify and respond to suspected outbreaks.

As the school year progressed and the number of ILI cases steadily increased, the monitoring process was adapted and scaled to help the school nurses deal with increasing illness in the student population. At the height of the H1N1 response, 73% of New Hampshire public schools were reporting absenteeism via the Web-based reporting tool. Media inquiries and briefings throughout the pandemic response routinely included updates based on school ILI activity and absenteeism data.

The Web-based reporting tool was a challenge for some school systems because it required schools to specifically identify why a student was absent from school. Reporting occurred either via secretarial staff taking messages from parents, staff directing parents to the school nurse, or parents leaving messages on an answering machine. Schools found that educating parents on messaging played a key role in successfully mitigating the spread of illness in the school and community settings, Morse said. NH DHHS public health staff maintained their availability to schools as subject matter experts throughout the pandemic response.

The School Nurse Toolbox and the Web-based reporting tool continue to be used post-pandemic during the 2010-2011 influenza season. NH DHHS recognizes that these resources will continue to assist school nurses and their respective communities by enhancing local preparedness and response capacity, Morse said.

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