Officials update guidelines for handling flu-like illness in child care settings and pre-school programs - September 21, 2009
More protective measures recommended for children under five years of age
The Minnesota Department of Health (MDH) has issued updated recommendations for handling influenza-like illness in child care settings and early childhood education programs that serve children under the age of five.
A major provision of the recommendations involves the amount of time a child should be kept home with possible symptoms of influenza. MDH is recommending that parents keep children under five at home until seven days after the symptoms first appeared or 24 hours after a child's symptoms go away, whichever is longer.
The updated recommendations call for keeping young children out of child care longer than school-age children who develop symptoms of influenza are kept out of school. If they feel well enough, school-age children may return to school 24 hours after their fever has resolved without the use of fever-reducing medicines like acetaminophen or ibuprofen.
The stricter child care recommendations also apply to facilities where children under five and older children are both present, unless the two groups – as well as staff who interact with them – can be kept separate.
MDH is taking a more protective approach than is currently called for in federal guidance for young children, primarily because they are at higher risk of severe illness from the novel H1N1 virus. In Minnesota, children under five have been hospitalized with novel H1N1 at twice the rate of children aged five to 12 years.
"Observing precautions for preventing the spread of influenza is often not very feasible for young children," said Dr. Ruth Lynfield, Minnesota State Epidemiologist. "For a young child, it can be difficult to control a runny nose and to cover their nose and mouth when coughing or sneezing. In addition, young children tend to put shared toys and other items in their mouths. Frequent handwashing is also a challenge. For these reasons, influenza and other infectious diseases are easier to spread among young children."
"We believe extra precautions are justified to protect the health of children in this very vulnerable age group," Lynfield said.
The new guidelines, which are part of the agency's ongoing effort to control the spread of novel H1N1, come at a time when influenza activity is increasing statewide.
Minnesota is now reporting "widespread" influenza activity – the highest classification under the system used by the U.S. Centers for Disease Control and Prevention (CDC).
In addition to the more stringent recommendation about how long to keep preschoolers home, MDH is also recommending that facilities or programs serving preschool age children take the following actions:
- Strongly encourage staff to get vaccinated against both novel H1N1 and regular, "seasonal" influenza as soon as vaccine is available. Shipments of this year's seasonal vaccine have already been arriving in the state. The first shipments of novel H1N1 vaccine are expected in early to mid-October.
- Strongly encourage parents to have their child vaccinated against both kinds of influenza as soon as vaccine is available. Children under six months of age can't be vaccinated, but older children should be vaccinated against both kinds of flu.
- Encourage parents to talk with their health care provider, and identify the steps they will take if their child develops – or is exposed to – influenza-like illness.
- Notify parents and staff if either children or staff in child care or other early childhood programs become ill with symptoms of influenza.
- Clean all areas of your facility regularly, with an emphasis on objects or surfaces that are likely to be in contact the hands, mouths, or bodily fluids of children.
Parents should also determine how they will handle caring for their child if their child has to stay home with an influenza-like illness, said Kathryn Como-Sabetti, Senior Epidemiologist at MDH.
Public health officials are also emphasizing the importance of simple, "low-tech" prevention measures in protecting yourself against the flu.
"We're not expecting to have the novel H1N1 vaccine available until early to mid-October," Como-Sabetti said. "That's another reason to keep stressing those simple personal protection measures that we've been telling people about since April."
In addition to covering your coughs and sneezes with a sleeve or a tissue, and frequent handwashing, health officials are urging ill people to stay at home. Flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. In some cases, symptoms of novel H1N1 can also include vomiting and diarrhea in addition to respiratory symptoms.
In most cases, people can recover at home without the need for visiting a health care provider. Individuals who are at high risk of severe illness or complications from influenza should talk to their doctor and plan for what to do if they are exposed to influenza or develop influenza symptoms. Those who may be at risk include children under five years of age – especially if they're under the age of two years; people 65 years of age or older; pregnant women; and people with underlying medical conditions.
Antiviral medications are frequently used to treat high-risk patients, but they need to be given promptly to be most effective. People who do develop severe symptoms from influenza should seek medical care promptly. It is also important to ensure that sick people have enough fluids to drink. Aspirin or medications containing aspirin should not be given to anyone 18 and under with influenza- like symptoms.
For more information about novel H1N1 flu, go to www.mdhflu.com.
-MDH-
H1N1 Federal Guidance for Schools—September 14, 2009
The federal government released its most recent Novel H1N1 flu guidance for the nation’s schools.
Developing a clear set of recommendations for schools, in dealing with the threat of novel H1N1 flu, is a high priority right now.
The Minnesota Department of Health (MDH) will be reviewing the new federal guidelines to see how they fit with the planning we have already been doing at the state level. They will be adapting and revising them as necessary to meet our unique needs and circumstances here in Minnesota.
Over the next few weeks, MDH and the Minnesota Department of Education (MDE) will continue to consult with schools regarding Minnesota’s guidance for schools. For example, there will be an opportunity to discuss H1N1 guidance and planning at next week’s superintendent’s conference.
Additionally, we need to be prepared on a number of fronts for a possible “second wave” of novel H1N1 – and the possibility that the virus will cause a much more severe form of the illness the second time around.
One of our highest priorities right now is individual preparedness for a second round of novel H1N1 flu – and the steps people can take to protect themselves and others. Those steps are simple, but can’t be repeated often enough:
- Wash your hands, thoroughly and frequently. Use soap and water or an alcohol-based scrub.
- Cover your face with a sleeve or a tissue when you cough or sneeze.
- If you’re sick, stay home from work, school, or other places where you may expose others to the virus.
Source: Minnesota Department of Education
Minnesota Department of Health Monitoring Swine Influenza and Identifies Prevention Measures—August 19, 2009
State health officials continue to monitor the situation closely and have increased disease surveillance. Please refer to the following Department of Health webpage to receive more information specific to Minnesota: http://www.health.state.mn.us/divs/idepc/diseases/flu/swine/index.htm
H1N1 Novel Influenza Epidemiology and Surveillance Update—August 12, 2009
PowerPoint Presentation--please click here
Minnesota Department of Education News and Information—May 7, 2009
H1N1 Novel Influenza Virus Update
To date, the Minnesota Department of Health has identified 16 probable and two confirmed cases of the H1N1 novel influenza in Minnesota. All of the cases so far have been mild. More severe cases will likely appear as MDH focuses its testing on hospitalized cases.
Four of the new probable cases are connected with Emerson Spanish Immersion School in Minneapolis. This brings to five the number of cases connected with the school, which remains open. The first case was identified Sunday by MDH. School officials have communicated with all staff and parents of students at the school.
MDH officials are contacting school superintendents when new cases are identified in schools. School officials are then communicating directly with staff and parents. MDH is also implementing a tracking system to monitor absenteeism in schools. Because the H1N1 virus appears to be behaving like seasonal influenza at this time, MDH officials expect to see more cases of the virus in schools, businesses and communities across the state.
MDH officials encourage people in high-risk groups to avoid contact with people who are ill, and to contact their physicians if they begin experiencing flu-like symptoms, including fever, cough, sore throat, stuffy nose, and, in some cases, diarrhea and vomiting.
High-risk groups include:
- Children under five
- Persons 65 and older
- Pregnant women
- Adults and children who have chronic pulmonary disorders (including asthma), cardiovascular problems (except hypertension), and renal, hepatic, hematological, or metabolic disorders (including diabetes mellitus)
- Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV)
- Adults and children who have any condition that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders)
- Residents of nursing homes and other chronic-care facilities.
MDH officials are also reminding people that they have a role in controlling the spread of infections like influenza. Stay home if you’re sick, cover your cough, wash your hands frequently and limit your contact with people who you think might be sick.
MDH will continue to provide daily updates on H1N1 novel influenza in Minnesota at http://www.health.state.mn.us/divs/idepc/diseases/flu/h1n1/index.html.
Visit us on the web at http://education.state.mn.us.
Inquiries can be directed to mde.webmaster@state.mn.us.
Minnesota Department of Education News and Information—May 6, 2009
H1N1 Novel Influenza Update
Subject: Updated Guidance from Minnesota Department of Health for Minnesota Schools (K-12) in Response to H1N1 Novel Influenza (formerly swine flu) Infections
The Minnesota Department of Health (MDH) has been working closely with federal, state and local partners to investigate and characterize the outbreak of H1N1 novel influenza. MDH has worked with schools and the Minnesota Department of Education (MDE) regarding the response to an identified probable or confirmed case of H1N1 novel influenza in a school. Previously, because of very limited knowledge of the severity and transmission of this novel strain, and out of an abundance of caution, we believed it was prudent to close affected schools while we learned more about the characteristics of this new disease. We greatly appreciate the collaboration of parents, students and school officials during this early stage of the outbreak.
Over the past week, much has been learned about the cases of H1N1 novel influenza. This virus currently appears to be acting like seasonal influenza in terms of the severity of illness and transmission of infection. We recognize that cases that have no relationship to travel or to other identified cases are occurring in communities, and that it is not possible to identify every case of novel influenza because the symptoms are similar to those of other acute respiratory infections. We also know that we have other acute viral respiratory infections circulating in Minnesota. Therefore we recommend an approach that will focus on keeping all students and staff with symptoms of influenza out of school in order to decrease transmission of infections to others. This will provide an approach for all schools to strengthen their measures to control the spread of infections whether or not a case is identified as H1N1 novel influenza. We will all need to continue to work together to control the spread of illness in our communities.
We recommend that all members of the school community – staff, parents and students take an active role in limiting the spread of infection. This will require increased vigilance among parents and caregivers, and school staff to identify students and staff with influenza-like illness, in particular looking for respiratory symptoms associated with fever.
We want you to vigilantly observe students and staff for illness characterized by having a fever (100◦ F or greater) and recent onset of at least one of the following: runny nose or nasal congestion, sore throat or cough.
Updated recommendations for school officials:
- School officials have several options, if a case has been identified in their school:
- Remain open with appropriate isolation of the individual, at home, and follow other recommendations noted in this memo to decrease the spread of any respiratory illness.
- Close school at their discretion, based on public health and community assessment.
- Close school for a number of days - for example, follow the CDC guidelines at: http://www.cdc.gov/h1n1flu/K12_dismissal.htm (please note these guidelines are subject to change).
As is our practice with seasonal influenza, schools may choose to close if large numbers of students or faculty become ill and school functioning is disrupted. We are available to provide specific guidance about school closure should a school encounter an increased number of absences due to influenza like illness. These recommendations are based on current information and we will continue to provide information about the H1N1 novel influenza outbreak. The current influenza outbreak appears to be acting like seasonal influenza.
Other recommendations for schools are as follows:
- Each morning, parents and caregivers should assess all family members and especially school-age children for influenza-like illness (defined above).
- School staff should assess themselves for influenza-like illness.
- Students or staff with influenza-like illness should stay home and not attend school for at least 7 days even if their symptoms resolve sooner. If after 7 days, the student or staff continues to have acute symptoms, he or she should stay home until 24 hours after these symptoms resolve.
- Schools should observe students and staff for influenza-like illness at school.
- Students and staff who are ill should be removed from the classroom and sent home.
- If a student or staff is ill with other symptoms, they should stay home at least one day to observe how the illness develops.
- Students and staff with influenza-like illness should stay home and not go into the community unless they need medical care. Ill students should not attend extracurricular activities, community activities or child care.
Recommendations for public health protection for all Minnesotans:
- Wash hands frequently and thoroughly with soap and water.
- Cover your nose and mouth with your sleeve when you cough or sneeze.
- Limit your contact with others who may be ill.
- Stay home from school or work if you are ill.
MDH is placing a priority on continuing to monitor disease severity. It is important to remember that even “routine” seasonal influenza can be a severe disease. Each year in the United States more than 200,000 people are hospitalized and about 36,000 people die from flu-related causes. Similarly we need to prepare for the possibility in this novel influenza outbreak of additional cases including severe cases and even deaths.
Reporting to MDH
At this time, we would like to closely monitor influenza-like illness activity in schools. MDH is developing enhanced school-based surveillance for influenza-like illness. We will provide schools with more detail shortly once we complete development.
Communications
MDH will continue to work closely with the Minnesota Department of Education (MDE) on issues that affect schools. MDH and MDE will continue to communicate with schools regularly about disease activity in the state and any changes in our recommendations. We will also inform you if cases are identified in your school and assist in making informed decisions for your community.
Preventing the spread of influenza requires all of us – schools, families, businesses, and government – to cooperate and work together. Thank for your work and your partnership.
For specific questions, please call MDH at 1-877-676-5414 or 651-201-5414.
Minnesota Department of Education News and Information—May 4, 2009
H1N1 Novel Influenza Update
The Minnesota Department of Health (MDH) is providing new guidance to schools about how to prevent the spread of the H1N1 virus in school settings. The new guidelines stress the importance of being alert for symptoms of the illness and responding promptly. School authorities are being advised that they can close schools at their discretion based on an assessment of their own situation. MDH is working with school systems in the state where closures have already taken place, in order to determine next steps for those schools.
MDH Guidance: http://education.state.mn.us/mdeprod/groups/Communications/documents/Announcement/013937.pdf
School officials can contact MDH at: 651-201-5414 or 1-877-676-5414.
MDH has also set up a toll-free public information number: 1-800-657-3903
Minnesota Department of Education News and Information—May 3, 2009
H1N1 Novel Influenza Update
The Minnesota Department of Education (MDE) is working closely with other government agencies, including the Minnesota Department of Health (MDH), in response to the H1N1 novel influenza virus. Further investigation by MDH has determined that two of Minnesota's cases of probable H1N1 novel influenza virus are in persons in two schools. As a result, school officials have decided to close the schools beginning Monday as a precaution. One of the individuals is in Orono High School, which is on a campus with two elementary schools and a middle school, all of which will close Monday. The other probable case is a person at Emerson Spanish Immersion School in Minneapolis. Schools will remain closed until confirmation testing is completed or additional guidance is available, which is expected early this week.
MDH is characterizing these cases as "probable," meaning that the MDH lab has identified the virus as type A influenza, but the strain cannot be confirmed as novel influenza using lab tests currently available to MDH. Additional testing by CDC is needed to determine if the individuals have the new strain of H1N1 influenza. (Read MDH's full news release)
MDH officials expect to see additional cases of the virus and are reminding people that they have a role in controlling the spread of infections like influenza. Stay home if you're sick, cover your cough, wash your hands frequently and limit your contact with people who you think might be sick. In addition, it is prudent for household members of people who have fever and respiratory symptoms to monitor their health and limit their contacts with others in the community.
School districts should keep in regular contact with local health officials and report to them if you have students or staff members with influenza-like symptoms who have been to Mexico or to parts of the U.S. with confirmed cases of H1N1 novel influenza, or students or staff members who have had contact with sick persons who had been to one of the areas. Any student or staff member who has influenza-like illness should be excluded from school until symptoms resolve.
Minnesota Department of Education News and Information—May 2, 2009
H1N1 Novel Influenza Update
As Governor Pawlenty has stated, we expected to have cases of the H1N1 virus in Minnesota and we have plans and preparations in place to respond appropriately and aggressively. This is certainly cause for concern, but not panic.
The Minnesota Department of Health (MDH) today announced that it is sending a lab sample from another individual to the U.S. Centers for Disease Control and Prevention (CDC) to be tested for the H1N1 novel influenza virus. This case does not involve a school.
The Minnesota Department of Education (MDE) is working closely with other government agencies, including the Minnesota Department of Health (MDH), in response to the H1N1 novel influenza virus.
Minnesotans have a role in controlling the spread of infections like influenza. Stay home if you’re sick, cover your cough, wash your hands frequently and limit your contact with people who you think might be sick.
School districts should keep in regular contact with local health officials and report to them if you have students with influenza-like symptoms who have been to Mexico or to parts of the U.S. with confirmed cases of H1N1 novel influenza, or students who have had contact with sick persons who had been to one of the areas. Any student who has influenza-like illness should be excluded from school until symptoms resolve.
School officials can contact MDH at: 651-201-5414 or 1-877-676-5414.
MDH has also set up a toll-free public information number: 1-800-657-3903.
MDH H1N1 General Information
http://www.health.state.mn.us/divs/idepc/diseases/flu/swine/index.html
MDH H1N1 Information for Schools
http://www.health.state.mn.us/divs/idepc/diseases/flu/swine/schools.html
MDH FAQ for Schools
http://www.health.state.mn.us/divs/idepc/diseases/flu/swine/schoolfaq.html
CDC H1N1 Page
http://www.cdc.gov/h1n1flu/
CDC H1N1 Guidelines for Schools
http://www.cdc.gov/h1n1flu/K12_dismissal.htm