Questions and Answers about CDC Guidance for State and Local Public Health Responses to Influenza during the 2009-2010 School Year
Q. How does CDC’s new flu guidance for schools differ from the previous school
The new guidance applies to any flu virus circulating during the 2009-2010 school year, not only 2009 H1N1 flu. The new guidance recognizes the need to balance the risks of illness among students and staff with the benefits of keeping students in school. It offers specific steps for school staff, parents, and students to take given the current flu conditions as well as for more severe flu conditions. The new guidance also provides information for making decisions at the community level about when to use these strategies aimed at schools.
In addition, this guidance recommends that, based on current flu conditions, students and staff with flu-like illness stay home until at least 24 hours after they no longer have a fever or signs of a fever. This should be determined without the use of fever-reducing medications (any medicine that contains ibuprofen or acetaminophen). This is a shorter time period from the previous guidance which recommended that sick students and staff stay home 7 days after symptoms begin. The 7 day period away from school for sick students and staff would still be recommended under more severe flu conditions. In addition, this longer period should be used in healthcare settings and in any place where a high number of high-risk people may be exposed, such as childcare facilities for children younger than 5 years of age.
Q. Why should we be concerned about the spread of flu in schools?
Students can get sick with flu and schools may act as a point of spread, where students can easily spread flu to other students and their families. So far, with 2009 H1N1 flu, the largest number of cases has been in people between the ages of 5 and 24-years-old.
Q. Which students and staff are at higher risk for complications from flu?
Anyone can get the flu (even healthy people), and serious problems from the flu can happen at any age. However, children under the age of 5 years, pregnant women, people of any age with chronic medical conditions (such as pulmonary disease, including asthma, diabetes, neuromuscular disorders or heart disease), and people age 65 years and older are more likely to get complications from the flu.
Q. How will schools and communities decide what steps to take?
? CDC and other public health agencies will be monitoring national data on the
number of people who seek care for flu-like illness, as well as the number of
hospitalizations and deaths. CDC will also look at the geographic spread of flu-
like illness and will look for changes in the characteristics of the virus. By
comparing data on a weekly basis with seasonal flu trends and trends from the
2009 H1N1 flu during the spring, CDC will be able to provide advice to state and
local agencies on appropriate steps to take. States and local communities can
expect the impact of flu in their communities to be different from that seen in
other parts of the country
Q. What can families, students, and school personnel do to keep from getting
sick and spreading flu?
Families, students, and school staff can keep from getting sick with flu in three ways:
? Practicing good hand hygiene. Students and staff members should wash their
hands often with soap and water, especially after coughing or sneezing. Alcohol-
based hand cleaners are also effective.
? Practicing respiratory etiquette. The main way that the flu spreads is from person
to person in the droplets produced by coughs and sneezes, so it’s important to
cover your mouth and nose with a tissue when you cough or sneeze. If you don’t
have a tissue, cough or sneeze into your elbow or shoulder, not into your hands.
? Staying home if you’re sick. Keeping sick students at home means that they keep
their viruses to themselves rather than sharing them with others.
Students, staff, and their families must take personal responsibility for helping to slow
the spread of the virus by practicing these steps to keep from getting sick with flu and
protecting others from getting the flu.
Q. What is the best way to practice good hand hygiene?
? Washing your hands with soap and water for at least 20 seconds (the time it
takes to sing “Happy Birthday” twice) is the best way to keep your hands from
spreading the virus.
? Alcohol-based hand cleaners containing at least 60% alcohol are also effective.
? If soap and water are not available and alcohol-based products are not allowed in
the school, other hand sanitizers that do not contain alcohol may be useful for
cleaning hands. However, they may not be as effective as alcohol-based
Q. What steps can schools take to keep students and staff from getting sick?
Schools should take the following steps to help keep students and staff from getting sick ? Encourage respiratory etiquette by providing staff and students with flu. These steps should be followed ALL the time, and not only during a flu o education and reminders about covering coughs and sneezes, and pandemic. easy access to tissues and running water and soap or alcohol-based hand
? Remind staff and students to practice good hand hygiene and provide the time
and supplies for students and staff to wash their hands when needed.
? Send sick students and staff home. Advise students, staff, and families that sick
people should stay at home until at least 24 hours after they no longer have a
fever or signs of a fever. This should be determined without the use of fever-
reducing medicines (any medicine that contains ibuprofen or acetaminophen).
They should stay home until at least 24 hours after they no longer have a fever
even if they are using antiviral medicines. Schools should revise their policies
and incentives to avoid unknowingly penalizing students who stay home when
they are sick (e.g., perfect attendance awards).
? Clean surfaces and items that are more likely to have frequent hand contact with
cleaning agents that are usually used in these areas. Additional disinfection
beyond routine cleaning is not recommended. Some states and localities have
laws about specific cleaning products used in schools. School officials should
contact their state health department and department of environmental protection
for additional guidance.
? Move students and staff who become sick at school to a separate room until they
can be sent home. Limit the number of staff who take care of the sick person and
provide a surgical mask for the sick person to wear if they can tolerate it.
? Have Personal Protective Equipment (PPE) such as masks available and ensure
it is worn by school nurses and other staff caring for sick people at school.
? Encourage sick students and staff at higher risk of complications from flu to get a
medical evaluation as soon as possible. Taking antiviral medicines early might
prevent severe complications from the flu, such as hospitalization or death.
Q. What should I do if I’m pregnant and I work or attend a K-12 school?
Pregnant women working in or attending schools should follow the same guidance as
the general public about staying home when sick, hand hygiene, respiratory etiquette,
and routine cleaning. Pregnant women are at higher risk of complications from flu and
should speak with their doctor as soon as possible if they develop a flu-like illness to
find out whether they should take antiviral flu medicines. Any person at high risk for flu
complications should do the same. Early treatment with antiviral flu medicines is
recommended for pregnant women who have the flu. Pregnant women and their doctors
should know that they are part of the first priority group to receive the 2009 H1N1 flu
Q. What are fever-reducing medications and when would I stop giving them to
Fever-reducing medications are medicines that contain acetaminophen (such as Tylenol)
or ibuprofen (such as Motrin). These medicines can be given to people who are sick
with flu to help bring their fever down and relieve their pain. Aspirin (acetylsalicylic acid)
should not be given to children or teenagers who have flu; this can cause a rare but
serious illness called Reye’s syndrome.
A sick student can return to school after 24 hours have passed with a normal
temperature (98.6 degrees Fahrenheit or 37 degrees Celsius) without the use of fever-
reducing medications. As the sick person begins to feel better you may decide to stop
giving fever-reducing medicines. Continue to monitor their temperature until the
temperature has been normal for 24 hours.
Q. Can the virus live on surfaces, such as computer keyboards?
? Yes, flu viruses may be spread when a person touches droplets left by coughs
and sneezes on hard surfaces (such as desks or door knobs) or objects (such as
keyboards or pens) and then touches his or her mouth or nose. However, it is not
necessary to disinfect these surfaces beyond routine cleaning.
? Clean surfaces and items that are more likely to have frequent hand contact with
cleaning agents that are usually used in these areas. Some states and localities
have laws about specific cleaning products used in schools. School officials
should contact their state health department and department of environmental
protection for additional guidance.
Q. How do I recognize a fever or signs of a fever?
A fever is a temperature taken with a thermometer that is equal to or greater than 100
degrees Fahrenheit (38 degrees Celsius). If you are not able to measure a temperature,
the sick person might have a fever if he or she
? feels warm,
? has a flushed appearance, or
? is sweating or shivering.
Q. How long should a sick student or staff member be kept home?
In the current flu conditions, students and staff with symptoms of flu should stay home
for at least 24 hours after they no longer have fever or do not feel feverish, without using
fever-reducing drugs. If the flu conditions become more severe, CDC recommends that
a sick person stay home for 7 days. A person who is still sick after 7 days should stay
home until 24 hours after the symptoms have gone away. In addition, this longer period
should be used in healthcare settings and in any place where a high number of high-risk
people may be exposed, such as childcare facilities for children less than 5 years of age.
Sick people should stay at home, except to go to the doctor’s office, and should avoid
contact with others. Keeping people with a fever at home may reduce the number of
people who get infected. Because high temperatures are linked with higher amounts of
virus, people with a fever may be more contagious.
Q. Should family members of sick students stay home too?
Not unless the flu conditions are determined to be more severe. If flu conditions are
more severe, school-aged children should also stay home for 5 days from the time
someone in their home became sick. It is possible that family members could already be
sick with flu and not be showing symptoms yet. The 5-day period provides enough time
to know if anyone else is sick with flu. Parents should continue to monitor their health
and the health of the sick child, as well as the health of their other children.
Q. What additional steps should schools and families take to keep students and
staff from getting sick in the event that the flu is more severe?
In addition to the steps that schools should be taking all the time, if flu conditions
? Extend the time sick students or staff stay home to at least 7 days, even if they become more severe, schools and families should consider adding the following steps.
feel better sooner. People who are still sick after 7 days should continue to stay
home until at least 24 hours after symptoms have gone away.
? Schools should allow high risk students and staff to stay home. These students
and staff should make this decision in consultation with their doctor.
? If a household member is sick, parents should keep any school-aged children
home for 5 days from the time the first person in the home became sick. Parents
should monitor the health of their other children for fever and other symptoms of
? Schools should find ways to increase social distances (the space between
people) at school if possible.
? Schools should work closely with their county and state public health officials to
decide how and when to dismiss students.
Q. What is a medically fragile child?
For this guidance, a medically fragile child is a child who needs intensive, life sustaining
medical assistance or therapy, and needs assistance with daily living (for example, a
child who uses an oxygen tank, has trouble moving, is fed through a tube, needs
suctioning, or is on a ventilator). Many of these children need skilled nursing care and
special medical equipment. These medically fragile children may have chronic lung
disease, severe cerebral palsy, muscular dystrophy, immunodeficiency, or problems
with their metabolism.
Q. How will the decision be made to dismiss schools?
The decision to dismiss students will be made at the community level. School officials ? the number and severity of cases in an outbreak (looking at national, regional, should work closely with their local and state public health and government officials to and local data), make sound decisions, based on local conditions. The decision should consider
? the risks of flu spread and benefits of dismissal,
? the problems that school dismissal can cause for families and communities, and
? different types of dismissal (selective, reactive, and preemptive).
CDC may recommend preemptive dismissals based on information that the outbreak is becoming more severe. An increase in flu spread without an impact on disease
outcomes will not lead to the use of preemptive dismissals in most cases.
Q. How will communities know if the flu is more severe and that they need to consider taking additional action steps?
CDC and other public health agencies will be monitoring national data on the number of people who seek care for flu-like illness, as well as the number of hospitalizations and deaths. CDC will also look at the geographic spread of flu-like illness and will look for changes in the virus. In addition, CDC will compare data on a weekly basis with seasonal flu trends from other years and with data collected during the spring 2009 outbreak. State and local health departments will also be on the lookout for increases in severe illness in their areas.
Q. How long will schools have to stay dismissed?
The length of time school should be dismissed will vary depending on how severe the flu is and how many people are sick. When the decision is made to dismiss students, CDC recommends doing so for 5-7 calendar days. Near the end of this period, communities should reassess the severity and impact of the flu, the benefits of keeping students home, and the consequences of doing so. Based on this reassessment, communities can decide whether to extend the school dismissal for another week or to reopen the school. However, if a flu outbreak is determined to be severe, a longer time period may be recommended.
Q. Why would one school dismiss students and another school continue to remain open?
School action steps should vary based on the severity of the pandemic and the impact it is having in the school. Decisions for school dismissal will be made at the community level, based on the number and severity of cases in the school and community. Because the impact of flu on a community will differ from location to location, the steps that are taken will also be different.
Also, certain schools may have a large number of students who are at high risk for
complications from the flu (such as a school for pregnant teens). These schools may
decide to close based on the local situation while other schools in the community
Q. What can a parent do to prepare for flu during the 2009-2010 school year?
? Plan for child care at home if your child gets sick or their school is dismissed (for
a minimum of 5 school days).
? Plan to monitor the health of the sick child and any other children by checking for
fever and other symptoms of flu.
? Update emergency contact lists.
? Identify a separate room in the house for care of sick family members. Consider
designating a single person as the main caregiver for anyone who gets sick.
? Pull together games, books, DVDs and other items to keep your family
entertained while at home.
? Talk to your school about their flu pandemic or emergency plan.
? Get your family vaccinated for seasonal flu and 2009 H1N1 flu when vaccines
Q. What can community- and faith-based organizations do to help families and
schools during a flu response?
Community-based and faith-based service organizations can help teach their members
about how to stay healthy. They also can offer support to families by providing meals,
transportation, and other services to make it easier to stay home if a family member is
sick or school is dismissed.
Q. How does CDC’s Guidance for School Response apply to my child at college?
This guidance only applies to K-12 schools. If you would like to learn more about what
to do if your child is in a college or university, please visit the Guidance for Institutions of
Higher Education: www.cdc.gov/h1n1flu/guidance/guidelines_colleges.htm. Continue to
monitor CDC’s website for information about flu. CDC will continue to update the
website and guidance recommendations as more is learned about the 2009 H1N1
influenza or flu conditions change.