By Roy Myers,2014-01-16 05:10
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    CDC recently estimated;估计; that more than one million cases of novel;新型; H1N1 flu have occurred

    ;take placein the United States and that the heightened (tensed) level of flu activitymostly novel

    H1N1being seen this summer in the U.S. is unusual. How worried is the U.S. government about the

    (react)? spread of this virus and what are you doing to respond

    The flu is a serious illness and the novel H1N1 virus is a serious flu virus. We know that it spreads among people

    easily and is affecting younger people disproportionately(不成比例地). We also know that a number of people,

    many with underlying;not obvious; not easy to discover or reveal conditions, have died from this virus. We are

    taking it very seriously and the President and the Administration (行政部门) are actively engaged in;be busy in

    combating (stop sth from happening) the spread of H1N1 and are developing a national action plan that build on

    the efforts and lessons learned from this spring’s initial(beginning) onset to prepare for the possibility of a serious fall flu season.

    We are closely monitoring (监控) the spread of the disease across this country and watching what is happening in

    the Southern Hemisphere where the flu season has already begun. Our concern is what will happen this fall when we head into flu season in this country and we are monitoring the novel H1N1 virus to see how it evolves;演变?

    变异; and whether it is expected to produce more severe;严重的; disease. So far the disease has been moderate

    ;not severebut Americans have died and many have fallen ill.

    As we prepare for the fall flu season, we will be working closely with our partners in the medical community to develop, test, produce, distribute(分发), and administer;管理; an H1N1 flu vaccine;疫苗; and to distribute

    and dispense;发放; antiviral;抗病毒; medications for those who may require treatment;治疗; for the H1N1


    We have been working with partners in the pharmaceutical;医药的; industry continually;not stopping since

    the virus first emerged (appeared) to develop a vaccine and are making good progress. We have placed initial

    orders with vaccine manufacturers and clinical trials(临床试验) of the new vaccines will begin later this summer. Working with Congress, governors, mayors, state and local health departments, the medical community and our

    private sector;部门; partners, the administration has been actively preparing for all possible H1N1 virus

    outbreak scenarios;事态?局势; that may develop over the next few months and will prepare action plans based on the best scientific information available to help our nation respond aggressively;积极地; to H1N1.

    What is H1N1 (swine) flu?

    H1N1 (referred to as “swine;猪; flu” early on) is a new influenza virus causing illness in people. This new virus

    was first detected in people in the United States in April 2009. Other countries, including Mexico and Canada,

    have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much

    the same way that regular;通常; seasonal influenza viruses spread.

    Why is this new H1N1 virus sometimes called “swine flu”?

    This virus was originally;最初; referred to as “swine flu” because laboratory testing showed that many of the genes;基因; in this new virus were very similar to influenza viruses that normally occur in pigs in North America. But further study has shown that this new virus is very different from what normally circulates;流传;


    in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and avian;鸟类; genes and human genes. Scientists call this a “quadruple;四种; reassortant;再归类;virus.


    How many H1N1 (swine) flu viruses are there?

    Like all influenza viruses, swine flu viruses change constantly;不断地;. Pigs can be infected by avian influenza

    and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species;物

    种; infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations;不同种; of swine flu viruses have

    emerged. At this time, there are four main influenza type A virus subtypes;亚型; that have been isolated;分离;

    in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

    How serious is H1N1 (swine) flu infection?

    Like seasonal flu, H1N1 (swine) flu in humans can vary in severity;严重性; from mild to severe. Between 2005

    until January 2009, 12 human cases of swine flu were detected;discovered in the U.S. with no deaths occurring.

    However, swine flu infection can be serious. In September 1988, a previously(先前) healthy 32-year-old pregnant

    ;怀孕的; woman in Wisconsin was hospitalized;住院; for pneumonia;肺炎; after being infected with swine

    flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

    How severe is illness associated with this new H1N1 virus?

    It’s not known at this time how severe this virus will be in the general population. CDC is studying the medical

    histories of people who have been infected with this virus to determine whether some people may be at greater

    risk;危险; from infection, serious illness or hospitalization from the virus. In seasonal flu, there are certain people that are at higher risk of serious flu-related complications;并发症;. This includes people 65 years and

    ld, pregnant women, and people of any age with chronic;慢性的; older, children younger than five years o

    medical conditions. It’s unknown at this time whether certain groups of people are at greater risk of serious flu-related complications from infection with this new virus. CDC also is conducting laboratory studies to see if

    certain people might have natural immunity;免疫力; to this virus, depending on their age.

    Is this H1N1 (swine) flu virus contagious?

    CDC has determined that this virus is contagious;有传染性的; and is spreading from human to human.

    However, at this time, it not known how easily the virus spreads between people.

    What are the signs and symptoms;症状; of H1N1 (swine) flu in people?

    The symptoms of H1N1 (swine) flu in people are similar to the symptoms of regular human flu and include fever, cough, sore;疼痛; throat, body aches, headache, chills;受寒; and fatigue;疲劳;. Some people have reported

    diarrhea;腹泻; and vomiting;呕吐; associated with H1N1 (swine) flu. In the past, severe illness (pneumonia

    and respiratory;呼吸道; failure and deaths have been reported with H1N1 (swine) flu infection in people. Like seasonal flu, H1N1 (swine) flu may cause a worsening of underlying chronic medical conditions.


In children emergency warning signs that need urgent medical attention include:

    ; Fast breathing or trouble breathing

    ; Bluish;青; or gray skin color

    ; Not drinking enough fluids;流体;

    ; Severe or persistent;持久的; vomiting

    ; Not waking up or not interacting

    ; Being so irritable;易怒的; that the child does not want to be held

    ; Flu-like symptoms improve but then return with fever and worse cough In adults, emergency warning signs that need urgent medical attention include:

    ; Difficulty breathing or shortness of breath

    ; Pain or pressure;压力; in the chest or abdomen;腹部;

    ; Sudden dizziness ;晕厥;

    ; Confusion ;意识混乱;

    ; Severe or persistent vomiting

    ; Flu-like symptoms improve but then return with fever and worse cough What is the difference between a vaccine and an antiviral?

    Vaccines are usually given to prevent infections. Influenza vaccines are made from either pieces of the killed

    influenza virus or weakened versions;版本?样本; of the live virus that will not lead to disease. When vaccinated,

    the body’s immune system makes antibodies which will fight off infection if exposure to the virus occurs.

    Antivirals are drugs that can treat people who have already been infected by a virus. They also can be used to

    prevent infection when given before or shortly after exposure and before illness occurs. A key difference

    between a vaccine and antiviral drug is that the antiviral drug will prevent infection only when administered within a certain time frame before or after exposure and is effective during the time that the drug is being taken

    while a vaccine can be given long before exposure to the virus and can provide protection over a long period of


    How do you catch H1N1 (swine) flu?

    Spread of H1N1 (swine) flu can occur in two ways:

    ; Through contact with infected pigs or environments contaminated;受污染的;with swine flu viruses.

    ; Through contact with a person with H1N1 (swine) flu. Human-to-human spread of H1N1 (swine) flu has

    been documented;纪录在案; also and is thought to occur in the same way as seasonal flu. Influenza is

    thought to spread mainly person-to-person through coughing or sneezing;打喷嚏; of infected people.

    How does this new H1N1 virus spread?

    Spread of this H1N1 virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are

    spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people

    may become infected by touching something with flu viruses on it and then touching their mouth or nose.


Are there medicines to treat H1N1 (swine) flu?

    Yes. CDC recommends;推荐; the use of oseltamivir (brand;品牌; name Tamiflu ?) or zanamivir (brand name

    Relenza ?) for the treatment and/or prevention of infection with these H1N1 (swine) influenza viruses. Antiviral drugs are prescription;处方; medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing;繁殖?复制; in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

    How long can an infected person spread H1N1 (swine) flu to others?

    People with H1N1 (swine) influenza virus infection should be considered potentially;潜在;contagious;会传染

    的; as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

    What can I do to protect myself from getting sick?

    There is no vaccine available right now to protect against H1N1 (swine) flu. There are everyday actions that can help prevent the spread of germs;细菌; that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

    ; Cover your nose and mouth with a tissue;纸巾; when you cough or sneeze. Throw the tissue in the trash

    ;垃圾;after you use it.

    ; Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based ;带酒

    精的; hand cleaners are also effective.

    ; Avoid touching your eyes, nose or mouth. Germs spread this way.

    ; Try to avoid close contact with sick people.

    ; If you get sick with influenza, CDC recommends that you stay home from work or school and limit;限

    制?减少; contact with others to keep from infecting them.

    How can someone with the flu infect someone else?

    Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are

    sick, as well as while you are sick.

    Can people catch H1N1 (swine) flu from eating pork?

    No. H1N1 (swine) influenza viruses are not transmitted;传播; by food. You can not get H1N1 (swine) influenza

    from eating pork;猪肉; or pork products. Eating properly;恰当地;handled and cooked pork and pork products

    is safe. Cooking pork to an internal temperature of 160?F kills the H1N1 (swine) flu virus as it does other bacteria;细菌; and viruses

    Do pigs carry this virus and can I catch this virus from a pig?


    At this time, there is no evidence;证据; that swine in the United States are infected with this new virus. However, there are flu viruses that commonly cause outbreaks of illness in pigs. Most of the time, these viruses do not infect people, but influenza viruses can spread back and forth between pigs and people.

    How long can influenza virus remain viable;可行的; on objects (such as books and doorknobs;门把手;)?

    Studies have shown that influenza virus can survive;存活; on environmental surfaces and can infect a person for

    up to 2-8 hours after being deposited;放置; on the surface;表面;.

    What surfaces are most likely to be sources of contamination?

    Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets;滴液; from a cough or sneeze of an infected person move through the air.

    Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

    Is there a risk from drinking water?

    Tap water that has been treated by conventional;传统的; disinfection ;消毒; processes;过程; does not

    likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations;处理规范;

    provide a high degree of protection from viruses. No research has been completed on the susceptibility;易感性;

    of the novel H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated;表明;that free chlorine;氯气; levels typically used in drinking water treatment are adequate to

    inactivate highly pathogenic;致病的; H5N1 avian influenza. It is likely that other influenza viruses such as

    novel H1N1 would also be similarly inactivated by chlorination;氯化;. To date;到今天;, there have been no

    documented human cases of influenza caused by exposure to influenza-contaminated drinking water. Can the new H1N1 flu virus be spread through water in swimming pools, spas;水疗中心;, water parks,

    interactive fountains;喷泉;, and other treated recreational;娱乐; water venues ;场地;?

    Influenza viruses infect the human upper respiratory tract ;上呼吸道;. There has never been a documented case

    of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant;消毒剂; levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of the H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (13 parts per million [ppm or

    mg/L] for pools and 25 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as novel H1N1 virus would also be similarly disinfected by chlorine. Can H1N1 influenza virus be spread at recreational water venues outside of the water?

    Yes, recreational water venues are no different than any other group setting. The spread of this novel H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

    What steps can I take to make sure that I prepare my food properly?


    USDA reminds consumers to practice safe food handling and preparation techniques for all meat and poultry. Eating properly handled and cooked meat and poultry products are safe. Information about safe food preparation and cooking is available at

    Are there other ways to prevent the spread of illness?

    All Americans share in the responsibility to plan for this fall’s flu season. Given the unique combination of regular seasonal flu , as well as the H1N1 virus, it’s important for every and take action to reduce the transmission of influenza. American families and businesses should prepare their own household and business plans and think through the steps they will need to take if a family member or a co-worker contracts the flu. We ask all Americans to visit our website at FLU.GOV to find information that will help them take the necessary steps to prepare for flu season and limit the spread of the flu virus. Here are some everyday actions that you and your family can take to stay healthy.

    ; Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact

    with others to keep from infecting them.

    ; Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after

    you use it.

    ; Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands

    cleaners are also effective.

    ; Avoid touching your eyes, nose or mouth. Germs spread that way.

    Follow the advice of your local public health department regarding school closures, avoiding crowds and other measures to reduce flu transmission. These measures will continue to be important after a novel H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections. What should I do to keep from getting the flu?

    First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

    What is the best way to keep from spreading the virus through coughing or sneezing?

    If you are sick, limit your contact with other people as much as possible. If you are sick, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.

    What is the best technique for washing my hands to avoid getting the flu?

    Washing your hands often will help protect you from germs. Wash with soap and water. or clean with alcohol-based hand cleaner. we recommend that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.


What kills influenza virus? What household cleaners kill the virus?

    Influenza virus is destroyed by heat (167-212?F [75-100?C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry. How should waste disposal be handled to prevent the spread of influenza virus?

    To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.

    What household cleaning should be done to prevent the spread of influenza virus?

    To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.

    How should linens, eating utensils and dishes of persons infected with influenza virus be handled? Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.

    Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry. Eating utensils should be washed either in a dishwasher or by hand with water and soap. Should I begin taking antiviral medications such as Tamiflu? if I'm planning a visit to another country known to have any type of flu?

    No, the Centers for Disease Control and Prevention (CDC) specifically states that at this time persons traveling to countries where there are cases of avian or H1N1 (swine) influenza in birds, poultry, swine, or humans do not need to take Tamiflu ? to prevent illness. If you become ill in any way while in the country, you should seek medical advice immediately. If you plan to travel to any country that has reported cases of flu among birds, swine, or humans, you should consider scheduling an appointment with your health care provider before traveling to discuss risks for potential exposure to diseases. Only you and your health care provider can determine that risk and what the most appropriate precautions are for you.

    What should I do if I get sick?

    If you live in areas where people have been identified with new H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people, except to seek medical care. If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.


    What are the warning signs of serious illness? When should I seek emergency medical care? If you become ill and experience any of the following warning signs, seek emergency medical care. In children emergency warning signs that need urgent medical attention include:

    ; Fast breathing or trouble breathing

    ; Bluish or gray skin color

    ; Not drinking enough fluids

    ; Severe or persistent vomiting

    ; Not waking up or not interacting

    ; Being so irritable that the child does not want to be held

    ; Flu-like symptoms improve but then return with fever and worse cough

    In adults, emergency warning signs that need urgent medical attention include:

    ; Difficulty breathing or shortness of breath

    ; Pain or pressure in the chest or abdomen

    ; Sudden dizziness

    ; Confusion

    ; Severe or persistent vomiting

    ; Flu-like symptoms improve but then return with fever and worse cough

    Does the United States plan to implement exit screening for travelers leaving the United States to prevent exporting novel H1N1 flu to other countries?

    At this time, screening travelers moving from the United States to other countries may be of very little public health benefit, as disease has been reported in more than 100 countries throughout the world. The World Health Organization (WHO) does not recommend entry or exit screening because the virus has already been confirmed in many parts of the world.

    Given that this is a novel strain of the influenza virus to which most persons are likely susceptible, the Administration and the CDC continues to aggressively perform surveillance for changes in the epidemiology or the strain of the novel H1N1 flu virus. In addition the Administration is focusing efforts on slowing the spread within communities, communicating health information and infection control messages to the public, and recommending that people stay home and do not travel when they are sick.

    What is the purpose of entry screening?

    In the context of a severe pandemic, the purpose of entry screening is to delay and reduce the impact of the disease in communities in the U.S. and buy time to put other public health interventions in place (e.g. produce vaccine, distribute antivirals, implement community mitigation strategies, etc.). At this time, entry screening during the current novel H1N1 flu outbreak would provide little to no benefit because thousands of confirmed cases already exist in the U.S.

    What is the purpose of exit screening?


    The purpose of exit screening is to prevent or slow global spread of communicable disease of public health importance. Ill persons from an “affected” nation are prevented form traveling to an “unaffected” nation. Exit screening MAY be recommended by the WHO under the International Health Regulations as the current novel H1N1 flu outbreak progresses, but it is NOT recommended at this time. CDC has exit screening plans drafted and partnering closely with DHS, is working with industry and federal partners to approve and implement in the event that exit screening were to become necessary.

    In some communications, CDC and DHS have described what they’re doing at the border as “passive surveillance” for ill travelers. Isn’t it time you stopped being so passive and started protecting Americans from people bringing this deadly virus into our country?

    “Passive surveillance” is a part of the every-day activities of DHS and CDC staff who work at ports of entry to

    prevent introduction of communicable disease in the United States. It involves watching for signs or reported symptoms among travelers as part of daily activities. If CBP officers notice signs or symptoms of illness, or they are reported by a traveler, they are expected to notify CDC. The U.S. is reinforcing these routine efforts at preventing the introduction of infectious diseases of public health significance through visual observation by DHS and illness response by CDC.

    In the context of a pandemic, the purpose of entry screening is to delay and reduce the impact of disease in communities in the U.S. and buy time to put other public health interventions in place. At this time, more active entry screening during the current novel H1N1 flu outbreak would not provide any benefit because multiple confirmed cases already exist in the U.S. in multiple locations. CDC and its quarantine stations maintain a close working relationship with DHS, especially CBP to continually watch out for illness at ports of entry. Measures in school settings

    Pandemic (H1N1) 2009 briefing note 10

    11 SEPTEMBER 2009 | GENEVA -- WHO is today issuing advice on measures that can be undertaken in schools to reduce the impact of the H1N1 influenza pandemic. Recommendations draw on recent experiences in several countries as well as studies of the health, economic, and social consequences of school closures. These studies were undertaken by members of a WHO informal network for mathematical modelling of the pandemic. Experience to date has demonstrated the role of schools in amplifying transmission of the pandemic virus, both within schools and into the wider community. While outbreaks in schools are clearly an important dimension of the current pandemic, no single measure can stop or limit transmission in schools, which provide multiple opportunities for spread of the virus.

    WHO recommends the use of a range of measures that can be adapted to the local epidemiological situation, available resources, and the social role played by many schools. National and local authorities are in the best position to make decisions about these measures and how they should be adapted and implemented. WHO continues to recommend that students, teachers, and other staff who feel unwell should stay home. Plans should be in place, and space made available, to isolate students and staff who become ill while at school.


    Schools should promote hand hygiene and respiratory etiquette and be stocked with appropriate supplies. Proper cleaning and ventilation and measures to reduce crowding are also advised.

    School closures and class suspensions

    Decisions about if and when schools should be closed during the pandemic are complex and highly context-specific. WHO cannot provide specific recommendations for or against school closure that are applicable to all settings. However, some general guidance comes from recent experience in several countries in both the northern and southern hemispheres, mathematical modelling, and experience during seasonal epidemics of influenza.

    School closure can operate as a proactive measure, aimed at reducing transmission in the school and spread into the wider community. School closure can also be a reactive measure, when schools close or classes are suspended because high levels of absenteeism among students and staff make it impractical to continue classes. The main health benefit of proactive school closure comes from slowing down the spread of an outbreak within a given area and thus flattening the peak of infections. This benefit becomes especially important when the number of people requiring medical care at the peak of the pandemic threatens to saturate or overwhelm health care capacity. By slowing the speed of spread, school closure can also buy some time as countries intensify preparedness measures or build up supplies of vaccines, antiviral drugs, and other interventions. The timing of school closure is critically important. Modelling studies suggest that school closure has its greatest benefits when schools are closed very early in an outbreak, ideally before 1% of the population falls ill. Under ideal conditions, school closure can reduce the demand for health care by an estimated 3050% at the peak of the

    pandemic. However, if schools close too late in the course of a community-wide outbreak, the resulting reduction in transmission is likely to be very limited.

    Policies for school closure need to include measures that limit contact among students when not in school. If students congregate in a setting other than a school, they will continue to spread the virus, and the benefits of school closure will be greatly reduced, if not negated.

    Economic and social costs

    When making decisions, health officials and school authorities need to be aware of economic and social costs that can be disproportionately high when viewed against these potential benefits.

    The main economic cost arises from absenteeism of working parents or guardians who have to stay home to take care of their children. Studies estimate that school closures can lead to the absence of 16% of the workforce, in addition to normal levels of absenteeism and absenteeism due to illness. Such estimates will, however, vary considerably across countries depending on several factors, including the structure of the workforce. Paradoxically, while school closure can reduce the peak demand on health care systems, it can also disrupt the provision of essential health care, as many doctors and nurses are parents of school-age children. Decisions also need to consider social welfare issues. Children’s health and well-being can be compromised if

    highly beneficial school-based social programmes, such as the provision of meals, are interrupted or if young children are left at home without supervision.


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