Chief Medical Officer
DATE: Aug. 17, 2009
RE: H1N1 guidance and new nationwide school dismissal reporting
This memo is intended to share with you what state and federal health officials are now telling us about
the possible impact of the H1N1 virus on our communities and schools in the coming school year.
Preliminary information from the national Centers for Disease Control and Prevention indicated that
those ages 6 months to 24 years will be among those designated a priority and receive the first doses of
vaccine. A vaccine for H1N1 may not be available until October. The CDC has stated that school‐aged
children will have the highest rates of illness and that the rate will decline with age.
To prepare, I am encouraging school administrators to:
• Be alert and attentive to changes in H1N1 guidance.
• Encourage students and staff to use proper hygiene practices.
• Communicate with parents, encouraging them to keep children who have a fever or flu‐like
symptoms home from school and other community activities.
• Encourage parents to plan ahead for the care of their children when they are ill or when school
may be closed because of an outbreak of illness or any other number of things such as a snow
• Meet with your local health department and school staff to discuss local emergency plans.
• Review your Continuity of Operations Plans and update as needed.
• Masks: A supply of masks will be provided each school in the state to help you minimize the
contact between healthy students and staff and those who may become ill at school. Your local
health department will provide the initial, small supply of masks but future supplies should be
purchased. Your local health department will contact you with more information. The
Department of Health and Human Services administers the state’s allotment of antiviral and
medical supplies from the federal Strategic National Stockpile.
• Medically‐fragile students: Extra precautions should be taken to prevent the spread of illness to
students who are medically fragile.
• Meals for at‐risk students in the event of school dismissals: The U. S. Department of Agriculture
has issued guidance on how schools and community organizations can receive authorization
from their states to use the Summer Food Service Program or the Seamless Summer Option to
be reimbursed for meal service to qualifying children if H1N1 school dismissals occur. Detailed
information is available at: http://www.fns.usda.gov/cnd/Governance/Policy‐
• Local health department contact information: Your local health departments will be valuable resources
in preparing for H1N1. A list of the departments, their directors and contact information is available at
• Monitoring school dismissals: The Centers for Disease Control (CDC) and U.S. Department of Education
will monitor school dismissals nationwide during the coming school year by 1) daily and systematic
searches of media reports and 2) direct reports from schools and school districts. In Nebraska, schools
and school districts will report directly to the CDC by completing a form available at
http://www.cdc.gov/h1n1flu/schools/dismissal_form/. You also may email the dismissal form to
FluSchoolDismissal@cdc.gov or fax to 770.488.6156. All web and email submissions will be sent
simultaneously to the CDC and the Nebraska Department of Education, as the designated state agency.
As of Aug. 7, the CDC provided the following guidance for schools:
Recommended school responses for the 2009‐2010 school year
Under conditions with similar severity as in spring 2009
• Stay home when sick:
Those with flu‐like illness should stay home for at least 24 hours after they no longer have a
fever, or signs of a fever, without the use of fever‐reducing medicines. They should stay home
even if they are using antiviral drugs. (For more information, see CDC Recommendations for the
Amount of Time Persons with Influenza‐Like Illness Should be Away from Others.)
See the Technical Report for more details about staying home when sick >>
• Separate ill students and staff:
Students and staff who appear to have flu‐like illness should be sent to a room separate from
others until they can be sent home. CDC recommends that they wear a surgical mask, if possible,
and that those who care for ill students and staff wear protective gear such as a mask.
See the Technical Report for more details about separating ill students and staff >>
• Hand hygiene and respiratory etiquette:
The new recommendations emphasize the importance of the basic foundations of influenza
prevention: stay home when sick, wash hands frequently with soap and water when possible,
and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow
if no tissue is available).
See the Technical Report for more details about hand hygiene and respiratory etiquette >>
• Routine cleaning:
School staff should routinely clean areas that students and staff touch often with the cleaners
they typically use. Special cleaning with bleach and other non‐detergent‐based cleaners is not
See the Technical Report for more details about routine cleaning >>
• Early treatment of high‐risk students and staff:
People at high risk for influenza complications who become ill with influenza‐like illness should
speak with their health care provider as soon as possible. Early treatment with antiviral
medications is very important for people at high risk because it can prevent hospitalizations and
deaths. People at high risk include those who are pregnant, have asthma or diabetes, have
compromised immune systems, or have neuromuscular diseases.
See the Technical Report for more details about early treatment >>
• Consideration of selective school dismissal:
Although there are not many schools where all or most students are at high risk (for example,
schools for medically fragile children or for pregnant students) a community might decide to
dismiss such a school to better protect these high‐risk students.
See the Technical Report for more details about selective school dismissal >>
You will find additional information specific to Nebraska at http://www.dhhs.ne.gov/H1N1flu/ and
national information at www.flu.gov.
Thank you for your diligence in preparing for a safe and productive school year.
And, for your information, here is the Aug. 7, 2009, news release from the CDC:
Updated Federal Guidelines for 2009 H1N1 Influenza in Schools Offer Many Options
Guidance Says Officials Should Consider Local Needs in Making Decisions
Updated federal guidelines offer state and local public health and school officials a range of options for
responding to 2009 H1N1 influenza in schools, depending on how severe the flu may be in their
communities. The guidance says officials should balance the risk of flu in their communities with the
disruption that school dismissals will cause in education and the wider community.
The guidance from the Centers for Disease Control and Prevention (CDC) was announced today at a joint
news conference by Health and Human Services Secretary Kathleen Sebelius, Education Secretary Arne
Duncan, Homeland Security Secretary Janet Napolitano, and CDC Director Thomas R. Frieden, M.D.,
The school guidance is a part of a broader national framework to respond to novel H1N1 influenza,
which includes encouraging people to be vaccinated against the virus and to take other actions to avoid
infection. The CDC anticipates more illness after the school year starts, because flu typically is
transmitted more easily in the fall and winter.
``We’re going to continue to do everything possible to keep our children – and all Americans – healthy
and safe this fall,’’ Secretary Sebelius said. ``But all Americans also have a part to play. The best way to
prevent the spread of flu is vaccination. A seasonal flu vaccine is ready to go, and we should have one
for the 2009 H1N1 flu by mid‐October.’’
“The federal government continues to coordinate closely with state and local governments, school
districts and the private sector on H1N1 preparation as we head into the fall flu season—and the
upcoming school year,” said Secretary Napolitano. “Readiness for H1N1 is a shared responsibility, and
the guidance released today provides communities with the tools they need to protect the health of
their students and teachers.”
For an outbreak similar in severity to the spring 2009 H1N1 infection, the guidelines recommend basic
good hygiene, such as hand washing. In addition, students or staff members with flu‐like illness
(showing symptoms of flu) should stay home at least 24 hours after fever symptoms have ended.
“We can all work to keep our children healthy now by practicing prevention, close monitoring, and using
common sense,” Secretary Duncan said. “We hope no schools have to close. But if they do, we need to
make sure that children keep learning.”
The guidelines also recommend schools have plans in place to deal with possible infection. For instance,
people with flu‐like illness should be sent to a room away from other people until they can be sent
home. Schools should have plans for continuing the education of students who are at home, through
phone calls, homework packets, Internet lessons and other approaches. And schools should have
contingency plans to fill important positions such as school nurses.
If H1N1 flu causes higher rates of severe illness, hospitalizations and deaths, school officials could add to
or intensify their responses, the guidelines say. Under these conditions, the guidelines advise parents to
check their children every morning for illness, and keep the children home if they have a fever.
In addition, schools could begin actively screening students upon arrival and sending ill students home
immediately. If one family member is ill, students should stay home for five days from the day the
illness develops, the guidelines say.
“Influenza can be unpredictable, so preparation and planning are key,” said Dr. Frieden. “We can't stop
the tide of flu, but we can reduce the number of people who become very ill by preparing well and
For more information visit www.flu.gov.