Date: May 4, 2009
To: Minnesota School District Officials
From: Commissioner Dr. Sanne Magnan
Dr. Ruth Lynfield, State Epidemiologist
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:
1) 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.
2) Close school at their discretion, based on public health and community assessment.
3) 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.
Copy to: Commissioner Alice Seagren, Minnesota Department of Education
