H1N1 (Swine) Flu Information

Note: If your student has not yet had a seasonal flu vaccine, as of Friday, November 20th, there is still some vaccine available at the Manchester Health Dept. for students under 18. Clinic hours are Mon. 1:30-3:30 pm and Thurs. 9:00-11:30 am and 3:00-6:00 pm. Call 603-624-6466 for more information.

H1N1 case reports continue throughout NH, the US, and the world. There are fewer headlines and generally those are associated with severe or fatal cases. H1N1 vaccine is still being recommended by CDC to protect against what is expected to be "the next wave of illness." NH has activated 211 as the official call line for H1N1 influenza information. Because of the ease and frequency of worldwide travel, all students and staff are asked to inform the nursing staff of all foreign travel so that we can be proactive with outbreak alerts and symptom recognition. Currently, there is an outbreak of Avian influenza (bird flu) in Egypt.) The best recommendations still call for good self care and prevention practices as well as plenty of common sense. CDC and NH DHHS - Bureau of Communicable Disease Control continue to advise treating the symptoms of this influenza strain as you/we would any other case of seasonal "flu." Persistent good hygiene and self care practices--not just now, but for the rest of your life are your best defense against many diseases. Carrying a 1-2 oz. container of hand sanitizer--and using it regularly--is a great prevention strategy. If you, or your student, have a fever (100.0 or more) & either a sore throat or cough, though these symptoms may indicate flu, it is important to also consider and rule out strep throat, bronchitis, sinus infection, etc. Please contact your PCP for specific recommendations and consideration of a differential diagnosis just as you would in other circumstances. They may (or may not) want to see you or your student. 2009 H1N1 and Seasonal Flu: What To Do If You Get Sick is a very informational resource.

If flu symptoms start to go away, but then return and worsen with ANY respiratory problems, please do not delay seeking assessment and treatment. In severe cases, complications generally begin 3 to 5 days after symptom onset and may be very rapid, with severe respiratory problems within 24 hours. Individuals with difficulty breathing should be assessed in the Emergency Room and may require immediate hospital admission.

• Prompt treatment with the antiviral drugs reduces the severity of illness and improves the chances of survival with complications.
• Pneumonia (usually due to co-infection with bacteria) can cause a severe, rapidly progressive illness.
• Risk of severe and potentially deadly illness is highest with: pregnant women (especially during last trimester of pregnancy), children younger than age 2 years, and those with chronic lung disease, including asthma. Neurological disorders can increase risk of severe disease in children.

Individuals who are sick should not be going to work, to the mall, to the restaurant, theater, etc. until symptoms and fever have been resolved for 24 hours. (There should be no fever without using a fever reducing medication such as Tylenol or Advil.) If you don’t have a thermometer at home, please buy one!

School closure remains highly unlikely for suspected or confirmed cases of novel influenza A (H1N1). Consistent with current recommendations for seasonal influenza, unless large numbers of faculty or students are affected to the point of creating significant absenteeism that interferes with the school’s ability to function. Absenteeism is being monitored on a daily basis. Though there have been over 13,000 deaths worldwide due to H1N1 (about 7200 in the Americas, including US cases most cases are relatively mild.

Individuals experiencing symptoms of the flu (fever with cough, sore throat, body aches, headache, chills, and fatigue--some, particularly children, also have nausea, vomiting, diarrhea, and other GI complaints) should remain at home and contact your PCP as you normally would. Individuals who are sick should remain at home until symptoms have been resolved for 24 hours and avoid exposing other people. CDC recommendations are good common sense actions that reduce the incidence of all types of infectious diseases including common colds, influenza (“the flu”), MRSA, some forms of hepatitis and meningitis, as well as many other communicable diseases. These include:

• Wash hands thoroughly and frequently with soap and water for 20 seconds or use an alcohol based hand sanitizer and rub hands until dry. (It takes 20 about seconds to sing “Happy Birthday” twice!)
• Always cover your cough using tissues or by coughing into the inside of your elbow, not into your hands. Dispose of the tissues properly, then wash your hands.
• Avoid close contact with individuals who are sick.
• Get plenty of rest and avoid getting “run down.” Teenagers should optimally get 9 hours of sleep each night.
• Eat a healthy diet with plenty of fruits and vegetables.
• Drink plenty of fluids but avoid sharing eating utensils and drinking from the same cup, can, bottle, etc.
• Avoid touching your eyes, nose, and mouth since many germs enter the body in this manner.
• Maximize ventilation by opening windows as appropriate (closing them will be an important reminder).
• Reduce close social contact and group activities to minimize contact between students.
• Sanitize frequently touched surfaces daily, or more often if needed, to decrease the spread of bacteria and viruses (keyboards, door knobs, etc.)
• Get a flu shot to prevent seasonal influenza.
• Get an H1N1 vaccine when it becomes available. - contact your PCP if you, or a family member, falls into a high risk group - DO NOT WAIT FOR A CLINIC.

Individuals who are sick and unable to attend school/work should remain at home and avoid contact with others to minimize the spread of disease. They should not be in the workplace, malls, restaurants, theaters, etc. Avoid close contact with others who are sick.

If your child (or others who live in the home) are sick with fever of 100 or more and flu-like symptoms, contacting Health Services (437-5218) will help the nursing staff to be alert for similar symptoms and trends in others.

Influenza or the “flu” occurs every year. Most individuals get well after a week or so. Because is new and many have not received the vaccine, there may be increased numbers who are susceptible. This is cause to increase prevention measures to decrease contagion. While flu related deaths occur every year, some individuals are at higher risk for flu related complications: very young children, pregnant women, individuals with chronic medical conditions, and the elderly. Some clinics and many providers still have H1N1 vaccine available. If you, or a family member, is at increased risk, contact your PCP for vaccine and/or medical recommendations.

For several years, families have been advised to be prepared for a Pandemic or other public health emergency. In the event that authorities advise the public to stay in their homes, families should have sufficient food, water, prescriptions and OTC medications, hand sanitizers, etc. on hand to provide essentials for your family for an extended period of time. It makes good common sense and it is good planning. The ice storm of December 2008 demonstrated very well how quickly our lives can be disrupted!

The most important prevention message is: Wash your hands, cover your coughs, and stay home if you are sick!

Additional information can be obtained at: NH DHHS, Division of Public Health, Communicable Disease: 1-603-271-4496. Call 211 for additional influenza information. The DHHS Parent Inquiry line is 1-888-330-6764.

Other helpful links:

CDC - Centers for Disease Control and Prevention

CDC - 2009 H1N1 Flu

CDC - What To Do If You Get Sick

CDC - H1N1 Q&A

PandemicFlu.gov

PandemicFlu.gov - Information for Families

PandemicFlu.gov - Pandemic Planning Checklist

NH Department of Health and Human Sevices

Flu Clinic Locator

Wash your hands and stay healthy!

(Mrs.) Anna Davis, MS, RN, ARNP, BC, Head Nurse, Pinkerton Health