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H1N1 Influenza
Recommendations
for Child Care Programs and Schools
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Influenza
• Influenza (flu) is a virus that is easily spread every season
usually from October to April and can cause outbreaks of
respiratory illness.
Symptoms:
– Chills
– Fever
– Headache
– Fatigue
– Muscle aches
– Sore throat
– Runny and stuffy nose
• Usually mild illness
• May cause complications in elderly people, children and those
with a chronic illness
• In some cases the flu can be fatal.
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Pandemic Influenza
• Pandemic Flu is a new highly infectious viral
respiratory illness that occurs when a new
strain of influenza virus appears and spreads
quickly around the world.
• Pandemic flu will spread more quickly than
seasonal flu because humans will have little or
no immunity to this new virus.
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Seasonal Flu vs Pandemic Flu
Occurs every year during the winter Has occurred 3 times in the last century. It is
season likely to occur at any time of the year
For most people it is an unpleasant but not It may be a serious infection for everyone
life threatening infection
Most people recover within one or two There is a higher risk of severe illness
weeks without requiring medical treatment There is greater risk of death
The very young, the very old and people People of every age may be at risk of serious
with chronic illness are most at risk of illness
serious illness
Vaccine is available in advance based on Vaccine will not be available when the
common circulating flu strain pandemic starts
Antiviral drugs are available to treat those Antiviral drugs are likely to be in limited
at special risk supply and will have to be used to best effect
according to how the disease develops
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H1N1 Flu Virus
• Pandemic H1N1 2009 influenza virus (also
known as swine influenza) is a type A influenza
virus that began circulating in the spring of
2009
• Infection with this virus results in an influenza-
like illness (ILI) similar to seasonal influenza
• People will likely have no natural immunity to
protect against the virus
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ILI Symptoms
• Acute onset of respiratory illness with cough, fever
And one or more of:
– Sore throat
– Joint pain
– Muscle soreness
– Prostration which could be due to influenza virus
• Nausea, vomiting and diarrhea may also be present
especially in children under 5 years of age
* in children under 5 years of age and adults 65 years of age and
older fever may not be present with infection
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How is the Pandemic Flu Spread
• Direct contact: spray with relatively large,
short range droplets produced by sneezing,
coughing (may spread up to 2 meters), or by
immediate transfer of the virus via touching,
kissing etc.
• Indirect Transmission: Via recently
contaminated toys, objects and surfaces.
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Who are at Risk
• People between 5 and 24 years of age comprise a larger
proportion of cases
• Children are highly susceptible to acquiring and
transmitting respiratory pathogens
• School/Childcare settings may facilitate the spread the
disease
• People at risk of complications:
– Younger children (especially under age 2)
– Pregnant women
– Aboriginal Canadians
– Adults and children with chronic conditions
– Immuno-compromised
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H1N1 Influenza
• On June 11, 2009, the WHO raised the
pandemic alert level from Phase 5 to Phase 6
(sustained human-to-human transmission in
more than one WHO Region)
• It does not indicate any change in the severity of
the circulating virus
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Vaccine
• Seasonal flu shot will NOT provide protection against
2009 pH1N1 flu virus
• Enough pandemic vaccine will be produced to cover all
Canadians, but in early stages vaccine may be in short
supply. In this situation, the province will follow the
national recommendations for priority groups for influenza
immunization
• When vaccine becomes available, Public Health will
organize vaccination clinics
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Treatment
• Antivirals are drugs used for treatment of influenza
• Two antivirals that appear to be effective in treating this
illness are oseltamivir (Tamiflu) and zanamivir (Relenza)
• Antivirals are used to treat H1N1 Flu Virus when the
illness is moderate to severe and the patient is at a
great risk for complications. The treatment is most
effective when administered within 48 hours of symptom
onset.
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Infection Prevention and Control
• Identification of students/staff/children with
symptoms of ILI
• Exclusion from the setting of anyone with
symptoms of ILI
• Routine infection control practices:
– Hand washing
– Cough etiquette
– Cleaning of the environment
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Monitoring
• Active
– Not recommended unless cluster of cases in
identified
• Passive
– Parents/guardians should monitor the health
of their children daily for symptoms of ILI
– Teachers and child care program staff should
observe children for any signs of ILI
– Identified cases of ILI should be recorded
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Monitoring and Reporting
• Report staff and student/child illness to supervisor
• Childcare absenteeism should be monitored and
reported to public health when rates exceed 5%
(remember to compare with regular baseline
numbers for your centre).
• Continue to report enteric illness at 10 %.
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Monitoring
If a suspect or confirmed case is documented:
– Inform the parents of children in the affected
class/group about:
• Potential exposure
• Symptoms to watch for
– If cluster of cases is identified:
• Start active surveillance for the affected
class/group
• School/childcare-wide information to parents may
be required
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Routine Infection Control Practices
Hand Washing
– Hand washing with plain soap and water is the
preferred method of hand hygiene in schools and child
care centers
– Children will need assistance for following the correct
technique
– In instances where hand washing sinks are not
available, supervised use of alcohol based hand rubs
may be considered
– Alcohol based hand rubs may not be effective if hands
are visibly soiled
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Routine Infection Control Practices
Hand Washing:
– before meals
– before and after preparing food
– after using the toilet
– after changing diapers or helping a child use the
toilet
– after blowing your nose, coughing or sneezing
– after wiping a child’s nose
– after playing with shared toys, including sensory play
– before and after visiting with people who are sick
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Routine Infection Control Practices
• Hand washing technique
– Remove all rings and wet your hands
– Put a small amount of liquid soap in the palm of one
hand.
– Rub your hands together for 15-20 seconds so you
produce lather
– Rinse your hands well with clean running water for at
least 10 seconds
– Dry your hands with a single use paper towel.
– Use hand lotion
– Model good hand washing technique to children
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Routine Infection Control Practices
Cough and Sneeze Etiquette
– Sneeze and cough into your elbow or
sleeve or use a tissue.
– After wiping or blowing your nose with a
tissue, throw away the tissue and wash
your hands.
– Keep your fingers away from your eyes,
nose and mouth
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Isolation
• Isolate students/children who become ill with ILI while
in school/child care settings in a area separate from
others with adequate supervision until they can go
home
– Ill children to stay 2 meters away from others
– Ensure respiratory and hand hygiene practices
• Notify parents/guardians
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Isolation
• Send home with parent or guardian (not by
public transit)
– If there is no other option and the child must ride a
school bus, ensure the child sits on a seat by
themselves and is able to cover their mouth and nose
with a tissue.
• Students/staff/children who become ill at home
with ILI should stay at home until they are
symptom free and are feeling well and able to
fully participate in all normal day to day activities
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School or Daycare Closure
• Proactive closure - in anticipation of disease
– Public Health Agency of Canada does not
recommend proactive school closures or
daycare closures at this time.
– Currently H1N1 virus primarily causes mild
illness in Canada
– High economic and social costs of proactive
school closure must be considered
***If the epidemiology of the disease changes
this recommendation will be reconsidered***
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School of Daycare Closure
• Reactive Closure - in response to disease or
outbreaks
– The decision on school/daycare closure will
be made by local public health officials and
school/child care administrations
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Environmental Cleaning
• Influenza viruses are rapidly destroyed by
cleaning
• High touch surfaces in child care centers should
be cleaned at least twice daily or more often
when visibly soiled
• Clean first, then disinfect
• Regular cleaning products and disinfectants are
sufficient
• Waste handling would be according to usual
standards
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Caring for Someone Who is Ill
• Separate ill children from well children until they
can be picked up (sick person should generally
stay at least 2 metres away from others)
• If providing direct care to an ill child surgical
masks can be worn
• Clean your hands often
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Caring for Someone Who is Ill
• Treat the fever and cough
– "Coughs and sneezes spread diseases"
– Acetaminophen or ibuprofen every 4-6 hours may help
to bring down the fever and take away the aches
– Do not give aspirin to children with fever
• Give lots of fluids and nutritious food, make the child as
comfortable as possible.
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Outbreak Recommendations
• For Staff/Students/Parents/Children:
– Look for symptoms of ILI
– Report symptoms to supervisor
– Stay home if ill
– Seek medical attention
– Contact health care provider remotely prior
to attempting visit
– Return to school/daycare/work when
symptoms resolve
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Outbreak Recommendations
• For school/daycare staff:
– Promote personal hygiene practices
• Posters of proper hand washing and cough
etiquette
– Promote vaccination for seasonal flu as well as
H1N1 when they are available
– Be supportive of children and staff who are ill
by allowing adequate sick time
– Ensure adequate supply of disinfecting agents and
adequate sanitation
– Consult Public Health
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Resources
• Public Health Agency of Canada
– http://www.phac-aspc.gc.ca/alert-alerte/h1n1/index-
eng.php
• Fight Flu
– www.fightflu.ca
• WHO
– http://www.who.int/csr/disease/swineflu/en/
• TeleHealth Ontario: 1-866-797-0000
• Other Useful Resourses:
– Pandemic Checklist for schools:
http://www.flu.gov/plan/school/schoolchecklist.html
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