H1N1 Update



What is the city doing to keep the schools safe from the new H1N1 flu?


The new H1N1 (swine origin) virus is present in New York City, and all evidence suggests that it is causing a large proportion of the city’s current flu cases. We have seen frequent transmission in schools. It is not possible to stop transmission of the flu, so the Health Department is working to protect the people who are most likely to suffer severe illness and complications. That is the rationale for closing schools – not to interrupt the spread of flu in the city as a whole but to protect students, staff and their close contacts who are at highest risk of complications. Those at high risk include people with chronic medical condition such as asthma or diabetes, and those who are younger than 2, older than 65, or pregnant.


The Health Department and the Department of Education work together to monitor daily flu-like illness in New York City schools. School nurses are instructed to notify the principal of flu cases and to contact the City’s Office of School Health if five or more children come to the medical room with temperatures of at least 100.4 degrees, accompanied by cough or sore throat. Once that threshold is reached, the Health Department reviews daily flu-like illness among students coming to the medical room, as well as absenteeism data over the past week. We look for either a sudden or a sustained increase in flu-like illness. Every school with a cluster of students with flu-like illness is monitored daily. High absenteeism, by itself, is not a basis for closure. If parents are keeping sick children home, high absenteeism actually reduces transmission and the risk to vulnerable people.


Hundreds of children are absent from my school. Is there threshold for closing it?


There is no single formula for closing a school. The decision to close a school balances a definite harm – lost education, parental wages, and possible unsupervised children – with a possible benefit. The potential benefit is a reduction in the number of people who might get seriously ill from flu because they have an underlying risk condition. The Health Department carefully evaluates the circumstances occurring at each school and considers many factors including the following:

  • The number of visits to the nurse by children with documented fever and flu-like illness
  • The trend of flu-like illness over several days, and the potential impact of reduced transmission over weekend days, when school is not in session
  • The percentage of the student body absent with flu-like illness
  • Reports of teachers becoming ill while they are in the school
  • Special circumstances of the school, such as District-75 status

We pay closest attention to schools in which 1% to 2% of the student body comes to the medical room in a given day with fever and cough or sore throat. This indicates that a significant number of students are ill while at school and may be spreading infection to those at higher risk of complications.


Where can I find information on public school closures?


The latest information on school closures can be found at the Department of Education’s website: http://schools.nyc.gov.


Is the recent increase in flu cases likely to continue?


Yes. Influenza rates typically decline during the summer months, but some transmission will continue, and the H1N1 virus could cause another surge of illness next fall.


How can parents prepare for the possibility of school closure?


As a parent, you can prepare by identifying a caretaker who can be with your child if school closes and you can’t miss work. Talk to your employer early to determine whether you can work from home or arrange other options if you need to stay home with your child. School closures are announced on the Department of Education’s website.

You can also prepare to cope with the stress and disruption that a school closure would cause in your family’s daily life. When your child is home, sticking to a regular routine will help you and your family members cope. You can also prepare your child by talking about the current situation.


Should I report an increase in flu-like illness in my child’s school?


No. The Health Department is tracking absenteeism and has advised school nurses to contact the Health Department if they see sudden or sustained increases in the number of students coming to school with flu-like illness.


What should I do if my child is sick?


If your child is sick, he or she should remain out of school until 24 hours after the symptoms resolve. The great majority of children recover from influenza quickly without treatment, but those with chronic underlying health conditions should call a doctor about receiving antiviral treatment.

Those at higher risk include:

  • People over 65 or under 2 years of age
  • People with chronic lung disorders such as asthma or emphysema
  • People with chronic heart, kidney, liver or blood disorders
  • People with diabetes
  • People whose immune systems are compromised by illness or medication
  • Pregnant women
  • People on long-term aspirin therapy
  • Children with signs of severe illness – such as fast breathing or trouble breathing – need medical attention at a hospital emergency department.
What should I do if a student is sick?


The student should be evaluated by the nurse. If the nurse believes that the student may have influenza, the child should be separated from other students and sent home. The student should not take the school bus. Students with symptoms of flu should not return to school until they have been symptom-free for at least 24 hours. There is no need for the student to have a doctor’s note to return to school.


What should a school employee do if he or she comes down with the flu?


The person should go home and not return to school until at least 24 hours after the symptoms resolve. If the employee belongs to any of the higher-risk groups listed above, he or she should call a doctor to discuss treatment with antiviral medicine.


Do employees or students who were out sick need a note to return to school?


No. Employees or students do not need a note from their doctor to return to school. But they should stay home until they have been free of symptoms for 24 hours.


What cleaning measures are needed in a school where children or staff members are ill?


No specialized cleaning or disinfection is required, but custodial engineers and building managers should attend to good maintenance practices such as:

  • Regularly cleaning and disinfecting bathrooms, cafeterias and doorknobs in common areas
  • Ensuring that all bathrooms are stocked with soap and paper towels
  • Opening windows to ensure that the building is properly ventilated 


Should I keep my healthy child home from school to prevent infection


Healthy children do not need to miss school, but those who develop fever or respiratory illness should be kept home until they have recovered and felt well for 24 hours.


How does H1N1 influenza spread?


Flu spreads mainly through coughing or sneezing. People can also become infected by touching a surface with virus on it, and then touching their mouth or nose.


How can I protect myself from H1N1 influenza


Here are the best ways to avoid getting or spreading H1N1 flu. The same precautions can help prevent seasonal flu and many other respiratory infections.

  • Cover your mouth and nose whenever you cough or sneeze – and encourage others to do the same. Use your sleeve or a tissue, not your bare hand.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
  • Try to avoid close contact with people who are sick.
  • If you get sick, limit contact with others to avoid infecting them.
How can I help my children if they are afraid or anxious?


Children may express a wide range of stress reactions that can vary according to their age. Most of these reactions are normal and should disappear within a few weeks. It is natural to seek information during an outbreak or an emergency. But watching report after report can distress children. Parents should limit TV time and talk with children about the events that are occurring. For information on talking to your child about H1N1 flu, visit http://www.cdc.gov/h1n1flu/talkingtokids.htm. Anyone feeling overwhelmed by stress can seek help by calling 1-800-Lifenet, a 24 hour, seven-days-a-week crisis hotline.

Updated May 22, 2009

How do you decide when to close a school?


Information for Parents, Teachers, and School Principals

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