Re-admitting Students and Staff after Flu-like Symptoms

INFORMATIONAL LETTER: 103
POLICY CODE: EEBA

TO: Superintendents of Schools, Private Schools, Special Purpose Private Schools, and School Nurses
FROM: Commissioner Susan A. Gendron, Department of Education
DATE: May 22, 2009
SUBJECT: Re-admitting Students and Staff after Flu-like Symptoms

SUMMARY: This letter provides instructions for determining if a child or staff person should stay home from school because of influenza-like illness.

The new strain of influenza H1N1 (or “swine flu”) is still circulating in Maine. Superintendents have asked the Department for guidance on whether to re-admit students and staff to school after exhibiting influenza-like illness (ILI) with a doctor’s note before the U.S. CDC-recommended seven-day exclusion.

In reviewing the current widespread outbreaks affecting schools in some parts of the country, including Boston and New York (both of which have had to close a number of schools), and in reviewing the US CDC guidance, the Maine CDC has advised that it is important to strictly adhere to U.S. CDC guidance.

The U.S. Centers for Disease Control and Prevention continues to recommend that individuals with influenza-like symptoms should stay at home and not attend school for seven days after illness onset or for 24 hours after resolution of symptoms, whichever is LONGER. This recommendation is based on the time period in which persons can shed the virus and is intended to decrease disease transmission in schools. The link for this information is available at http://www.cdc.gov/h1n1flu/K12_dismissal.htm .

As with all guidance to this point, we advise schools to follow the recommendations of the Maine CDC and U.S. CDC with regard to the H1N1 flu.

Individuals with fever (100 F or 37.7 C) AND sore throat or cough may have influenza. These persons should remain home from school for seven days or until symptoms are gone for 24 hours, whichever is longer.

Individuals who test negative for influenza by a PCR test may return to school when asymptomatic. A negative rapid antigen test is not an acceptable substitute for a PCR test because of false negative results.

The above guidance remains in effect even if an individual has a note from a physician, unless an alternative diagnosis is supported by laboratory results (e.g., strep throat, pertussis)

If an individual has a) fever alone, b) vomiting or diarrhea, or c) sore throat or new cough, he/she should remain home from school until symptoms are gone for 24 hours.

We advise superintendents and principals to involve their school nurses in decisions about re-admittance, as well as in all H1N1 planning, decision-making, and actions.

As media attention to the H1N1 flu has subsided, it is important that health professionals and school officials continue to maintain a heightened awareness of the H1N1 infection, continue to track U.S. CDC and Maine CDC guidance, and not reduce vigilance when it comes to hygiene etiquette, industrial cleaning, and educating parents about the importance of keeping their children home if they exhibit influenza-like illness (ILI).

Significant influenza activity is still ongoing in much of the country with increased severity and hospitalizations being reported. Schools in other states are re-implementing school closures based on this latest report. As of May 21, the U.S. CDC reported a total of 5,764 probable cases and 9 deaths from the novel H1N1 infection. This virus is not “going away” as some people seem to think. It’s uncertain at this time how severe this novel H1N1 outbreak will be in terms of illness and death compared with other influenza viruses.

Influenza is always serious – each year in the United States, seasonal influenza results, on average, in an estimated 36,000 deaths and more than 200,000 hospitalizations from flu-related causes. This outbreak certainly poses the potential to be at least as serious as seasonal flu, if not more so, especially given the fact that there currently is no vaccine against this virus and there is no immunity against this virus in the population. Because of these factors, CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks. The media spotlight may have shifted, but CDC’s response and focus has not. Now is not the time for complacency or to let down our guard. The United States is already engaged in implementing its pandemic response plan.

For further information contact Nancy Dube, School Nurse Consultant, at 624-6688 or email her at nancy.dube@maine.gov .