IAC Express 2009
Issue number 796: May 6, 2009
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Contents of this Issue
Select a title to jump to the article.
  1. CDC issues new guidance on closure of schools and childcare facilities related to the H1N1 influenza virus epidemic
  2. CDC has recently posted additional interim guidance documents related to H1N1 influenza
  3. IAC adds web resources related to H1N1 influenza
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
Issue 796: May 6, 2009
1.  CDC issues new guidance on closure of schools and childcare facilities related to the H1N1 influenza virus epidemic


On May 5, HHS Secretary Kathleen Sebelius and Acting CDC Director Richard Besser announced new CDC guidance on closure of schools and childcare facilities where there have been reported cases of the novel H1N1 flu virus. The new guidance was developed in consultation with top scientists at the CDC and some of the top public health departments across the country. A statement by Secretary Sebelius and Acting CDC Director Besser follows in its entirety.

Since the beginning of this outbreak, the CDC has been working to update, or in some cases, quickly develop interim guidelines to help healthcare providers, health departments, and communities take effective action to prevent the spread of this novel H1N1 virus. Our interim guidelines are guided by science, based on available data, and designed so that resources and efforts are directed toward actions and activities that make a difference in preventing spread of this virus.

Today, we are announcing a change with respect to CDC's interim guidance on closing schools and childcare facilities. The initial guidance CDC issued on May 1st recommended that affected communities with laboratory-confirmed cases of influenza A H1N1 consider adopting school dismissal and childcare closure measures, including closing for up to 14 days depending on the extent and severity of illness. At the onset of this outbreak of a previously unknown influenza virus, we believed it would be helpful to close affected schools while we learned more about the virus's transmission and the severity of disease. Further, the U.S. national strategy for pandemic influenza suggested that ongoing community-wide closure of all schools and daycare centers should be considered in the event of a severe outbreak, especially if these measures could be implemented early.

As CDC's daily press briefings have illustrated, much has been learned quickly about the virus's severity and its spread. We have learned that in many communities, the virus is widely circulating. When influenza becomes common in a community, it is unlikely that actions such as closing schools or daycare facilities are effective when it comes to slowing or stopping the spread of influenza viruses. Instead, such measures bring significant cost--such as interrupting student learning--without a significant public health benefit. In addition, we have learned that the disease currently being caused by this novel flu virus appears to be similar with that typically caused by seasonal influenza. Although many people may get sick, the available data do not indicate we are facing an unusually severe influenza virus.

With the modified policy being issued today, CDC no longer recommends that communities with a laboratory-confirmed case of influenza A H1N1 consider adopting school dismissal or childcare closure measures. Rather, in line with policies being undertaken in Seattle, New York, and Canada, CDC has modified its policy to recommend implementation of measures that focus on keeping all students, faculty, and staff with symptoms of influenza out of schools and childcare facilities during their period of illness and recuperation, when they are potentially infectious to others.

More specifically, at this time, CDC recommends the primary means to reduce spread of influenza in schools focus on early identification of ill students and staff, staying home when ill, and good cough and hand hygiene etiquette. It is imperative that schools and parents reiterate this message. Students, faculty, or staff with influenza-like illness (fever with a cough or sore throat) should stay home and not attend school or go into the community except to seek medical care for at least 7 days even if symptoms resolve sooner. Students, faculty, and staff who appear to have an influenza-like illness at arrival or become ill during the school day should be isolated promptly in a room separate from other students and then sent home.

It's important to note that schools that were closed based on previous interim CDC guidance related to this outbreak may reopen. That said, decisions about school closure should be at the discretion of local authorities based on special circumstances and local considerations, including public concern and the impact of school absenteeism and staffing shortages.

Some have asked whether the World Health Organization might raise the pandemic phase alert from 5 to 6 and how that might affect our school closure and other community mitigation recommendations. As we have stated previously, it is important to note that the WHO pandemic phase designation is based on geographic spread of the influenza virus, not on the severity of the illness. In the event that sustained transmission is found in another part of the world, it is not unlikely that WHO would raise the level to 6. Furthermore, from the beginning, we have assumed an aggressive public health approach to this outbreak. For those reasons, should a phase 6 alert designation be made, it would not affect our guidance on school closure in particular or raise our concerns on the virus more generally.

We appreciate the efforts that communities, particularly school districts, have taken to protect students and staff from this influenza A H1N1 virus. Communities and schools are at the forefront of protecting people's health, and we are committed to providing them the flexibility they need to deal with local conditions, and the best possible guidance that reflects our most current understanding of the scientific and medical facts.

To read this statement online, go to:

To access the revised guidelines from CDC, "Update on School (K-12) and Childcare Facilities: Interim CDC Guidance in Response to Human Infections with the Novel Influenza A (H1N1) Virus," go to:

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2 CDC has recently posted additional interim guidance documents related to H1N1 influenza


CDC's web page titled Swine Flu: Interim Guidance for Clinicians & Public Health Professionals has recently been updated with more interim guidance documents. Following are the titles and URLs of guidance documents that have been added or revised since the last IAC Express Extra Edition of May 1, excluding the school closing document discussed in the first article of this issue.

Novel H1N1 Flu (Swine Flu) and Feeding your Baby: What Parents Should Know

Considerations for Pregnant Women Who Are More Likely to Be Exposed to Novel H1N1 Flu (Swine Flu) at Work; Information for Women in Education, Childcare, and Healthcare

What Pregnant Women Should Know About H1N1 (formerly called swine flu) Virus

H1N1 Flu: Interim Guidance for People with Heart Disease, Stroke, or Cardiovascular Disease

Interim Guidance for Clinicians on Identifying and Caring for Patients with Swine-origin Influenza A (H1N1) Virus Infection http://www.cdc.gov/h1n1flu/identifyingpatients.htm [updated since first release]

Key Mental and Behavioral Health Issues Related to Social Distancing For State, Local, and Tribal Health Departments and Community Based Organizations

Interim Guidance for Employers for Protection of Migrant and Seasonal Farmworkers from the Novel H1N1 Flu Virus http://www.cdc.gov/h1n1flu/guidance/migrant_farmworkers.htm

Interim Guidance to Assist State and Local Health Departments in Developing Programs for Migrant and Seasonal Farmworkers in Response to Human Infections with Novel Influenza A (H1N1) Virus http://www.cdc.gov/h1n1flu/guidance/migrant_farmworkers_doh.htm

CDC has also posted interim guidance on such topics as screening, specimen collection, facemask and respirator use, travel, and emergency personnel. To access the web page, which is constantly evolving, go to: http://www.cdc.gov/H1N1flu/guidance

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3 IAC adds web resources related to H1N1 influenza


To aid visitors looking for H1N1 influenza information, IAC has developed a brand new section of related resources on its main website.

The main page for important information related to H1N1 influenza (swine flu) can be accessed at http://www.immunize.org/h1n1

The new section includes H1N1 influenza guidance documents from CDC on prevention and patient care for the public and healthcare professionals, including information targeted to pregnant women, persons with medical conditions, school and childcare facilities, employers, and much more. The page also features a video on hand washing produced by CDC. You may wish to bookmark the main page, http://www.immunize.org/h1n1, for ease in referring to it later.

The following subsections can be accessed from the main page above, or directly with the following links:

Partner Resources: Influenza-H1N1

Includes resources from AAP, WHO, AMA, HHS, FDA, NNii (National Network for Immunization Information), ASTHO (Association of State and Territorial Health Officials), as well as CDC.

Vaccine in the News: Influenza-H1N1

Includes current articles on H1N1 influenza from major newspapers and radio programs.

Journal Articles: Influenza-H1N1

A collection of articles published in peer-reviewed journals related to H1N1 influenza or general pandemic influenza.

IAC also features a handy box on the top of its home page that provides a link to this new section, as well as to CDC, HHS, and other important sources of H1N1 influenza information. Look for the box titled "H1N1 Flu (Swine Flu)" at the top of http://www.immunize.org

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About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of Immunize.org and do not necessarily represent the official views of CDC.

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ISSN 2771-8085

Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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