Fighting Off Swine Flu

• By Michael Fickes
• 09/01/09

Starting in October, K-12 schools will play a major role in immunizing Americans against swine flu, also known as the H1N1 virus, which will make a return visit to the northern hemisphere this winter.

All told, the Center for Disease Control plans to immunize 195 million people across the nation. By comparison, the polio vaccination program in the 1960s immunized 100 million people.

The vast number of people to be immunized requires a phased program, with six highest-risk groups going first. The highest-risk groups comprise those most likely to come down with H1N1 and to suffer complications. “The highest-risk groups include people aged 6 months to 24 years, pregnant women, people aged 25 to 64 with underlying medical conditions, healthcare workers, first responders that have patient care duties and those who live with babies younger than 6 months,” says Diane Helentjaris, a physician and the director of the Virginia Department of Health’s Office of H1N1 Response.

Young people attending elementary, middle and high schools every day form the largest of the six highest-risk groups. “School is where the kids are, and schools suffer disproportionately,” continues Dr. Helentjaris. “A school is a hot bed for sharing germs. When one child gets sick with H1N1, the virus can make quite a dent in the student population,” and when students get sick, they often take the virus home to their families.

Research has proven school vaccination programs effective in containing the spread of flu. A study conducted by Gaithersburg, Md.-based MedImmune, Inc., during the 2005-2006 flu season compared absentee rates in Carroll County, Md., schools where students had received vaccine with absentee rates during several years of baseline periods with no flu activity. The study also compared the results in Carroll County schools with those in neighboring Frederick County, which did not immunize students. These comparisons also went back several years.

Results: Absenteeism in both Carroll and Frederick County schools increased during flu outbreaks as compared to the non-flu baseline periods studied in the years before the test. During the 2005-2006 season, however, Frederick County schools saw a typical rise in absenteeism over its baseline period, while Carroll County schools, where students had been vaccinated, saw virtually no increase in absenteeism compared to the non-flu baseline period.

In addition, high schools where students had not been immunized suffered relatively small increases in absenteeism compared to elementary schools, suggesting that the youngest school children spread the flu virus most efficiently.

Important, too, the families of students given the vaccine recorded fewer visits to the doctor and fewer work absences during flu season.

In other words, a school-based H1N1 immunization program will likely go a long way toward ameliorating the effects of a swine flu outbreak in your school and in your community.

Preparing An Immunization Program
While every state and school district organizes immunization programs in individual ways, each must tend to certain basics.

Initial questions to answer include whom do you plan to vaccinate? Just students? Others on the highest-risk list as well? Your answer to these questions will determine your schedule. Student vaccinations can probably be handled during school hours. Other groups would likely require working before and after business hours.

What kind of immunizations will you offer? The H1N1 vaccine comes in the form of a nasal spray and an inter-muscular injection. You can offer one, the other or both. Most schools will likely offer both. Younger children will prefer the nasal spray, and others don’t like needles. Then again, the nasal spray isn’t appropriate for people with certain medical conditions. They’ll need shots.

Who will give the vaccinations? “In Virginia, we’re asking public and private sector organizations with professionals licensed to give vaccinations to sign up on our Web site,” says Dr. Helentjaris. “About 2,600 doctors offices, pharmacies, retail outlets, home health programs, long term care facilities and other organizations have indicated an interest.

“School districts can work with their state and local health departments to find people to help give immunizations as well as supplies of vaccine.”

Planning and organizing an immunization program requires considering many more details such as preparing and outfitting clinic space, promoting the use of the clinics to students and their parents, obtaining consent forms for both the nasal spray and injection vaccines, storing and handling the vaccine, managing the clinics, reporting potential adverse events and recording vaccines given, legal and regulatory issues and much more.

The CDC has set up a Web page that explains all of these details — it even provides sample consent forms. If you’ve just started preparing to offer vaccinations, the Web site will help you get organized. If you’re down the road but have specific questions, the Web site will most likely have what you need. The address for the site is: .

The CDC also says that educating students, parents, faculty and staff is an important part of a prevention program. “Schools should educate how to prevent the spread of flu, encourage vaccination among the recommended groups and make plans for handling a severe or very severe swine flu outbreak,” Artealia Gilliard, a spokesperson for the CDC, says in a written response to e-mailed questions.

Finally, tell everyone how important it is to wash your hands during a flu outbreak. A recent study provided hand sanitizers in half the classrooms used by 6,000 elementary school students. Teachers urged the students in the classrooms with sanitizers to wash their hands frequently. In the end, students using the sanitizers logged 20 percent fewer sick days. Teachers benefited too. Their absenteeism dropped by 10 percent.
 
So whatever you do, make sure you wash your hands — like your mother told you.