Archive for September, 2009

Flu-proof your college kids

Monday, September 7th, 2009

As kids prepared to return to K-12 schools last month, my GERMBlog entry focused on pre-college kids and their schools (see Dr. Rotbart’s GERMBlog August 10, 2009). Now the CDC, and I, are turning our attention to your older kids as they return to college campuses across the country. Already, thousands of cases of H1N1 influenza (“swine flu”) are being reported from institutions of higher education in all regions across the country; the highest incidences so far are in the South and the Pacific Northwest. As with last month’s blog, I reprint below the core recommendations of the CDC regarding protecting your college kids, along with my annotated comments:

Recommended responses to influenza for the 2009 – 2010 academic year

Recommended strategies under current flu conditions
(similar severity as in Spring/Summer 2009)

Facilitate self-isolation of residential students with flu-like illness

  • Those with flu-like illness should stay away from classes and limit interactions with other people (called “self-isolation”), except to seek medical care, for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. Some people with influenza will not have fever; therefore, absence of fever does not mean absence of infection. They should stay away from others during this time period even if they are taking antiviral drugs for treatment of the flu. (For more information, visit http://www.cdc.gov/h1n1flu/guidance/exclusion.htm .)

        Dr. Rotbart: This is tough for kids taking classes in the first weeks of college, but professors are being urged to provide consideration for students absent due to illness (see below) and it’s the right thing to do to protect your kids’ classmates and friends.

  • Review and revise, as needed, policies, such as student absenteeism policies and sick leave policies for faculty and staff, that make it difficult for students, faculty, and staff to stay home when they are ill or to care for an ill family member,. Do not require a doctor’s note to confirm illness or recovery. Doctor’s offices may be very busy and may not be able to provide such documentation in a timely way.
  • If possible, residential students with flu-like illness who live relatively close to the campus should return to their home to keep from making others sick. These students should be instructed to do so in a way that limits contact with others as much as possible. For example, travel by private car or taxi would be preferable over use of public transportation.

Dr. Rotbart: The ill student should have alcohol hand sanitizer in his/her room for use by anyone coming or going into the room, whether at home or on campus.

  • Students with a private room should remain in their room and receive care and meals from a single person. Students can establish a “flu buddy scheme” in which students pair up to care for each other if one or the other becomes ill. Additionally, staff can make daily contact by e-mail, text messaging, phone calls, or other methods with each student who is in self-isolation.

Dr. Rotbart: The ill student should have alcohol hand sanitizer in his/her room for use by anyone coming or going into the room whether at home or on campus.

  • If close contact with others cannot be avoided, the ill student should be asked to wear a surgical mask during the period of contact. Examples of close contact include kissing, sharing eating or drinking utensils, or having any other contact between persons likely to result in exposure to respiratory droplets.

Dr. Rotbart: This recommendation got the most ridicule in the media – pictures of college kids kissing with masks on, etc. Skip the mask if you must, but most importantly skip the close contact, too, until the ill student is no longer ill.

  • For those who cannot leave campus, and who do not have a private room, IHEs may consider providing temporary, alternate housing for ill students until 24 hours after they are free of fever.

Dr. Rotbart: A number of schools (e.g. Emory University in Atlanta) where the majority of students are from out of state have instituted “sick dorms” for student isolation in groups. During an epidemic due to a single germ, this may well be effective. Later in the fall when other germs are also circulating, isolation in a single dorm won’t work because student A’s germ is the last thing that student B needs when student B already has his own germ to fight off.

  • Instruct students with flu-like illness to promptly seek medical attention if they have a medical condition that puts them at increased risk of severe illness from flu, are concerned about their illness, or develop severe symptoms such as increased fever, shortness of breath, chest pain or pressure, or rapid breathing.

Dr. Rotbart: So far, the most severe cases (and the few fatalities) have occurred in patients who already have some kind of underlying condition that predisposes them to more severe flu.

Promote self-isolation at home by non-resident students, faculty, and staff

  • Non-residential students, faculty, and staff with flu-like illness should be asked to self-isolate at home or at a friend’s or family member’s home until at least 24 hours after they are free of fever, or signs of a fever, without the use of fever-reducing medicines.
  • Review, and revise if needed, sick leave policies to remove barriers to faculty and staff staying home when they are ill or caring for an ill family member. For students, consider altering policies on missed classes and examinations and late assignments so that students’ academic concerns do not prevent them from staying home when ill or prompt them to return to class or take examinations while still symptomatic and potentially infectious.
  • Do not require a doctor’s note for students, faculty, or staff to validate their illness or to return to work, as doctor’s offices and medical facilities may be extremely busy and may not be able to provide such documentation in a timely way.  
  • Distance learning or web-based learning may help students maintain self-isolation.  
  • Visit for more information on staying home while sick.

Considerations for high-risk students and staff

  • People at high risk for flu complications who become ill with flu-like illness should speak with their health care provider as soon as possible. Early treatment with antiviral medications often can prevent hospitalizations and deaths. Groups that are at higher risk of complications from flu if they get sick include: children younger than age 5; people age 65 or older; children and adolescents (younger than age 18) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye’s syndrome after flu virus infection; pregnant women; adults and children who have asthma, other chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders such as diabetes; and adults and children with immunosuppression (including immunosuppression caused by medications or by HIV). People age 65 and older, however, appear to be at lower risk of 2009 H1N1 infection compared to younger people. But, if older adults do get sick from flu, they are at increased risk of having a severe illness.

Dr. Rotbart: So far, almost all of the flu we’ve seen during this outbreak has been susceptible to “Tamiflu”, the medicine referred to in the recommendation above. Within 24-48 hours of onset of illness, Tamiflu can effectively reduce the severity of influenza.

  • One of the best ways to protect against the flu is to get vaccinated against the flu. People under age 25 are one of the key groups recommended by CDC’s Advisory Committee on Immunization Practices (ACIP) to be among the first to receive the 2009 H1N1 flu vaccine. For more information, visit http://www.cdc.gov/h1n1flu/vaccination.

Dr. Rotbart: Stay tuned on this one – as the number of available doses may fall below the optimal number needed, college age students may no longer be in the high priority group unless they have underlying medical conditions.

  • Communicate with local health officials to determine where vaccine will be administered and to discuss the possibility of a vaccination clinic at the IHE.

Discourage campus visits by ill persons: Use a variety of communication methods such as e-mail, posters, flyers, and media coverage to discourage people with flu-like illness from visiting the campus or attending IHE events such as football games or concerts until they have been free of fever for at least 24 hours.

Encourage hand hygiene and respiratory etiquette of both people who are well and those that have any symptoms of flu:  Emphasize the importance of the basic foundations of flu prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).

Dr. Rotbart: Here’s the bottom line – although this flu has a fancy name and has reached “pandemic” proportions in terms of numbers of cases worldwide, it’s still just “flu”, and all the rules for prevention apply – personal hygiene, home hygiene, and community hygiene.

Routine cleaning

  • Establish regular schedules for frequent cleaning of high-touch surfaces (for example, bathrooms, doorknobs, elevator buttons, and tables).

Dr. Rotbart: Once again, as in the post last month, I take issue with the CDC here. There is a difference between cleaning and disinfecting. A disinfectant should be used on high-touch surfaces – either out of the bottle or a disposable disinfecting wipe. Disinfectants kill germs like influenza, whereas cleaning washes away the loose germs and leaves others behind.

  • Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks) can be wiped down by students before each use.

Dr. Rotbart: Disposable wipes should be disinfecting wipes (see above comment). These should be put into every dorm room, frat, and sorority, as well as all off campus student housing where more than one student resides.

  • Encourage students to frequently clean their living quarters, including high-touch surfaces.

Considerations for specific student populations

  • Review policies for study abroad programs, including accessing health services abroad and reporting illness to the IHE.
  • Communicate plans, policies, and strategies to partner K-12 schools regarding “early/middle college” students, prospective student tours, and other K-12 students regularly on campus.
  • Determine if special communication strategies are needed to meet the needs of students with disabilities.
  • Remind health-care profession students to follow infection control guidance for health-care workers. Visit http://www.cdc.gov/h1n1flu/clinicians for guidance for health care settings.

Dr. Rotbart: For more useful information, see these links:

http://www.cdc.gov
http://www.sayboototheflu.com

http://www.webmd.com

http://collegesurvivalguide2009.com/National_Edition.pdf