Back-to-School Germs

Well, the retail stores are all having their “back-to-school” sales, so it must be time to remind you all of the strategies you should be taking to protect your kids from “back-to-school” germs!

Schools are truly “ground zero” for infectious disease transmission, because schools are both amplifiers of personal and community infections, as well as potential original sources of infections. There are many examples of both the amplifier and the originator roles that schools play in infectious diseases. Of the 3 great influenza pandemics of the 20th century (1918, 1957, and 1968 – I’m not counting the Swine Flu epidemic of 2009 because much has been written about that in my previous GERMBlog entries), the mildest of the 3 (1968) reached its peak during the winter break weeks of December. Because kids were not in school, the 1968 flu pandemic never really took hold in the U.S. to the extent that its forerunners did. In contrast, those two more severe pandemics (1918 and 1957) occurred just as kids were returning to school in Sept-Oct.  Kids in school rapidly became infected, and in turn infected their families and their communities. Influenza pandemics are examples of the amplifier role of schools in infectious diseases.  An infection enters the schools from the community and “explodes”, rapidly spreading among a highly susceptible and highly concentrated population of kids. Another extraordinary example of the critical role that schools play as germ amplifiers is smallpox.  It was mandatory school smallpox vaccination laws that were the ultimate key to eradicating that dread disease from this country – by protecting kids in schools, we saved millions of their lives as well as the lives of millions of others in the larger community.  Similar successes have been seen with mandatory polio, measles, mumps, meningitis, and other vaccines that are given to school kids and in so doing protect the country’s population as a whole.

In Sept-Oct, 2007, we saw examples of the potential for schools to also be the original source of infections.  MRSA (methicillin-resistant staphylococcus aureus – also known as “superbug”) outbreaks occurred in schools throughout the country (see Dr. Rotbart’s GERMBlog entries of October 17, 2007 and October 28, 2007). Although never proven to come from environmental contamination in the schools, the Centers for Disease Control and Prevention (CDC) and school districts across the country undertook rigorous measures to clean and disinfect schools.

At the forefront of the war against infectious diseases stand our school nurses.  In my talks to school nurses around the country, titled “Germ Proof Your Schools”, I emphasize the 3 core strategies that nurses must take to reduce school infections and reduce student absenteesim. The strategies are:

1. Reinforce students’ personal health and hygiene practices (including handwashing, wound care, vaccines, proper nutrition, adequate sleep, reduced stress, appropriate clothes to match the weather, and regular moderate excercise)

2. Adhere to health department exclusion and inclusion policies for infectious diseases (each state sets its own rules for which infections or symptoms warrant exclusion from school, and for how long).

3. Practice prudent environmental hygiene (strategic disinfecting policies, as well as meticulous attention to food safety).

There is no better group of professionals than our school nurses to undertake this crucial mission for the health of our kids and for the health of our country.

For much, much more about school health and protecting our kids from germs, see Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, 2008) (

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