H1N1 Influenza

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H1N1 Influenza

• Recommendations
• for Child Care Programs and Schools

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Influenza

• Influenza (flu) is a virus that is easily spread
  every season usually from October to April and
  can cause outbreaks of respiratory illness.
• Symptoms
• Chills
• Fever
• Headache
• Fatigue
• Muscle aches
• Sore throat
• Runny and stuffy nose
• Usually mild illness
• May cause complications in elderly people,
  children and those with a chronic illness
• In some cases the flu can be fatal.

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Pandemic Influenza

• Pandemic Flu is a new highly infectious viral
  respiratory illness that occurs when a new strain
  of influenza virus appears and spreads quickly
  around the world.
• Pandemic flu will spread more quickly than
  seasonal flu because humans will have little or
  no immunity to this new virus.

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Seasonal Flu vs Pandemic Flu 
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H1N1 Flu Virus

• Pandemic H1N1 2009 influenza virus (also known as
  swine influenza) is a type A influenza virus that
  began circulating in the spring of 2009 
• Infection with this virus results in an
  influenza-like illness (ILI) similar to seasonal
  influenza
• People will likely have no natural immunity to
  protect against the virus

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ILI Symptoms

• Acute onset of respiratory illness with cough,
  fever
• And one or more of
• Sore throat
• Joint pain
• Muscle soreness
• Prostration which could be due to influenza virus
• Nausea, vomiting and diarrhea may also be present
  especially in children under 5 years of age
• in children under 5 years of age and adults 65
  years of age and older fever may not be present
  with infection

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How is the Pandemic Flu Spread

• Direct contact spray with relatively large,
  short range droplets produced by sneezing,
  coughing (may spread up to 2 meters), or by
  immediate transfer of the virus via touching,
  kissing etc.
• Indirect Transmission Via recently contaminated
  toys, objects and surfaces.

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Who are at Risk

• People between 5 and 24 years of age comprise a
  larger proportion of cases
• Children are highly susceptible to acquiring and
  transmitting respiratory pathogens
• School/Childcare settings may facilitate the
  spread the disease
• People at risk of complications
• Younger children (especially under age 2)
• Pregnant women
• Aboriginal Canadians
• Adults and children with chronic conditions
• Immuno-compromised

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H1N1 Influenza

• On June 11, 2009, the WHO raised the pandemic
  alert level from Phase 5 to Phase 6 (sustained
  human-to-human transmission in more than one WHO
  Region)
• It does not indicate any change in the severity
  of the circulating virus

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Vaccine

• Seasonal flu shot will NOT provide protection
  against 2009 pH1N1 flu virus
• Enough pandemic vaccine will be produced to cover
  all Canadians, but in early stages vaccine may be
  in short supply. In this situation, the province
  will follow the national recommendations for
  priority groups for influenza immunization
• When vaccine becomes available, Public Health
  will organize vaccination clinics

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Treatment

• Antivirals are drugs used for treatment of
  influenza
• Two antivirals that appear to be effective  in
  treating this illness are oseltamivir (Tamiflu)
  and zanamivir (Relenza)
• Antivirals are used to treat H1N1 Flu Virus when
  the illness is moderate to severe and the patient
  is at a great risk for complications. The
  treatment is most effective when administered
  within 48 hours of symptom onset.

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Infection Prevention and Control

• Identification of students/staff/children with
  symptoms of ILI
• Exclusion from the setting of anyone with
  symptoms of ILI
• Routine infection control practices
• Hand washing
• Cough etiquette
• Cleaning of the environment

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Monitoring

• Active
• Not recommended unless cluster of cases in
  identified
• Passive
• Parents/guardians should monitor the health of
  their children daily for symptoms of ILI
• Teachers and child care program staff should
  observe children for any signs of ILI
• Identified cases of ILI should be recorded

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Monitoring and Reporting

• Report staff and student/child illness to
  supervisor
• Childcare absenteeism should be monitored and
  reported to public health when rates exceed 5
  (remember to compare with regular baseline
  numbers for your centre).
• Continue to report enteric illness at 10 .

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Monitoring

• If a suspect or confirmed case is documented
• Inform the parents of children in the affected
  class/group about
• Potential exposure
• Symptoms to watch for
• If cluster of cases is identified
• Start active surveillance for the affected
  class/group
• School/childcare-wide information to parents may
  be required

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Routine Infection Control Practices

• Hand Washing
• Hand washing with plain soap and water is the
  preferred method of hand hygiene in schools and
  child care centers
• Children will need assistance for following the
  correct technique
• In instances where hand washing sinks are not
  available, supervised use of alcohol based hand
  rubs may be considered
• Alcohol based hand rubs may not be effective if
  hands are visibly soiled

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Routine Infection Control Practices

• Hand Washing
• before meals
• before and after preparing food
• after using the toilet
• after changing diapers or helping a child use the
  toilet
• after blowing your nose, coughing or sneezing
• after wiping a childs nose
• after playing with shared toys, including sensory
  play
• before and after visiting with people who are
  sick

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Routine Infection Control Practices

• Hand washing technique
• Remove all rings and wet your hands
• Put a small amount of liquid soap in the palm of
  one hand.
• Rub your hands together for 15-20 seconds so you
  produce lather
• Rinse your hands well with clean running water
  for at least 10 seconds
• Dry your hands with a single use paper towel.
• Use hand lotion
• Model good hand washing technique to children

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Routine Infection Control Practices

• Cough and Sneeze Etiquette
• Sneeze and cough into your elbow or sleeve or use
  a tissue. 
• After wiping or blowing your nose with a tissue,
  throw away the tissue and wash your hands. 
• Keep your fingers away from your eyes, nose and
  mouth

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Isolation

• Isolate students/children who become ill with ILI
  while in school/child care settings in a area
  separate from others with adequate supervision
  until they can go home
• Ill children to stay 2 meters away from others
• Ensure respiratory and hand hygiene practices
• Notify parents/guardians

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Isolation

• Send home with parent or guardian (not by public
  transit)
• If there is no other option and the child must
  ride a school bus, ensure the child sits on a
  seat by themselves and is able to cover their
  mouth and nose with a tissue.
• Students/staff/children who become ill at home
  with ILI should stay at home until they are
  symptom free and are feeling well and able to
  fully participate in all normal day to day
  activities

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School or Daycare Closure

• Proactive closure - in anticipation of disease
• Public Health Agency of Canada does not recommend
  proactive school closures or daycare closures at
  this time.
• Currently H1N1 virus primarily causes mild
  illness in Canada
• High economic and social costs of proactive
  school closure must be considered
• If the epidemiology of the disease changes
  this recommendation will be reconsidered

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School of Daycare Closure

• Reactive Closure - in response to disease or
  outbreaks
• The decision on school/daycare closure will be
  made by local public health officials and
  school/child care administrations

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Environmental Cleaning

• Influenza viruses are rapidly destroyed by
  cleaning
• High touch surfaces in child care centers should
  be cleaned at least twice daily or more often
  when visibly soiled
• Clean first, then disinfect
• Regular cleaning products and disinfectants are
  sufficient
• Waste handling would be according to usual
  standards

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Caring for Someone Who is Ill

• Separate ill children from well children until
  they can be picked up (sick person should
  generally stay at least 2 metres away from
  others)
• If providing direct care to an ill child surgical
  masks can be worn
• Clean your hands often

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Caring for Someone Who is Ill

• Treat the fever and cough
• "Coughs and sneezes spread diseases"
• Acetaminophen or ibuprofen every 4-6 hours may
  help to bring down the fever and take away the
  aches
• Do not give aspirin to children with fever
• Give lots of fluids and nutritious food, make the
  child as comfortable as possible.

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Outbreak Recommendations

• For Staff/Students/Parents/Children
• Look for symptoms of ILI
• Report symptoms to supervisor
• Stay home if ill
• Seek medical attention
• Contact health care provider remotely prior to
  attempting visit
• Return to school/daycare/work when symptoms
  resolve

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Outbreak Recommendations

• For school/daycare staff
• Promote personal hygiene practices
• Posters of proper hand washing and cough
  etiquette
• Promote vaccination for seasonal flu as well as
  H1N1 when they are available
• Be supportive of children and staff who are ill
  by allowing adequate sick time
• Ensure adequate supply of disinfecting agents
  and adequate sanitation
• Consult Public Health

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Resources

• Public Health Agency of Canada
• http//www.phac-aspc.gc.ca/alert-alerte/h1n1/index
  -eng.php
• Fight Flu
• www.fightflu.ca
• WHO
• http//www.who.int/csr/disease/swineflu/en/
• TeleHealth Ontario 1-866-797-0000
• Other Useful Resourses
• Pandemic Checklist for schools
  http//www.flu.gov/plan/school/schoolchecklist.htm
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