Influenza Pandemic Mitigation: Schools Play Major Role

Cases of the seasonal influenza, a respiratory infection sometimes called “fl u” that is accompanied by fever and cough, typically peak between November and March in the United States, though the season can last until May, and fl u viruses circulate year round. Millions of people in the U.S. get the fl u each year resulting in approximately 36,000 deaths and 200,000 hospitalizations annually according to the Centers for Disease Control and Prevention (CDC). Certain groups, such as the elderly, young children, and those with immune diseases, are more susceptible to serious complications from the fl u, but anyone can get the virus—including very healthy adults.

There is a global concern among health experts and government officials regarding a deadly respiratory influenza virus that has been transmitted from wild birds and domestic fowl (avian species) to humans. Mutations in this virus have resulted in a small number of cases of human-to-human transmission. It is possible the virus will continue to mutate and could lead to an influenza pandemic. A pandemic is an outbreak of disease that spreads easily and rapidly over a large geographic area, possibly throughout the globe. Potentially life threatening to millions of people instead of thousands, an infl uenza pandemic could cause severe illness and negative impact to society as a whole.

The current concern regarding influenza pandemic stems from a particularly virulent avian influenza virus known as H5N1. The World Health Organization (WHO) reports that this virus has led to millions of avian cases and almost 230 human cases in southeast and central Asia, plus an additional 50 cases in the Middle East and Africa, during the past few years. WHO is monitoring reported cases of humans who contract the avian flu virus and issues frequent updates on its Web site ( So far human cases have occurred primarily when a person came into contact with an infected bird, but there have been a few cases of person-to-person transmission. The concern is that the highly pathogenic H5N1 virus could mutate, thus becoming more easily transmitted between humans.

Resources to Aid Schools With Planning

When a new strain of virus emerges, natural immunity is limited, and it takes time to develop a virus-specific vaccine. With 55 million students enrolled in U.S. schools, it is imperative for school districts to include pandemic flu preparedness in their crisis plans. Within local communities, children are more likely to transmit an infectious disease for a variety of reasons. They are not as diligent in following hygiene practices, like washing their hands with soap and covering their noses when they sneeze. Also, students and teachers spend a lot of time in close quarters during the school day making it easier for a virus to spread. During a 2006 national tour, Education Secretary Margaret Spellings joined Health and Human Services Secretary Mike Leavitt to discuss pandemic planning at the federal, state, and local levels.

During a stop in North Carolina, Secretary Spellings said, “When it comes to preparing our school community … there are three key steps to take: One, talk to your local health officials and work together to develop a plan. Then secondly, train your teachers and administrators to implement the plan. And fi nally, teach students and parents so they understand what to do in the event of a pandemic.”

To help schools and communities prepare for and mitigate the onset of a pandemic, numerous resources offer guidance on the matter. The White House developed a national strategy and released guidelines in the National Strategy for Pandemic Influenza: Implementation Plan. This plan outlines the responsibilities regarding pandemic planning and response for all levels of the U.S. government and society.

The U.S. Department of Health and Human Services (HHS) manages and maintains a Web site with comprehensive information about pandemic planning, including definitions and latest news. The site,, offers specific guidelines and checklists for schools, businesses, communities, and individuals. It offers one-stop access to pandemic information and resources, including global monitoring and state-by-state activity.

In February 2007, the Centers for Disease Control and Prevention (CDC) at HHS published guidelines for non-pharmaceutical interventions (NPIs). The Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States describes strategies to help reduce the spread of disease, a pandemic severity index, triggers for initiating interventions, and specific planning guidance for employers, schools, faith-based and community organizations, families, and individuals.

These interventions include the following community measures to be used or considered, along with individual measures, such< as hand washing and cough etiquette:

  • Isolation (at home or in a health-care setting) and treatment (as appropriate) with influenza antiviral medications of all persons with confirmed or probable pandemic influenza;
  • Voluntary home quarantine and prophylactic use of antiviral medications, providing sufficient supplies and ensuring means of distribution exist;
  • Dismissal of students from school and school-based activities and closure of child care programs coupled with protecting children and teenagers through social distancing to limit out-of-school social contacts and community mixing; and
  • Social distancing measures in the community and workplace that may include canceling large public gatherings, altering workplace environments and schedules, and implementing workplace leave policies.

The CDC has created a pandemic severity index that is similar to the indexes used for hurricanes or tornadoes. It is based on the case fatality ratio, which is the percentage of deaths among those clinically ill. The index, which charts the severity of a pandemic from Category 1 to Category 5 (low to high), is available for contingency planning. Accordingly, the index will be activated to measure any future pandemic and inform communities of the appropriate interventions at each stage. For instance, closing schools would become a consideration during categories 2 or 3 and would be a recommendation during categories 4 and 5.

Alert, Standby, Activate

Choosing the optimal time to begin intervention methods is critical. Beginning interventions too early can lead to unnecessary economic and social hardship as well as “intervention fatigue,” but waiting too long may limit the public health benefit of the interventions. CDC suggests that the primary activation trigger for implementing interventions be the arrival and transmission of pandemic virus within a community. Local jurisdictions would make that determination relying heavily on public health monitoring. The CDC guidance refers to three levels of notification to signal when communities should begin implementing measures:

Alert, Standby, and Activate. CDC will use this system in conjunction with its severity index and WHO’s phases of pandemic. Communities, schools, and individuals should be familiar with the terminology and the appropriate community measures for each category.

Another consideration is the duration of implementing various measures. Current guidelines suggest that communities be prepared to sustain measures for up to 12 weeks during a Category 4 or 5 pandemic.

Putting Planning Into Action

The U.S. Department of Education (ED) and other departments, including HHS, encourage schools to conduct interagency exercises using their pandemic plans. Practice will show limitations and unexpected consequences that will help fill any gaps in plans and procedures. CDC will continue to revise the community mitigation guidance based on lessons learned from exercises led by HHS and the Department of Homeland Security.

ED is preparing specific guidance for schools, school districts, and higher education institutions to explain how Department regulations and policy may apply to the CDC guidance. These guidelines, shaped in part by solicited public comments and questions, are expected to be released in late 2007.
Visit for one-stop access to pandemic flu information.