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  • Planning and Coordination Infection Control Policies and Procedures Continuity of Core Operations and Student Instruction Communications
  • Transcript

    • 1. Pandemic Influenza and Schools: Preparing to Respond
    • 2. Learning Objectives
      • Understand the history and current status of avian influenza and the potential for pandemic influenza
      • Describe the issues and efforts surrounding preparations for pandemic influenza
      • Identify components to be included in your district's crisis management and/or pandemic influenza plan
      • Describe steps districts can take to develop their pandemic influenza plan
    • 3. Outline
      • Background
      • Planning for Pandemic Influenza
      • How Can Schools Prepare?
      • Developing Your Plan
      • Questions and Discussion
      • Evaluation
    • 4. Background
    • 5. Influenza-Speak
      • Seasonal flu
      • Avian flu
      • Pandemic flu
          • What do they mean? How are they different?
    • 6. Seasonal Flu
      • Illness in humans caused every year by influenza viruses
        • e.g. H1N1, H1N2, H3N2 influenza A viruses, influenza B viruses
      • 5%-20% of the U.S. population gets the flu every year
      • Estimated 36,000 annual deaths in U.S.
      Adapted from CDC Influenza (Flu) Key Facts
    • 7. Seasonal Flu
      • Spread by respiratory droplets (coughing and sneezing)
        • Usually person-to-person: can infect others from 1 day before getting sick to 5 days after becoming sick
        • Sometimes from touching infected surfaces
      • Vaccine offers effective protection
        • Vaccines are developed to match the viral strains expected to circulate each year
      Adapted from CDC Influenza (Flu) Key Facts
    • 8. Avian (Bird) Flu
      • Illness in birds caused by avian influenza viruses
        • Low pathogenic types
        • Highly pathogenic types (e.g. H5N1)
      • Illness in humans caused by avian influenza viruses
        • Spread by direct or close contact with infected poultry or contaminated surfaces
        • No vaccine currently commercially available
      Adapted from CDC Influenza (Flu) Key Facts
    • 9. Pandemic Flu
      • Increased and sustained transmission of influenza in the general population
      • Generally caused by a “new” influenza virus to which few, if any, people have immunity
        • New viruses result from new combinations on viral proteins: i.e. a major change in influenza A virus (“antigenic shift”)
        • Results in viruses that can spread easily from person to person and can cause serious illness due to low levels of immunity in a population
    • 10. Pandemics in the Past 100 Years
      • 1918-1919: H1N1 influenza A virus
        • 500,000 U.S. deaths
        • 20-50 million worldwide deaths
        • H1N1 still in circulation today
      • 1957-58: H2N2 influenza A virus
        • 70,000 U.S. deaths
      • 1968-1969: H3N2
        • 32,000 U.S. deaths
        • H3N2 still in circulation today
      Adapted from CDC Influenza (Flu) Key Facts
    • 11. WHO Pandemic Phases
      • Inter-Pandemic Period
      • Phase 1 : No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in humans, the risk of human infection or disease is considered low
      • Phase 2 : No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease
    • 12. WHO Pandemic Phases
      • Pandemic Alert Period
      • Phase 3 : Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact
      • Phase 4 : Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans
    • 13. WHO Pandemic Phases
      • Pandemic Alert Period
      • Phase 5 : Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk)
      • Pandemic Period
      • Phase 6 : Pandemic occurring – increased and sustained transmission in the general population
    • 14. Current Status
      • Through February 2007, there have been 273 laboratory-confirmed cases of avian influenza A/H5N1 among humans reported to WHO
        • 167 deaths
        • 11 countries – far and middle east, Indonesia, northern Africa
      • Avian influenza A/H5N1 has been confirmed in poultry and/or wild birds in these areas as well as India, Russia and Europe
    • 15. Planning for Pandemic Influenza
    • 16. Planning Goals
      • Prevent/minimize morbidity and mortality
        • Limit disease spread
        • Mitigate disease, suffering and death
      • Minimize social disruption
      • Minimize economic effects
    • 17. Reducing Morbidity and Mortality
      • Primary strategies for combating pandemic flu
        • Vaccination
        • Antiviral medications
        • Community control measures
    • 18. Primary Strategies - Vaccination
      • Vaccination would be the single most effective intervention, BUT:
        • Unlikely that a well-matched vaccine will be available when a pandemic begins
        • Current technology would require 4-6 months for vaccine development after the pandemic begins
        • Once developed, production capacity would limit availability
    • 19. Primary Strategies - Antivirals
      • Antivirals could be used for both treatment and prophylaxis, BUT:
        • Effectiveness of current antivirals against a future pandemic strain is unknown
        • Quantities are limited
    • 20. Primary Strategies – Community Control Measures
      • Two approaches:
        • Decrease the probability that contact will result in infection
          • Cough etiquette, hand hygiene, infection control
        • Decrease contact between infected and uninfected individuals
          • Isolation, quarantine, travel advisories, cancellation of mass gatherings, social distancing, school closures
    • 21. Primary Strategies – Community Control Measures
      • These “nonpharmaceutical interventions” will
        • Help buy time for production and distribution of vaccine
        • Reduce the total number of cases, thus reducing community morbidity and mortality
    • 22. Primary Strategies – Community Control Measures CDC, 2007 Pandemic outbreak: no intervention Daily cases Pandemic outbreak: With intervention Days since first case
    • 23. Primary Strategies – Community Control Measures Collins SD, Frost WH, Gover M, Sydenstricker E: Mortality from influenza and pneumonia in the 50 largest cities of the United States First Edition Washington: U.S. Government Printing Office 1930 .
    • 24. Primary Strategies: Community Control Measures Mayor closes “theaters, moving picture shows, schools, pool and billiard halls, Sunday schools, cabarets, lodges, societies, public funerals, open air meetings, dance halls and conventions until further notice” Closing order withdrawn Levins, H. What he knew in 1918 could save millions of lives. St. Louis Post-Dispatch Jul. 08 2006.
    • 25. Primary Strategies – Community Control Measures
      • Mathematical modeling has shown that closing schools at the outset of a pandemic could decrease attack rates in a community by about 33%
        • Compared to the attack rate when not implementing any control measures
        • School closures would likely occur in concert with other control measures
      National Academy of Sciences, 2006
    • 26. Primary Strategies – Community Control Measures
      • Recommendations for closing schools will depend upon the severity of the pandemic. For example:
        • Category 1 – no closure
        • Category 2 & 3 – short-term closure (~4 weeks)
        • Category 4 & 5 – longer-term closure (~12 weeks)
      CDC, 2007
    • 27. Who will implement these strategies?
    • 28. Public Health Officials
      • Federal, state and local public health agencies maintain the lead role in preparing for and responding to pandemic influenza
        • Examples
          • Federal – Centers for Disease Control and Prevention (CDC)
          • State – Texas Department of State Health Services (TDSHS)
          • Local – Harris County Public Health & Environmental Services (HCPHES)
    • 29. Public Health’s Authority
      • Chapter 81 of the Texas Health and Safety Code establishes the role of the health authority , a physician appointed to administer laws related to public health within their jurisdiction
        • Including laws related to community control measures
          • Such measures include isolation, quarantine, immunization, detention, restriction, disinfection, decontamination, disinfestation, chemoprophylaxis, preventive therapy, prevention and education
    • 30. Public Health’s Authority
      • The authority to compel disease control measures is derived from the state’s inherent “police powers”
        • Police powers refer to the authority of a state government to enact laws and promote regulations to safeguard the health, safety and welfare of its citizens
    • 31. Public Health’s Authority
      • There are 172 local health authorities in Texas, many affiliated with local health departments
        • Areas without local health authorities are “covered” by TDSHS regional health authorities
      • Contact TDSHS Region 6/5S for your local health authority
        • (713) 767-3000
    • 32. Public Health and Pandemic Planning
    • 33. Roles and Responsibilities
      • Federal Agencies (CDC, etc.)
        • Supporting the establishment of stockpiles of vaccines and antivirals
        • Facilitating (and funding) state and local planning
        • Providing guidance to the private sector
        • Overall domestic incident management
      • TDSHS
        • Developing and exercising preparedness and response plans
        • Managing federal pandemic preparedness grant funding to local agencies
        • Maintaining state-purchased stockpiles of medications
    • 34. Roles and Responsibilities
      • Local Health Departments
        • Developing and exercising preparedness and response plans
        • Integrating non-health entities in pandemic planning
        • Providing education to the public and other key stakeholders on pandemic influenza
        • Monitoring local disease status
        • Providing local incident management
      • In Texas, decision-making regarding pandemic influenza will be made at the local level
    • 35. Assumptions
      • 30% of population may become ill
      • 15% of population will seek outpatient care
      • 0.3 to 3% of population will be hospitalized
      • 0.07 to 0.64% of population may die
    • 36. Assumptions
      • The duration of illness for an uncomplicated case of influenza is five days
      • Medical care services may be severely taxed or overwhelmed
      • Illness rates may be up to 40% among school-aged children and 20% among working adults
      • 30% or more of the workforce may be out of work due to illness at the peak of a major pandemic influenza wave.
        • This includes work loss while caring for oneself or for ill family members
    • 37. Surveillance
      • In addition to conducting year-round monitoring of influenza in the health-care sector, DSHS collaborates with schools to track reports of influenza-like illness among students
        • Participating schools submit weekly reports of influenza-like illness activity to via fax
    • 38. Prevention/Containment
      • Discusses local plans for the three strategies of pandemic prevention and containment:
        • Vaccines
        • Antivirals
        • Community Control Measures
    • 39. Vaccines and Antivirals
      • DSHS will coordinate decision-making regarding vaccine and antiviral allocation
        • Once vaccines are available, DSHS 6/5S will implement its Mass Vaccination Plan to provide flu vaccine to the public
        • Once antivirals are widely available, DSHS 6/5S will implement its Mass Dispensing Plan to provide public sector distribution of antivirals
    • 40. Community Control Measures
      • DSHS in coordination with local health authorities will develop and enact control measures within jurisdictions. Examples:
        • Isolation and quarantine
        • Social distancing
        • Cancelling mass gatherings
        • Closing schools
      • The types of measures implemented will depend upon the location of cases, size of clusters, availability of vaccine, pandemic severity, etc.
      • Measures will be undertaken in coordination with other local, state and federal officials
    • 41. What’s Your Plan?
      • Contact DSHS Region 6/5S to obtain your area’s pandemic influenza plan
        • (713) 767-3000
    • 42. How Can Schools Prepare?
    • 43. School Planning
      • Schools face several unique challenges:
        • Planning assumptions estimate that in the absence of intervention, illness rates would be highest among school-aged children (~40%)
        • Children may be more likely to spread influenza than adults
        • Unlike many sectors, schools must focus upon protecting their workforce AND their students
        • Schools must address continuity of instruction
    • 44. School Planning
      • Every Independent School District (or the equivalent) should ensure plans to protect the health and safety of their staff and students during a pandemic
        • Plans should build upon existing Emergency Operations Plans (EOPs)
    • 45. School Planning
      • The U.S. Department of Education’s Practical Information on Crisis Planning: A Guide for Schools and Communities is a useful tool for developing and enhancing EOPs
    • 46. School Planning
      • Four domains must be considered when developing plans to prepare for and respond to pandemic influenza:
        • Planning and Coordination
        • Infection Control Policies and Procedures
        • Continuity of Core Operations and Student Instruction
        • Communications
    • 47. 1. Planning and Coordination
      • Planning and coordination refers to:
        • Determining who is responsible for making decisions related to the response to a pandemic
        • Carrying out activities before, during and after a pandemic
        • Developing and maintaining the response plan
    • 48. 1. Planning and Coordination
      • Key activities:
        • Identify the authorities responsible for executing community response plans and activities, including case identification, isolation, quarantine and community control measures
          • On Page 1 of its Pandemic Influenza Plan, Tomball ISD describes the role of HCPHES, references the HCPHES pandemic influenza plan and lists HCPHES contact information
    • 49. 1. Planning and Coordination
      • Key activities:
        • Identify the authority responsible for activating the district’s pandemic influenza plan
          • Provide the contact information for this person(s) to the public health authority so that information regarding community control measures can be communicated efficiently
    • 50. 1. Planning and Coordination
      • Key activities:
        • Address pandemic influenza preparedness as part of your district’s crisis management plan
          • Involve all relevant stakeholders
          • Delineate accountability and responsibility
          • Coordinate with other relevant response plans
          • Establish an organizational structure to manage the execution of the plan, such as an Incident Command Structure – see page 6-19 of the DOE guide
    • 51. 1. Planning and Coordination
      • Key activities:
        • Test your pandemic plan
          • Implement an internal exercise/drill
          • Participate in exercises of the community’s plan
        • Periodically revise your plan
    • 52. 2. Infection Control
      • Infection control refers to:
        • Decreasing the probability that contact will result in infection
        • Decreasing contact between infected and uninfected individuals
    • 53. 2. Infection Control
      • Key activities:
        • Implement policies and procedures that can limit the spread of influenza at school
          • Promote of hand hygiene and cough etiquette
          • Ensure appropriate supplies are available – soap, tissues, hand sanitizer, waste baskets
          • Limit face-to-face contact, when possible
        • Making good hygiene a habit now can help protect children from many infectious diseases, including flu
    • 54. 2. Infection Control
      • Sample policy language from the HCPHES Occupational Health and Safety Manual :
          • “ Following Centers for Disease Control and Prevention (CDC) hand hygiene guidelines, all HCPHES staff will maintain hand hygiene including, but not limited to, hand washing.  HCPHES will ensure that hand hygiene facilities and supplies are readily accessible”
    • 55. 2. Infection Control
      • Houston’s Grace School has permanently posted handwashing and cough etiquette signs in each restroom and classroom
        • The school nurse provides classroom instruction on proper handwashing techniques
    • 56. 2. Infection Control
      • Hand hygiene and cough etiquette resources
          • CDC/DHHS hand hygiene materials targeted to schools -
          • CDC hand hygiene guidelines -
          • CDC “Germstopper” campaign –
          • CDC “Cover Your Cough” campaign -
    • 57. 2. Infection Control
      • At this time, the benefit of wearing disposable surgical masks by asymptomatic persons in a community setting (such as a school) has not been demonstrated to decrease infections during a community outbreak
        • However, you may anticipate that persons at risk may choose to obtain and wear such masks
    • 58. 2. Infection Control
      • Key activities:
        • Establish special policies and procedures regarding absenteeism that may be unique to a pandemic situation
          • Non-punitive absenteeism policies for students
          • Relaxed and/or enhanced sick leave and absenteeism policies for employees
    • 59. 2. Infection Control
      • Sample policy language:
        • “During times of a declared public health emergency and/or large-scale disease outbreak, the district may suspend district policies that penalize students for excessive student absenteeism”
        • “During times of a declared public health emergency and/or large-scale disease outbreak, the district may suspend district programs regarding perfect attendance achievement”
    • 60. 2. Infection Control
      • Sample policy language:
        • “During times of a declared public health emergency and/or large-scale disease outbreak and school remains in session, the district may suspend district policies or temporarily adopt alternate policies regarding staff sick leave and absenteeism”
          • Example - Harris County has a policy that allows 24 hours of sick leave per year to be used to care for ill family members. This type of policy could be waived or expanded during a pandemic
    • 61. 2. Infection Control
      • Key activities:
        • Establish special policies and procedures for staff and students suspected to be ill or who become ill at school, including policies for returning to school
          • Grace School amended its policies to require that an employee or student must be fever-free for 24 hours without the use of fever-reducing medicine prior to returning to school
        • Establish policies for transporting ill students and staff
    • 62. 2. Infection Control
      • Sample policy language:
        • “Staff and students with a known or suspected communicable disease should not remain at school and should return only after symptoms resolve and they are physically ready. Certification of fitness for duty by a medical professional may be required”
          • Consider allowing for modification during a pandemic to encourage home quarantine if a family member is ill
    • 63. 2. Infection Control
      • Key activities:
        • Ensure that school-based health facilities follow national infection control guidelines
          • See for specific guidance regarding infection control procedures for healthcare facilities during a pandemic
    • 64. 3. Continuity of Operations and Instruction
      • Continuity of operations refers to ensuring that the capability exists to continue essential agency functions when faced with high absenteeism or temporary school closure
      • Continuity of instruction refers to minimizing the potential disruption to student learning
    • 65. 3. Continuity of Operations and Instruction
      • Key activities:
        • Develop a continuity of operations plan (COOP) for essential central office functions
          • Payroll
          • Communication with staff, students and parents
        • The basic elements of a COOP can be found at
    • 66. 3. Continuity of Operations and Instruction
      • Key activities:
        • Develop scenarios describing the potential impact of a pandemic on student learning, school closings and extracurricular activities
          • Based on various levels of illness and absenteeism, and different mandates from public health authorities
          • Brainstorm possible alternatives and solutions for each scenario
    • 67. 3. Continuity of Operations and Instruction
      • Possible scenarios:
        • Your public health authority recommends heightening adherence to hand hygiene and cough etiquette and limiting face-to-face contact
        • Your public health authority recommends cancellation of large group gatherings
        • Your district is experiencing a 15% absenteeism rate among staff and 20% among students
        • Your public health authority recommends school closures for twelve weeks
    • 68. 3. Continuity of Operations and Instruction
      • Tomball ISD’s plan contains a flow chart describing action steps for each of the following scenarios:
        • Less than 10% of students absent
          • Letter to parents, heightened surveillance, heightened infection control, etc.
        • 10%-29% of students absent
        • 30% or more of students absent
    • 69. 3. Continuity of Operations and Instruction
      • Key activities:
        • Brainstorm alternate methods to provide instruction to students in the event of high absenteeism or temporary school closure
          • Tomball ISD plans to use its website and “homework hotlines” to disseminate lesson plans, with tutorials conducted through its website, emails and instant messaging
          • Grace School will extend the school year
    • 70. 4. Communications
      • Communications planning refers to ensuring accurate and timely information regarding the impact of the pandemic on your operations
      • Also refers to assisting public health authorities with disseminating messages to the public
        • Schools are a trusted source of information within their communities
    • 71. 4. Communications
      • Key activities:
        • Develop a plan to disseminate information to staff, students and families
          • Designate a lead spokesperson
          • Incorporate links to other communication networks
          • Ensure language, culture and reading level appropriateness
    • 72. 4. Communications
      • Key activities:
        • Develop and test any methods for communicating to staff, students and families during a pandemic
          • Tomball ISD has developed templates for press releases, letters to parents and talking points for school officials in English and Spanish
          • Grace School has developed templates for email blast alerts and “canned” answering machine messages
    • 73. 4. Communications
      • Key activities:
        • Maintain updated communication contacts of key public health and education stakeholders
          • Provide updated status information to these contacts during a pandemic as necessary, including absenteeism rates due to influenza
    • 74. 4. Communications
      • Key activities:
        • Inform staff, students and families where they can find up-to-date and reliable pandemic information
          • State website -
          • Federal website -
    • 75. 4. Communications
      • Key activities:
        • Disseminate information from public health sources about important pandemic topics:
          • Infection control (hand hygiene, cough etiquette)
          • Disease basics (signs and symptoms, modes of transmission)
          • Personal and family protection strategies (family preparedness, at-home care of ill family members)
        • Tomball ISD has developed templates of letters to parents about family preparedness, caring for ill persons at home and stress/crisis management
    • 76. 4. Communications
      • Remember to anticipate the potential fear, stress and anxiety of staff, students and families
      • If possible, minimize rumors and the circulation of misinformation
      • Share your plan with all stakeholders BEFORE a pandemic situation
    • 77. Developing Your Plan: Next Steps
    • 78. Developing Your Plan: Next Steps
      • Identify and engage stakeholders (internal/ external) to be included in planning
      • Determine areas of overlap with EOP
      • Develop action plan and timelines for new items
      • Share draft plan with your public health department for feedback (if desired)
      • Present completed plan to School Board for approval
      • Communicate plan to others
    • 79. Identify and Engage Stakeholders
        • Director of Risk Management
        • Superintendent
        • Director of Health Services
        • Director of Human Resources
        • Director of Curriculum & Instruction
        • Principals (elementary, middle, high school)
        • Teachers
        • Counselors/Mental Health professionals
        • Director of Administrative Services
        • Director of Transportation
        • Public Health
        • Director of Child Nutrition
        • Director of Maintenance
        • Office of Public Information
        • Local Emergency Response
        • Local Law Enforcement
        • Director of Technology
        • Parent representatives
      Who will assist with preparing, responding and recovering from an event?
    • 80. Develop Action Plan & Timeline
      • Key activities:
        • Delineate roles and responsibilities for key stakeholders engaged in planning and executing specific components of the plan.
          • Develop Action Plan using the Pandemic Influenza Planning Tool
        • Ensure timelines are determined
          • Completion by the beginning of the ’07-’08 school year is recommended
    • 81. Pandemic Influenza Planning Tool
      • Assess financial impact of alternate scheduling or school closures
      • Work with Human Resources regarding schools functioning with 30% of work force absent. Look at alternatives such as staggered school times, changes in bussing, and telecommunications
      • Develop communications plan for possible school closures
      April 2, 2007 Stakeholders will outline further areas for development.
      • EOP
      • Suggested Pan Flu policies and procedures
      All key stakeholder stakeholders
      • Determine if any additional policies/procedures need to be in place
      April 2, 2007 Stakeholders to review additional needs re: Pan Flu planning for their department. EOP developed last year with an existing communicable disease plan. Director of Risk Management & other key stakeholders
      • Review district emergency response and communicable disease policies and procedure
      March 14, 2007 Identify and contact district stakeholders and schedule a time to meet. EOP Strategic Planning Work Group developed EOP last year. Example: Jim (Director of Risk Management)
      • Identify or create district committee to provide guidance to school sites regarding pandemic flu preparations
      Timeline Next Steps Existing Resources Responsible Person(s) Task Mitigation and Prevention
    • 82. Resources
      • School District Pandemic Influenza Planning Checklist -
      • Pandemic Influenza Community Mitigation Interim Planning Guide for Elementary and Secondary Schools (see p. 87) -
      • Pandemic Flu: A Planning Guide for Educators -
      • Practical Information for Crisis Planning: A Guide for Schools and Communities -
    • 83. Resources
      • Contra Costa Health Services Pandemic Flu School Action Kit – /
      • Texas A&M Center for Rural Public Health Preparedness Pandemic Flu Toolkit Training – CD provided at registration table
      • HCPHES School Pandemic Flu Preparedness PowerPoint Template –
    • 84. Recognition
      • Special thanks to Harris County Department of Public Health and Environmental Services for the use of this presentation.
    • 85. Questions?
      • Brian Winegar, MPH
      • Public Health Preparedness Program
      • 713-767-3034
      • [email_address]