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their best course of action to help decrease the spread of influenza. Decision-makers should explicitly identify and communicate their objectives which might be one or more of the following: (a) protecting overall public health by reducing community transmission; (b) reducing transmission in students and school staff; and (c) protecting people with high-risk conditions.

Some strategies can have negative consequences in addition to their potential benefits. In the particular case of school dismissals, decision-makers also must consider and balance additional factors: (a) how to ensure students continue to learn; (2) how to provide an emotionally and physically safe place for students; and (3) how to reduce demands on local health care services. The following questions can help begin discussions and lead to decisions at the state and local levels.

Decision-Makers and Stakeholders

Are all the Right Decision-Makers and Stakeholders Involved in the Decision-Making Process?

  • Identify the decision-makers. In different jurisdictions, local and state health, education, and homeland security agencies may have relevant decision- making responsibilities. Direct involvement of governors, mayors, public health officials, or school superintendents may be needed.

  • Identify the stakeholders. Stakeholders will vary from community to community but may include parent representatives, students, local business and faith community representatives, teachers, health care providers, hospitals, community organizations, school nurses, school food service directors, and vendors that supply schools.

What is the Process for Working Together?

  • Do you have a process for regular input and collaboration on decisions?

  • Are there strong, open communication channels between health and education officials? Does this include frequent information sharing?

  • Do you regularly review your crisis and pandemic plans? Do you revise as needed?

Information Collection and Sharing

Can Local or State Health Officials Determine and Share Information About the Following?

  • What is the severity and extent of spread of the disease in the state or locality? What is the rate of outpatient visits for influenza-like illness? What is the local hospitalization rate for influenza-like illness? Are the



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