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settings. The guidance applies to such schools in their entirety, even if they provide services for younger or older students. Guidance for child care settings and institutions of higher education will be addressed in separate documents.

This Technical Report includes detailed information on the reasons for the strategies presented in the CDC Guidance for School (K-12) Responses to Influenza During the 2009-2010 School Year3 and suggestions on how to use them. The guidance is designed to decrease exposure to regular seasonal flu and 2009 H1N1 flu while limiting the disruption of day-to-day activities and the vital learning that goes on in schools. CDC will continue to monitor the situation and update the current guidance as more information is obtained on 2009 H1N1.

About 55 million students and 7 million staff attend the more than 130,000 public and private schools in the United States each day. By implementing these recommendations, schools and health officials can help protect one-fifth of the country’s population from flu. In addition to their central mission of educating children and adolescents, schools meet other basic needs: feeding students and providing needed child care, health and mental health services, and safe and stable routines. It is crucial not to interrupt the learning process without due cause. Although illness may be such a cause, schools and their communities have a responsibility to balance the risks of illness among students and staff with the benefits of keeping students in school.

The decision to dismiss students should be made locally and should balance the goal of reducing the number of people who become seriously ill or die from influenza with the goal of minimizing social disruption and safety risks to children sometimes associated with school dismissal. Based on the experience and knowledge gained in jurisdictions that had large outbreaks in spring 2009, the potential benefits of preemptively dismissing students from school are often outweighed by negative consequences, including students being left home alone, health workers missing shifts when they must stay home with their children, students missing meals, and interruption of students’ education. Still, although the situation in fall 2009 is unpredictable, more communities may be affected, reflecting wider transmission. The overall impact of 2009 H1N1 should be greater than in the spring, and school dismissals may be warranted, depending on the disease burden and other conditions.

CDC is continually monitoring the spread of flu, the severity of the illness it is causing (including hospitalizations and deaths), and whether the virus is changing; CDC will provide periodic updates of these assessments. If this information indicates that flu is causing more severe disease than during the spring 2009 outbreak, or if other developments might require more aggressive mitigation measures, CDC might recommend preemptive, or early, school dismissals.

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