Basic foundations of infection control in school settings should always be promoted and facilitated, not only during an influenza pandemic. During flu season, schools should be particularly vigilant about keeping sick students and staff home. Schools should be proactive, develop contingency plans to cover key positions (for example, school nurses) when staff are home ill, and regularly remind parents and staff of the exclusion recommendations. Plans should focus on protecting people at high risk for influenza complications as these groups are frequently found in schools. For example, asthma alone affects nearly one in ten school-aged youth. For a list of groups at high risk for influenza complications, see Novel H1N1 Flu and You.4
For general guidance on infection control in schools, see the American Academy of Pediatrics’ Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 2nd Edition5 (2009).
CDC recommends that individuals with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8° C] or greater), or signs of a fever, without the use of fever-reducing medications.
This recommendation is based on epidemiologic data about the overall risk of severe illness and death and attempts to balance the risks of severe illness from influenza and the potential benefits of decreasing transmission through the exclusion of ill persons with the goal of minimizing social disruption.
Decisions about extending the exclusion period should be made at the community level, in conjunction with local and state health officials. More stringent guidelines and longer periods of exclusion – for example, until complete resolution of symptoms – may be considered for people returning to settings where high numbers of high-risk people may be exposed.
Epidemiologic data collected during spring 2009 found that most people with 2009 H1N1 flu who were not hospitalized had a fever that lasted 2 to 4 days; this would require an exclusion period of 3 to 5 days in most cases. Those with more severe illness are likely to have fever for longer periods of time. Although fever is a component of the case definition of influenza-like illness, the epidemiologic data collected during spring 2009 found that a minority