Dr. Cynthia Devore, a Western New York School Physician and member of the Executive Committee of the Council on School Health of the American Academy of Pediatrics (AAP) has just returned from meetings in Washington, D.C. with the following valuable information for school health professionals:

Virtually all of my districts are seeing an increase in reports of Influenza Like Illness (ILI), though there are some schools being hit harder than others, even within the same district. The news at the AAP conference that I attended supported all our actions and indicated that 99% of all ILI that is tested is coming back as H1N1 at this time.

The best course of action at this time would be:

1. Encourage vaccination with seasonal and H1N1 as priority groups come up and vaccine is available.

2. Continue education about good hand hygiene and respiratory etiquette, and continue routine cleaning practices, especially high touch surfaces.

3. Continue any surveillance reporting of absences.

4. Nurses:  Continue to ask sick people to stay home for 24 hrs after symptoms have subsided and to call their MD before they head out for medical care while they are ill, as most people do not need antivirals. Anyone in a risk group should be advised to call their MD to arrange for antivirals within 48 hrs of onset of symptoms.

The conference advised us that things will probably get worse before they get better and that while there are no mutations to the virus seen so far, that can still happen. 

One last concern: if you have an unusually medically fragile child whose parent has been told by the MD to keep a child out of school if H1N1 is identified, it is important to remind parents in general we are not being alerted to specific cases, so we will not be able to give out a notice that H1N1 Influenza is in a given classroom.   Instead, everyone should assume we have H1N1 Influenza in our schools, and parents of high risk students must talk to their private healthcare providers as to whether it is safe for the child to be there.   If a child has a known immunologic, hematologic, or neurological/neuro-muscular condition that is so severe as to risk their lives if they came to school when H1N1 Influenza was present, that child might do well to have home instruction until he/she gets the vaccine and a few weeks have passed.  Those decisions should be made on an individualized basis by the treating specialist, school medical director and school administration.