Monday, April 27, 2009

Interim Guidance for Nonpharmaceutical Community Mitigation

Late last night, the CDC posted interim guidance for nonpharmaceutical community mitigation in response to human infections with swine influenza (H1N1) virus. The CDC stresses that these recommendations are based on current information and are subject to change based on ongoing surveillance and continuous risk assessment.

The following are scenario-related recommendations:

When Human Infection with Swine Influenza A (H1N1) Virus is Confirmed in a Community Strongly Recommend Home Isolation of Cases:
• Persons who develop influenza-like-illness (ILI) (fever with either cough or sore throat) should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer. Persons who experience ILI and wish to seek medical care should contact their health care providers to report illness (by telephone or other remote means) before seeking care at a clinic, physician’s office, or hospital. Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention.
• If ill persons must go into the community (e.g., to seek medical care) they should wear a face mask to reduce the risk of spreading the virus in the community when they cough, sneeze, talk or breathe. If a face mask is unavailable, ill persons needing to go into the community should use a handkerchief or tissues to cover any coughing.
• Persons in home isolation and their household members should be given infection control instructions: including frequent hand washing with soap and water. Use alcohol-based hand gels (containing at least 60% alcohol) when soap and water are not available and hands are not visibly dirty. When the ill person is within 6 feet of others at home, the ill person should wear a face mask if one is available and the ill person is able to tolerate wearing it.

Regarding Household Contacts:
• Household contacts who are well should:
1. remain home at the earliest sign of illness;
2. minimize contact in the community to the extent possible;
3. designate a single household family member as the ill person’s caregiver to minimize interactions with asymptomatic persons.

School Dismissal and Childcare Facility*Closure:
• Dismissal of students should be strongly considered in schools with a confirmed or a suspected case epidemiologically linked to a confirmed case.
• Decisions regarding broader school dismissal within these communities should be left to local authorities, taking into account the extent of ILI in the community.
• If the school dismisses students or a childcare facility closes, they should also cancel all school or childcare related gatherings and encourage parents and students to avoid congregating outside of the school.
• Schools and childcare facilities should dismiss students for a time period to be evaluated on an ongoing basis depending upon epidemiological findings.
• Schools and childcare facilities should consult with their local or state health departments for guidance on reopening. If no additional confirmed or suspected cases are identified among students (or school-based personnel) for a period of 7 days, schools may consider reopening.
• Schools and childcare facilities in unaffected areas should begin to prepare for the possibility of school dismissal or childcare facility closure. This includes asking teachers, parents and officials in charge of critical school-associated programs (such as meal services) to make contingency plans.

Other Social Distancing Interventions:
• Large gatherings linked to settings or institutions with laboratory-confirmed cases should be cancelled, for example a school event linked to a school with cases; other large gatherings in the community may not need to be cancelled at this time.
• Additional social distancing measures are currently not recommended.
• Persons with underlying medical conditions who are at high risk for complications of influenza may wish to consider avoiding large gatherings.

These recommendations are subject to change as additional epidemiological and clinical data become available.

*Childcare facility: centers and facilities that provide care to any number of children in a nonresidential setting, large family childcare homes that provide care for seven or more children in the home of the provider and small family childcare homes that provide care to six or fewer children in the home of the provider.

To read the entire posting, including background information, please visit CDC’s swine flu website by clicking on the following link:

1 comment:

Anonymous said...

For more information on community mitigation review:

"Reducing excess mortality
from common illnesses
during an influenza pandemic
WHO guidelines for emergency health
interventions in community settings"
Geneva, 2008