Officials update guidelines for handling flu-like illness

Thursday, October 8th, 2009 at 6:02 am

The Minnesota Department of Health (MDH) has issued updated recommendations for handling influenza-like illness in child care settings and early childhood education programs that serve children under the age of five.

A major provision of the recommendations involves the amount of time a child should be kept home with possible symptoms of influenza. MDH is recommending that parents keep children under five at home until seven days after the symptoms first appeared or 24 hours after a child’s symptoms go away, whichever is longer.

The updated recommendations call for keeping young children out of child care longer than school-age children who develop symptoms of influenza are kept out of school. If they feel well enough, school-age children may return to school 24 hours after their fever has resolved without the use of fever-reducing medicines like acetaminophen or ibuprofen.

The stricter child care recommendations also apply to facilities where children under five and older children are both present, unless the two groups – as well as staff who interact with them – can be kept separate.

MDH is taking a more protective approach than is currently called for in federal guidance for young children, primarily because they are at higher risk of severe illness from the novel H1N1 virus. In Minnesota, children under five have been hospitalized with novel H1N1 at twice the rate of children aged five to 12 years.

“Observing precautions for preventing the spread of influenza is often not very feasible for young children,” said Dr. Ruth Lynfield, Minnesota State Epidemiologist. “For a young child, it can be difficult to control a runny nose and to cover their nose and mouth when coughing or sneezing. In addition, young children tend to put shared toys and other items in their mouths. Frequent handwashing is also a challenge. For these reasons, influenza and other infectious diseases are easier to spread among young children.”

“We believe extra precautions are justified to protect the health of children in this very vulnerable age group,” Lynfield said.

The new guidelines, which are part of the agency’s ongoing effort to control the spread of novel H1N1, come at a time when influenza activity is increasing statewide.

Minnesota is now reporting “widespread” influenza activity – the highest classification under the system used by the U.S. Centers for Disease Control and Prevention (CDC).

In addition to the more stringent recommendation about how long to keep preschoolers home, MDH is also recommending that facilities or programs serving preschool age children take the following actions:

* Strongly encourage staff to get vaccinated against both novel H1N1 and regular, “seasonal” influenza as soon as vaccine is available. Shipments of this year’s seasonal vaccine have already been arriving in the state. The first shipments of novel H1N1 vaccine are expected in early to mid-October.
* Strongly encourage parents to have their child vaccinated against both kinds of influenza as soon as vaccine is available. Children under six months of age can’t be vaccinated, but older children should be vaccinated against both kinds of flu.
* Encourage parents to talk with their health care provider, and identify the steps they will take if their child develops – or is exposed to – influenza-like illness.
* Notify parents and staff if either children or staff in child care or other early childhood programs become ill with symptoms of influenza.
* Clean all areas of your facility regularly, with an emphasis on objects or surfaces that are likely to be in contact the hands, mouths, or bodily fluids of children.

Parents should also determine how they will handle caring for their child if their child has to stay home with an influenza-like illness, said Kathryn Como-Sabetti, Senior Epidemiologist at MDH.

Public health officials are also emphasizing the importance of simple, “low-tech” prevention measures in protecting yourself against the flu.

“We’re not expecting to have the novel H1N1 vaccine available until early to mid-October,” Como-Sabetti said. “That’s another reason to keep stressing those simple personal protection measures that we’ve been telling people about since April.”

In addition to covering your coughs and sneezes with a sleeve or a tissue, and frequent handwashing, health officials are urging ill people to stay at home. Flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. In some cases, symptoms of novel H1N1 can also include vomiting and diarrhea in addition to respiratory symptoms.

In most cases, people can recover at home without the need for visiting a health care provider. Individuals who are at high risk of severe illness or complications from influenza should talk to their doctor and plan for what to do if they are exposed to influenza or develop influenza symptoms. Those who may be at risk include children under five years of age – especially if they’re under the age of two years; people 65 years of age or older; pregnant women; and people with underlying medical conditions.

Antiviral medications are frequently used to treat high-risk patients, but they need to be given promptly to be most effective. People who do develop severe symptoms from influenza should seek medical care promptly. It is also important to ensure that sick people have enough fluids to drink. Aspirin or medications containing aspirin should not be given to anyone 18 and under with influenza- like symptoms.

For more information about novel H1N1 flu, go to

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