COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY. Acknowledgments

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2 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY Acknowledgments San Benito County Public Health Services acknowledges the contributions of the US Department of Health and Human Services Center for Disease Control and Prevention, and The American Red Cross. San Benito County Public Health Services would like to thank Contra Costa County for permission to adapt their Pandemic Influenza Plan. Finally, San Benito County Public Health Services gratefully appreciates the school staff and administration of San Benito County for their time, effort and energy in making sure this plan is reviewed and utilized in the event of a pandemic flu incident. P ANDEMIC A CTION K IT FOR S CHOOLS 1

3 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY PANDEMIC ACTION KIT FOR SCHOOLS TABLE OF CONTENTS* INTRODUCTION LETTER FROM THE HEALTH OFFICER OF SAN BENITO COUNTY... 4 PROCESS School Action Steps for Pandemic Flu... 5 Prior to Outbreak/Preparedness & Planning Phase... 5 Outbreak of Flu Disease: Less than 10% Students... 5 Expansion of the Outbreak: 10% or more Students Ill (but less than 30%)... 6 Continued Expansion of the Outbreak: More than 30% of Students Ill... 6 Following the Outbreak... 6 School Response to Pandemic Flu Flow Chart... 7 School District (K-12) Pandemic Influenza Planning Checklist... 8 SAMPLE LETTERS FROM HEALTH OFFICER Sample Health Officer ADA Support Letter to Schools/Epidemic Declaration Sample Health Officer Declaration Closing Schools Public Health Instructions during a Pandemic Flu FACT SHEETS CDC Influenza Stopping Germs at Home, Work, and School Pandemic Influenza Characteristics and Challenges SURVEILLANCE/REPORTING Surveillance and Reporting Definition of Surveillance Levels Standard Surveillance Heightened Surveillance Intensive Surveillance Influenza Case Definition SAMPLE FORMS Weekly Pandemic Flu Census Daily Pandemic Flu Census Daily Pandemic Flu Census Log PARENT INFORMATION Sample Parent Letters Letter #1 Prevention (English) Letter #1 Prevention (Spanish) Letter #2 First Bird Case (English) Letter #2 First Bird Case (Spanish) Letter #3 Initial Outbreak (English) Letter #3 Initial Outbreak (Spanish) Letter #4 Expanded Outbreak (English) Letter #4 Expanded Outbreak (Spanish) Letter #5 School Closure (English) Letter #5 School Closure (Spanish) Letter #6 School Reopens (English) P ANDEMIC A CTION K IT FOR S CHOOLS 2

4 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY Letter #6 School Reopens (Spanish) Parent Tips Plan for an extended stay at home Items to have on hand If someone in your home develops symptoms CDC Family Pandemic Planning Checklist English CDC Family Pandemic Planning Checklist Spanish American Red Cross Home Care for Pandemic Flu MEDIA MATERIAl Sample Press Releases Press Release A- School Open Press Release B-School Closed Sample Talking Points for School Officials Key messages for School Officials A Outbreak Key Messages for School Officials B Closures PUBLIC INFORMATION Posters and Fact Sheets What is Avian Flu (Bird Flu) English What is Avian Flu (Bird Flu) Spanish CDC Be a Germ Stopper CDC Cover Your Cough CDC Germ-Free Zone How Does Seasonal Flu Differ From Pandemic Flu? CDC Keep Our School Healthy CDC Stop Disease (Multilingual) Stopping the Flu Is Up To You (English) Stopping the Flu Is Up To You (Spanish) Pandemic Influenza PowerPoint Presentation Health Emergency Related Topics OTHER RESOURCES Resources for Emergency Information *All material is available electronically on a CD and online at P ANDEMIC A CTION K IT FOR S CHOOLS 3

5 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY SAN BENITO COUNTY Health & Human Services Agency ELIZABETH FALADE, M.D., M.P.H. HEALTH OFFICER KATHRYN FLORES DIRECTOR Public Health Services Healthy People in Healthy Communities 11/12/2006 Dear School Official: This binder of information is designed to provide you with the practical tools you and your staff will need to prepare for a pandemic flu outbreak. At the present, there is no pandemic flu in the United States. It is important to understand that every year, a large number of people get sick with seasonal flu; 30,000 people in the United States die from seasonal flu. Flu vaccines are effective ways to prevent people from getting sick with seasonal flu. At this time, there is also an avian/bird flu (H5 N1) virus in birds circulating in several countries. It is not in the United States now. When cases of flu in birds are identified in the United States, there may be confusion and concern. However, presence of the virus in birds doesn t necessarily mean there will be human cases. There also is no conclusive evidence that the disease spreads easily from person-toperson. At some point, whether it is the H5N1 virus or another virus, health experts believe that there will be a new virus that spreads easily among people for which most people have no immunity and for which there is no vaccine. When that happens and people begin to get sick from the virus, we will have a pandemic flu. There is a great deal of planning for this pandemic underway at the federal, state and local level. The tools in this binder will help your school begin those efforts. They should also help your parents begin their preparations. As the months go by, we will be giving you additional information about: How your school might be used as a site for providing treatment or vaccination. At the moment, site selection is still in process. (This is sometimes called mass prophylaxis) What plans have been developed to care for those who are extremely ill when hospital beds in the county are full. (This is sometimes called surge capacity planning) We hope you will work with us and help us educate the community about the importance of preparation. Please call me if you have any questions. Sincerely, Elizabeth Falade, M.D., M.P.H, Health Officer San Benito County Health & Human Services Agency P ANDEMIC A CTION K IT FOR S CHOOLS 4

6 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY SCHOOL ACTION STEPS FOR PANDEMIC FLU The following is a chronological list of important step-by-step actions schools should take before, during and after a pandemic flu outbreak. Pandemic flu can have several cycles or waves so this list may need to be repeated. PRIOR TO OUTBREAK/PREPAREDNESS & PLANNING PHASE Create a pandemic flu plan. (Use the CDC School Pandemic Flu Planning Checklist and Flow Chart in this section of the binder) Work with local health officials and emergency preparedness officials. They may want to use the schools as a way to disseminate information to families. You can begin with Parent Letter #1 in the Parent section of this binder. Decide the roles and responsibilities of school staff (including all ancillary staff) to prevent the spread of flu. Train nurses and staff in flu-symptom recognition. (See surveillance section of this binder). Remember that a person who is infected does not show symptoms right away. But children who are getting ill may show different behavior than usual, such as eating less or being irritable. Insure that standard surveillance/disease recognition procedures are in place and implemented. (See surveillance section of this binder) Improve the hygiene of students and staff. Use simple non-medical ways to reduce the spread of flu by cough and sneeze etiquette, clean hands, and clean work areas. (See public information section of this binder for posters) Determine whether the school should be cleaned differently or more often. Decide to what extent you will encourage or require children and staff to stay home when they are mildly ill. Identify students who are most vulnerable to serious illness (immune compromised, chronic illness, etc.) Review the health needs of students. Some students may have a greater risk of infections. Encourage those families to talk to their health care provider. Some parents may need to be more cautious in keeping their children out of school. Develop alternative learning strategies such as collaborative agreements with San Benito Television or other local cable stations, teleconferencing, lessons on CDs. Educate staff, students, and parents about: the differences between seasonal flu, bird flu and pandemic flu; best hygienic practices to prevent any sort of flu; what could occur in a pandemic. (Use the information in the public information section of this binder) P ANDEMIC A CTION K IT FOR S CHOOLS 5

7 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY OUTBREAK OF FLU DISEASE LESS THAN 10% STUDENTS Begin Heightened Surveillance Reporting Send out Parent Letter #3 Initial Outbreak, informing parents that some students are sick but schools remain open, include tip sheets and info resource list* Work with San Benito Health Services regarding a Press Release A announcing schools remain open but parents need to prepare/use key message A* Post flu prevention signs on campus EXPANSION OF THE OUTBREAK 10% OR MORE OF STUDENTS ILL (BUT LESS THAN 30%) Local Health Officer issues ADA Support Letter to schools/epidemic Declaration Begin Intensive Surveillance Reporting Send Parent Letter #4 Expanded Outbreak include prevention tip sheets, etc. CONTINUED EXPANSION THE OUTBREAK MORE THAN 30% OF STUDENTS ILL San Benito Health Officer issues Declaration and press release closing school(s) Close school Send out Parent Letter #5 School Closure, announcing closure(s) Cancel any non-academic events FOLLOWING THE OUTBREAK San Benito Health Services issues declaration and press release that schools can open. Issue Parent Letter #6 Continue communicating with local health department Return to heightened surveillance reporting If students get sick again, start checklist again at Outbreak section. 7/06 P ANDEMIC A CTION K IT FOR S CHOOLS 6

8 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY SCHOOL RESPONSE TO PANDEMIC FLU FLOW CHART Flu Cases No Standard Surveillance Reporting Yes Begin Heightened Surveillance Reporting Local Outbreak Health Officer ADA Support Letter/Epidemic Declaration Are Students Ill? Fewer than 10% Letter #3 to parents (prevent, prepare) Begin Intensive Surveillance Reporting 10% or more Letter #4 to parents (stay home) Press Release A Increase in ill students? More than 30% Contact SBCPHS Health Officer issues declaration to close school Continue Heightened Surveillance 30% or less Close School Parent Letter #5 Press Release B New Cases? Resume Standard Surveillance Reporting P ANDEMIC A CTION K IT FOR S CHOOLS 7

9 SCHOOL DISTRICT (K-12) PANDEMIC INFLUENZA PLANNING CHECKLIST Local educational agencies (LEAs) play an integral role in protecting the health and safety of their district s staff, students and their families. The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed the following checklist to assist LEAs in developing and/or improving plans to prepare for and respond to an influenza pandemic. Building a strong relationship with the local health department is critical for developing a meaningful plan. The key planning activities in this checklist build upon existing contingency plans recommended for school districts by the U.S. Department of Education (Practical Information on Crisis Planning: A Guide For Schools and Communities crisisplanning.pdf). This checklist has been modified by San Benito County Public Health Services. Further information on pandemic influenza can be found at and 1. Planning and Coordination: Completed In Progress Not Started Identify the authority responsible for declaring a public health emergency at the state and local levels (San Benito County Health Officer) and for officially activating the district s pandemic influenza response plan. Identify for all stakeholders the legal authorities responsible for executing the community operational plan, especially those authorities responsible for case identification, isolation, quarantine, movement restriction, healthcare services, emergency care, and mutual aid. As part of the district s crisis management plan, address pandemic influenza preparedness, involving all relevant stakeholders in the district (e.g., lead emergency response agency, district administrators, local public health representatives, school health and mental health professionals, teachers, food services director, and parent representatives). This committee is accountable for articulating strategic priorities and overseeing the development of the district s operational pandemic plan. Work with local and/or state health departments and other community partners to establish organizational structures, such as the Incident Command System, to manage the execution of the district s pandemic flu plan. An Incident Command System, or ICS, is a standardized organization structure that establishes a line of authority and common terminology and procedures to be followed in response to an incident. Ensure compatibility between the district s established ICS and the local/state health department s and state education department s ICS. Delineate accountability and responsibility as well as resources for key stakeholders engaged in planning and executing specific components of the operational plan. Assure that the plan includes timelines, deliverables, and performance measures. Work with your local and/or state health department and state education agencies to coordinate with their pandemic plans. Assure that pandemic planning is coordinated with the community s pandemic plan as well as the state department of education s plan. Test the linkages between the district s Incident Command System and the local/state health department s and state education department s Incident Command System. Contribute to the local health department s operational plan for surge capacity of healthcare and other services to meet the needs of the community (e.g., schools designated as contingency hospitals, schools feeding vulnerable populations, community utilizing LEA s healthcare and mental health staff). In an affected community, at least two pandemic disease waves (about 6-8 weeks each) are likely over several months. Incorporate into the pandemic influenza plan the requirements of students with special needs (e.g., low income students who rely on the school food service for daily meals), those in special facilities (e.g., juvenile justice facilities) as well as those who do not speak English as their first language. Participate in exercises of the community s pandemic plan. Work with the local health department to address provision of psychosocial support services for the staff, students and their families during and after a pandemic.

10 1. Planning and Coordination (cont.): Completed In Progress Not Started Review San Benito County Public Health Services surveillance and reporting system that would alert the local health department to a substantial increase in absenteeism among students. Implement an exercise/drill to test your pandemic plan and revise it periodically. Share what you have learned from developing your preparedness and response plan with other LEAs as well as private schools within the community to improve community response efforts. 2. Continuity of Student Learning and Core Operations: Completed In Progress Not Started Develop scenarios describing the potential impact of a pandemic on student learning (e.g., student and staff absences), school closings, and extracurricular activities based on having various levels of illness among students and staff. Develop alternative procedures to assure continuity of instruction (e.g., web-based distance instruction, telephone trees, mailed lessons and assignments, instruction via local radio or television stations) in the event of district school closures. Develop a continuity of operations plan for essential central office functions including payroll and ongoing communication with students and parents. 3. Infection Control Policies and Procedures: Completed In Progress Not Started Work with the local health department to implement effective infection prevention policies and procedures that help limit the spread of influenza at schools in the district (e.g. promotion of hand hygiene, cough/sneeze etiquette). Make good hygiene a habit now in order to help protect children from many infectious diseases such as flu. (See Process and Public Information sections of the PAK binder.) Provide sufficient and accessible infection prevention supplies (e.g., soap, alcohol-based/waterless hand hygiene products, tissues and receptacles for their disposal). Establish policies and procedures for students and staff sick leave absences unique to a pandemic influenza (e.g., non-punitive, liberal leave). Establish sick leave policies for staff and students suspected to be ill or who become ill at school. Staff and students with known or suspected pandemic influenza should not remain at school and should return only after their symptoms resolve and they are physically ready to return to school. Establish policies for transporting ill students. Assure that the LEA pandemic plan for school-based health facilities conforms to those recommended for health care settings (Refer to 4. Communications Planning: Completed In Progress Not Started Assess readiness to meet communication needs in preparation for an influenza pandemic, including regular review, testing, and updating of communication plans. Develop a dissemination plan for communication with staff, students, and families, including lead spokespersons and links to other communication networks. Ensure language, culture and reading level appropriateness in communications by including community leaders representing different language and/or ethnic groups on the planning committee, asking for their participation both in document planning and the dissemination of public health messages within their communities.

11 4. Communications Planning (cont.): Completed In Progress Not Started Develop and test platforms (e.g., hotlines, telephone trees, dedicated websites, and local radio or TV stations) for communicating pandemic status and actions to school district staff, students, and families. Develop and maintain up-to-date communications contacts of key public health and education stakeholders and use the network to provide regular updates as the influenza pandemic unfolds. Assure the provision of redundant communication systems/channels that allow for the expedited transmission and receipt of information. Advise district staff, students and families where to find up-to-date and reliable pandemic information from federal, state and local public health sources. Disseminate information about the LEA s pandemic influenza preparedness and response plan (e.g., continuity of instruction, community containment measures). Disseminate information from public health sources covering routine infection control (e.g., hand hygiene, cough/sneeze etiquette), pandemic influenza fundamentals (e.g., signs and symptoms of influenza, modes of transmission) as well as personal and family protection and response strategies (e.g., guidance for the at-home care of ill students and family members). See Public Information section of binder. Anticipate the potential fear and anxiety of staff, students, and families as a result of rumors and misinformation and plan communications accordingly.

12 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY SAN BENITO COUNTY Health & Human Services Agency ELIZABETH FALADE, M.D., M.P.H. HEALTH OFFICER KATHRYN FLORES DIRECTOR Public Health Services Healthy People in Healthy Communities SAMPLE HEALTH OFFICER ADA SUPPORT LETTER TO SCHOOLS/EPIDEMIC DECLARATION To School Officials: Because of the pandemic flu epidemic in our community, your school(s) is experiencing a material decrease in attendance and is eligible to apply for waivers to recoup average daily attendance (ADA) loss. According to Education Code Section [a][4], schools experiencing a material decrease in attendance- at least 10% of the students who would normally attend a school do not attend on any one day may file for reimbursement for ADA funds due to disease epidemic. The California Department of Education requires the Local Health Officer to verify the cause of increased absenteeism is due to a disease outbreak. This letter serves as verification that the Local Health Officer has declared a pandemic flu epidemic in San Benito County. During the period from (enter DATE) though (DATE), cases of pandemic flu were significantly above baseline levels in San Benito County. For the purposes of Education Code, this constitutes a pandemic flu epidemic that likely resulted in a material decrease in school attendance during this period of time. If you have any questions regarding this letter, call San Benito County Public Health Services Communicable Disease Program at Sincerely, Liz Falade, MD, MPH San Benito County Health Officer P ANDEMIC A CTION K IT FOR S CHOOLS 11

13 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY SAN BENITO COUNTY Health & Human Services Agency ELIZABETH FALADE, M.D., M.P.H. HEALTH OFFICER KATHRYN FLORES DIRECTOR Public Health Services Healthy People in Healthy Communities SAMPLE HEALTH OFFICER DECLARATION CLOSING SCHOOLS To School Officials: The health department is ordering all schools to close immediately due to the pandemic flu epidemic in our community. If you have any questions regarding this declaration, please call San Benito County Public Health Services Communicable Disease Program at Because the virus is spread easily from person-to-person, it is no longer safe for children to attend class. Colleges, daycare centers, and preschools also have been ordered to close. Please inform your students parents and guardians immediately that school facilities will be closed to all activities, including sport and non-academic events, and may remain closed for an extended period of time (for example, up to 6 weeks). The purpose of closing schools is to decrease contact among children to decrease their risk of getting sick and to limit the spread of infection. The health department will keep school officials updated as the situation changes. A press release is being issued to inform the public of this declaration. Sincerely, Elizabeth Falade, M.D., M.P.H, Health Officer San Benito County Health & Human Services Agency P ANDEMIC A CTION K IT FOR S CHOOLS 12

14 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY SAN BENITO COUNTY Health & Human Services Agency ELIZABETH FALADE, M.D., M.P.H. HEALTH OFFICER KATHRYN FLORES DIRECTOR Public Health Services Healthy People in Healthy Communities PUBLIC HEALTH INSTRUCTIONS DURING A PANDEMIC FLU Throughout a pandemic flu, people may be asked or required to do things to help hold back the spread of the disease in our community. Here are some examples of what San Benito County Public Health Services may ask people to do: STAY HOME People who are sick should stay home. Children should not go to school if they are sick. Staying home will be absolutely necessary during a pandemic flu to limit the spread of the disease. AVOID LARGE GROUPS People even those who are well should stay away from gatherings of people such as sporting events, movies, and festivals. During a pandemic flu these kinds of events could be cancelled because large gatherings of people help spread the flu virus. Isolation and Quarantine are public health actions used to contain the spread of a contagious disease. If asked, it will be important to follow Isolation and/or Quarantine instructions. ISOLATION is for people who are already ill. When someone is isolated, they are separated from people who are healthy. Having the sick person isolated (separated from others) can help to slow or stop the spread of disease. People who are isolated can be cared for in their homes, in hospitals, or other healthcare facilities. Isolation is usually voluntary, but local, state, and federal government have the power to require the isolation of sick people to protect the public. QUARANTINE is for people who have been exposed to the disease but are not sick. When someone is placed in quarantine, they are also separated from others. Even though the person is not sick at the moment, they were exposed to the disease and may still become infectious and then spread the disease to others. Quarantine can help to slow or stop this from happening. States generally have the power to enforce quarantines within their borders. P ANDEMIC A CTION K IT FOR S CHOOLS 13

15 FACT SHEET Stopping Germs at Home, Work and School How Germs Spread The main way that illnesses like colds and flu are spread is from person to person in respiratory droplets of coughs and sneezes. This is called "droplet spread." This can happen when droplets from a cough or sneeze of an infected person move through the air and are deposited on the mouth or nose of people nearby. Sometimes germs also can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches his or her own eyes, mouth or nose before washing their hands. We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. How to Stop the Spread of Germs In a nutshell: take care to Cover your mouth and nose Clean your hands often Remind your children to practice healthy habits, too Cover your mouth and nose when coughing or sneezing Cough or sneeze into a tissue and then throw it away. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze. The "Happy Birthday" song helps keep your hands clean? Not exactly. Yet we recommend that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. That's about the same time it takes to sing the Happy Birthday song twice! Alcohol-based hand wipes and gel sanitizers work too When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.* * Source: FDA/CFSAN Food Safety A to Z Reference Guide, September 2001: Handwashing. Germs and Children Remind children to practice healthy habits too, because germs spread, especially at school. February 1, 2004 Page 1 of 2

16 Stopping Germs at Home, Work and School (continued from previous page) The flu has caused high rates of absenteeism among students and staff in our country's 119,000 schools. Influenza is not the only respiratory infection of concern in schools -- nearly 22 million schools days are lost each year to the common cold alone. However, when children practice healthy habits, they miss fewer days of school. School administrators, teachers and staff: See Preventing the Spread of Influenza (the Flu) in Schools for CDC interim guidance. More Facts, Figures, and How-Tos CDC and its partner agencies and organizations offer a great deal of information about handwashing and other things you can do to stop the germs that cause flu, the common cold, and other illnesses. See Other Resources and Posters on this Stop the Spread of Germs site for a select listing of Web sites, materials, and contact information. Source: Am J Infect Control 2000;28: Stop the Spread of Germs in Schools Fast Facts Approximately 1/5 of the U.S. population attends or works in schools. (U.S. Dept of Ed, 1999). Some viruses and bacteria can live from 20 minutes up to 2 hours or more on surfaces like cafeteria tables, doorknobs, and desks. (Ansari, 1988; Scott and Bloomfield, 1989) Nearly 22 million school days are lost annually due to the common cold alone. (CDC, 1996) Addressing the spread of germs in schools is essential to the health of our youth, our schools, and our nation. Students need to get plenty of sleep and physical activity, drink water, and eat good food to help them stay healthy in the winter and all year. For more information, visit or call the CDC Flu Information Line at (800) CDC-INFO. February 1, 2004 Page 2 of 2

17 Pandemic Influenza: CHARACTERISTICS & CHALLENGES A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza virus emerges for which there is little or no immunity in the human population, begins to cause serious illness and then spreads easily person-to-person worldwide. Historically, the 20th century saw three pandemics of influenza: 1918 influenza pandemic caused at least 500,000 U.S. deaths and up to 50 million deaths worldwide 1957 influenza pandemic caused at least 70,000 U.S. deaths and 1-2 million deaths worldwide 1968 influenza pandemic caused about 34,000 U.S. deaths and 700,000 deaths worldwide Characteristics and Challenges in a Pandemic: 1. There Will Be Rapid Worldwide Spread When a pandemic influenza virus emerges, its global spread is considered inevitable. Preparedness activities should assume that the entire world population would be susceptible. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it. 2. Health Care Systems Will Be Overloaded Most people have little or no immunity to a pandemic virus. Infection and illness rates soar. A substantial percentage of the world s population will require some form of medical care. Nations unlikely to have the staff, facilities, equipment and hospital beds needed to cope with large numbers of people who suddenly fall ill. Death rates are high, largely determined by four factors: the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected populations and the effectiveness of preventive measures. Past pandemics have spread globally in two and sometimes three waves. 3. Medical Supplies Will Be Inadequate The need for vaccine is likely to outstrip supply. The need for antiviral drugs is also likely to be inadequate early in a pandemic. A pandemic can create a shortage of hospital beds, ventilators and other supplies. Surge capacity at non-traditional sites such as schools may be created to cope with demand Difficult decisions will need to be made regarding who gets antiviral drugs and vaccines. 4. There Will Be Economic and Social Disruption Travel bans, closings of schools and businesses and cancellations of events could have major impact on communities and citizens. Care for sick family members and fear of exposure can result in significant worker absenteeism.

18 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY Surveillance and Reporting During all stages of a pandemic flu outbreak, it will be essential to monitor and document the number of students and faculty who are absent and meet the definition of influenza-like illness. Keeping track of these numbers will help health officials determine when and whether to close schools, whether the epidemic is increasing in scope and whether to declare an epidemic, making schools eligible to apply for reimbursement of ADA funds during increased absenteeism. Schools are provided with the following information to monitor the illness rate and potential epidemic: Basic surveillance instructions and definitions of surveillance levels Case definition to assist in determining whether the ill student and/or faculty is suffering from an influenza-like illness Reporting form(s) to submit to the San Benito County Public Health Services Division Sample Attendance Log to document flu-related absences to document need to apply for an Average Daily Attendance Waiver P ANDEMIC A CTION K IT FOR S CHOOLS 17

19 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY Definition of Surveillance Levels Standard Surveillance No flu activity reported in the community (flu season) Monitor daily attendance for increased reports of absence due to flu-like illness Do not report absences to the Health Department unless greater than 10% Heightened Surveillance Flu activity reported in the community (less than 10% school absenteeism due to flu-like illness) Monitor daily attendance for flu-like illness/absences Begin morning flu check first hour of school screen those who report positive for symptoms Log absences due to flu-like illness Send weekly absence report (via fax) to Health Department Intensive Surveillance High number of flu illness reported in the community (10% or greater school absenteeism due to flu-like illness) Monitor daily attendance and log absences on log sheet Continue morning flu check Send daily absence report (via fax) to Health Department Begin preparation for potential school closure 7/06 P ANDEMIC A CTION K IT FOR S CHOOLS 18

20 COUNTY OF SAN BENITO HEALTH & HUMAN SERVICES- PUBLIC HEALTH AGENCY Influenza Case Definition The Centers for Disease Control and Prevention defines an influenza-like illness as having the following symptoms: Fever of 101.5º degrees Fahrenheit or higher AND ONE OF THE FOLLOWING Cough Sore throat Headache Muscle ache A student with flu-like symptoms must be sent to the office for screening (symptom check and/or taking temperature). If student meets the case definition as described above, he/she must be excluded from school until symptom free. Enter name of student on tracking log and report on the daily/weekly report form. P ANDEMIC A CTION K IT FOR S CHOOLS 19

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