Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
Status
Status Update
NEW Dec 16, 2009
Flu Activity May Occur in “Waves”
The timing, spread and severity of influenza viruses is uncertain.
Outbreaks of influenza may occur in different places at different times.
Outbreaks may occur in waves of about 6-12 week time periods.
These waves of influenza may occur over a year or so after the emergence of a new influenza virus.
In past pandemics, “waves” of activity have been observed.
The first wave is usually a smaller wave; followed by a larger “peak” wave. Subsequent smaller waves can occur as well.
The United States experienced its first wave of 2009 H1N1 pandemic activity in the spring of 2009.
At this time, we are experiencing a second wave of 2009 H1N1 activity.
It’s possible that other waves of influenza activity may occur after this current wave – caused by either 2009 H1N1 viruses or regular seasonal flu viruses.
Because the timing and spread of influenza viruses are unpredictable, CDC is continuing to recommend vaccination with seasonal influenza vaccine and 2009 H1N1 vaccine for those people in whom it is recommended.
Overall influenza activity is increased over baseline in New York City, indicating citywide circulation of influenza, but has begun to decrease and is still far below the levels seen in May and June of 2009.
Hospitalizations and deaths due to influenza A (including the novel H1N1 subtype) are increased over baseline in NYC, but are not as high as during May and June of 2009.
H1N1 remains the predominant influenza subtype currently present in NYC. A small amount of influenza B is also present. Laboratory surveillance shows increasing levels of Respiratory Syncytial Virus (RSV) circulating in NYC.
Seasonal flu shots and flu mist are now available from many doctors, clinics and pharmacies. There's plenty of time to get seasonal flu vaccine which increases in December or sometimes later.
New York City encourages all parents to have their children vaccinated by the child's medical provider. This year the City is also working with schools to offer the A/H1N1 vaccine at no cost to parents at public, private and parochial elementary schools starting in late October/early November (Learn more). Schools should be distributing permission packets soon. Dr. Anne Schuchat of the CDC said that, "not being vaccinated or not having your children be vaccinated does put them at risk. And the delay in being vaccinated is also a decision to continue to be at risk for the virus."
This flu seems to disproportionately affect children and pregnant women, making them priorities for the first available flu vaccines.
When and how much of the 2009 H1N1 vaccine will be available?
Both the flu shot (in the arm) and nasal spray form of 2009 H1N1 vaccines have now been produced and licensed by the Food and Drug Administration. The federal government has purchased a total of 250 million doses of 2009 H1N1 vaccine. 2009 H1N1 vaccine was available starting early October and approximately 29 million doses of licensed vaccine may be available by the end of October. Vaccine availability, however, depends on many factors so these numbers will be frequently updated. The first doses of live attenuated 2009 H1N1 flu vaccine were administered on October 5, 2009. Administration of the 2009 H1N1 flu shot will begin the week of October 12.
Will there be enough 2009 H1N1 flu vaccine for everyone who wants it?
It is expected that there will be enough 2009 H1N1 flu vaccine for anyone who chooses to get vaccinated. The US federal government has procured 250 million doses of 2009 H1N1 flu vaccine. This quantity of vaccine accounts for the National Institutes of Health (NIH) clinical trial data showing that children 6 months to 9 years of age will need two doses and persons 10 and older will need one dose. Limited amounts of 2009 H1N1 vaccine became available in early October, and more will continue to become available over the upcoming weeks
Where can I find the vaccines?
Get the vaccines from your own medical professional.
NYC residents can learn about additional options or receive information from trained nurses by dialing 311.
More information on the history of flu pandemics can be found here.A Harvard School of Public Health survey finds that nearly half of Americans are concerned (46%) that they or someone in their immediate family may get sick from swine flu during the next 12 months. Click here for the entire report.
Background
This new H1N1 is not the flu we’re used to. It was just getting started when our flu season should have been ending. While anyone can get sick, the pattern of infection is unusual. It hasn’t yet affected many seniors, but it spreads rapidly among otherwise healthy kids up to college age. Scientists at the Centers for Disease Control and Prevention continue to observe higher levels of flu-like illness than normal for this time of year.
All influenza can be serious — and deaths can be expected. Each year on average there are 36,000 seasonal influenza-related deaths in the U.S. – including approximately 2,000 deaths in New York State. People with identified risk factors are especially susceptible.
The new H1N1 virus has been found in many countries, including the southern hemisphere(which is currently in its flu season). The specimens recently tested by the CDC, including from southern hemisphere countries, have not changed — meaning that the vaccines in development is directed against the strain that is still active both here in the U.S. and in the southern hemisphere countries.
Developing Strategies for your organization
Schools and employers should expect to see a wide range of disease patterns across the country and should base their strategies and response to influenza outbreaks on local information from local and state public health authorities. Some of the key indicators that should be used when making decisions on appropriate responses are:
Disease severity (i.e., hospitalization and death rates) in the community where business is located;
Extent of disease (number of people who are sick) in the community;
Amount of worker absenteeism in your business or organization;
Impact of disease on workforce populations that are vulnerable and at higher risk (e.g., pregnant women, employees with certain chronic medical conditions that put them at increased risk for complications of influenza); and
Other factors that may affect employees’ ability to get to work, such as school dismissals or closures due to high levels of illness in children or school dismissals.
During an influenza pandemic, all sick people should stay home and away from the workplace, hand washing and covering coughs and sneezes should be encouraged, and routine cleaning of commonly touched surfaces should be performed regularly.
If the severity of illness increases, organizations should be ready to implement additional measures while continuing to rigorously implement the interventions recommended for an outbreak similar to the spring/summer 2009 H1N1 outbreak.
At some point public health officials may recommend a variety of methods for increasing the physical distance between people (called social distancing) to reduce the spread of disease, such as school dismissal, child care program closure, canceling large community gatherings, canceling large business-related meetings, spacing workers farther apart in the workplace, canceling non-essential travel, and recommending work-from-home strategies for workers that can conduct their business remotely.
Symptoms
The symptoms of swine flu in people appear to be similar to the symptoms of regular seasonal flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting as well. New Yorkers experiencing severe symptoms such as difficulty breathing, should seek health care and treatment.
Updated guidance
Based on information gathered during the spring outbreak, the CDC revised its recommendation about how long people with flu-like illness should stay home and away from other people to prevent spreading the flu. The CDC now recommends that those with flu-like illness stay home until at least 24 hours after their fever is gone, without using fever-reducing medicines like acetaminophen or ibuprofen.
The new recommendation applies to camps, schools, businesses and other community settings where most people are not at high risk for flu complications. It’s important that those with flu-like illness stay home while sick, except to seek medical care, and avoid contact with other people. During spring 2009, most people infected with the new H1N1 flu had fevers for 2-4 days.
Those in high risk groups — with flu like symptoms — should seek immediate medical advice.
The Health Department advises anyone experiencing flu like symptoms to seek immediate medical advice if they belong to any of the higher-risk groups listed below:
people over 65 or under 2 years of age;
people with chronic lung, heart, kidney, liver or blood disorders;
people with immune systems that are compromised (either due to illness or medicines);
NEW October 6 Initial shipments of the New H1N1
have arrived in NYC, and millions of doses are being produced by four manufacturers. People need to be vaccinated for both the seasonal flu and the new H1N1 virus. Vaccination efforts are designed to help reduce the impact and spread of New H1N1 and key populations should get the vaccinations as soon as possible.
The CDC recommends that other vaccination efforts focus on five key populations. The key populations include those who are at higher risk of disease or complications, those who are likely to come in contact with New H1N1, and those who could infect young infants. When vaccine is first available, the committee recommended that programs and providers try to vaccinate:
pregnant women,
people who live with or care for children younger than 6 months of age,
health care and emergency services personnel,
persons between the ages of 6 months through 24 years of age, and
people from ages 25 through 64 years who are at higher risk for New H1N1 because of chronic health disorders or compromised immune systems.
Anti-viral guidance
This flu strain responds to treatment by antiviral medicines, but the antiviral guidance recommends that antiviral treatments be prescribed only under specific conditions:
NEW July 30 Pregnant women are at higher risk of complications of influenza, whether it's the seasonal influenza or pandemics of the past. Pregnant women experiencing flulike symptoms should contact their doctor immediately to discuss the proper course of treatment. An article: “H1N1 2009 Influenza Virus Infection During Pregnancy in the USA” in the online edition of TheLancet on July 29, 2009 at http://www.thelancet.com/ makes the following key points:
Pregnant women with suspected or confirmed influenza infection need prompt treatment with antiviral medication.
Pregnant women are at an increased risk for pregnancy complications if infected with an influenza virus.
Pregnant women who are otherwise healthy have been severely impacted by the New H1N1 influenza virus.
Pregnant women who have been infected with New H1N1 influenza virus have had a higher rate of hospitalization than the general population.
Of 45 deaths reported to CDC during the first two months of the outbreak, 6 (13%) were in pregnant women.
Immunosuppression, including that caused by medications or by HIV;
Persons younger than 19 years of age who are receiving long-term aspirin therapy;
Residents of nursing homes and other chronic-care facilities.
That hospitalized patients be treated with antiviral medications and that sick patients who are at high risk of serious seasonal flu-related complications also receive antiviral treatment.
For prevention (chemoprophylaxis), CDC recommends that clinicians consider use of antivirals in people who are at high risk of serious seasonal flu-related complications and have been in close contact with someone who is ill with New H1N1 virus.
CDC recommends that health care workers, public health workers and emergency responders use appropriate personal protective equipment during exposures with persons who are ill with New H1N1.
Pregnant health care workers whose job brings them in daily close contact with people who are potentially ill with New H1N1 influenza, should consider temporary reassignment to a position that does not involve direct patient contact.
Obviously, people should not self-medicate.
New York City information sources
The NYC New H1N1 with the latest New York information is available here. Check out NYC DOHMH's:
Cover Your Cough ( available in 14 languages including Hebrew, Russian and Yiddish)
Ready New York: Pandemic FluNEW APR 29 (now available in 23 languages, including Hebrew, Russian and Yiddish) Use this order form to request multiple copies.
If the outbreak becomes more serious Mayor Bloomberg and the Commissioner of Health are prepared to take additional steps. JCRC will relay any such recommendations or orders.
Recommended precautions
Get the vaccines: the seasonal flu vaccine now and the A/H1N1 as soon as it becomes available.
Clean your hands. Wash your hands frequently with soap and water or alcohol-based hand gel; use soap and water and wash long enough to sing Happy Birthday twice. If you don’t have soap and water, use alcohol-based hand cleaner.
Stay away from people who are sick, if possible . Avoid close contact with people who are sick.
Stay home when you are sick. When you are sick, keep your distance from others to protect them from getting sick too. Stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
Review your family's emergency plan. If you don’t have one yet, consider developing a family emergency plan as a precaution. This should include storing a supply of extra food, medicines, facemasks and other essential supplies. Plan for the eventuality that schools, offices or other businesses may close.
For an outbreak similar to the spring H1N1 outbreak, the CDC recommends stepping up basic good hygiene practices like hand washing, keeping sick students and staff away from school and helping families identify their children who are at high-risk for flu complications and would benefit from early evaluation from their physician if they develop the flu.
If outbreaks become more severe, CDC recommends extending the time that sick people are away from school, allowing people at high risk for flu to stay home, actively watching for signs of illness in students and staff and considering preemptive school dismissal.
The recommendations will be most effective when implemented together as a package that combines good hygiene and practices to keep those who are ill separated from those who are well, with more active interventions based on the severity of the flu outbreak.
CDC experts do not anticipate more illness from the new H1N1 influenza than this past spring and more school-based outbreaks because influenza is typically transmitted more easily in fall and winter. By taking planning steps now schools can help ensure they’re prepared for any future flu activity.
CDC and its partners will be continually monitoring the spread of flu, the severity of the illness it’s causing (including hospitalizations and deaths) and whether the virus characteristics are changing. We will provide updated assessment of severity and revise guidance as indicated.
School and day care administrators, employers and managers of group living facilities should make sure to do the following to avoid the spread of illness:
Keep shared spaces clean and well ventilated.
Group living facilities should separate people who are sick
Schools and employers should encourage those who are sick to stay at home, but should not require doctors’ notices to let healthy people return.
Encourage hand washing and the covering of mouths when coughing.
For more information see Update on School (K – 12) and Child Care Programs. If a cluster of cases in a particular school, business or organization appears or the number of cases in the region increases dramatically government officials may advise or order closings. Plan for that eventuality and ask your constituencies to do so, too. Parents should have a backup plan for childcare in the event of a school closing. Businesses and organizations should have business continuity plans assuming the potential of pandemic flu. Guidance from the NYC Office of Emergency Management is available here.
Be informed. Check out the NYC Swine Flu information page often. Subscribe to receive automatic updates on Swine Flu from the Centers for Disease Control and Prevention right on your desktop or browser at Swine Flu RSS feed. The U.S. Department of Homeland Security Daily Update briefing and materials can be found here.
Consider impacts on faith and social group activities. If you participate in regular group activities, such as worship services, sports teams, book clubs, service groups, or volunteer programs, discuss how a possible pandemic flu might affect your meeting frequency and location, routine practices, and planned activities. Also consider what your group can do to help your community during disease outbreaks or other emergencies, such as collecting donations of supplies, checking on people who may need help, and providing child-care support.
Alternative work arrangements might be needed. Health officials currently recommend that those with flu-like symptoms stay home for seven days in order to minimize the possibility of contagion. Think about your business' or organization's capacity for telecommuting, remote desktopping, conference calls, online collaboration tools and other options. For ideas, check out the article: "Reduce Travel By Telecommuting" on the nonprofit Techsoup webpage.
Pandemic Flu: A Planning Guide for Educators (U.S. Department of Education)
Identifies issues to consider when planning for seasonal flu, a mild or moderate pandemic flu, or a severe pandemic. It tells what a "flu pandemic" is, how influenza spreads, and what can be done to limit the spread of the flu.
Guidance on Preparing Workplaces for an Influenza Pandemic (Occupational Safety and Health Administration) Provides guidance and recommendations on infection control in the workplace, including information on engineering controls, work practices, and personal protective equipment, such as respirators and surgical masks.
Review your leave policies. Are your organization's sick leave policies adequate and flexible to cover the possible eventualities in the event of pandemic flu? Check out the federal government's plans to provide for options such as flexibility and telecommuting.
Take steps to stop the spread of germs. Initiate programs in your school or workplace.
Plan for the eventuality that things might get worse. Flu outbreaks are unpredictable because the flu virus readily mutates. At this time the swine flu is not considered a pandemic but it might become one or it might fizzle. A pandemic is a global disease outbreak. A flu pandemic occurs when a new influenza virus emerges for which people have little or no immunity, and for which there is no vaccine. The disease spreads easily person-to-person, causes serious illness, and can sweep across the country and around the world in very short time. Although the publications below are focused on pandemic flu, almost all of the recommendations are helpful in the current situation.
NEW MAY 7 CDC School Closure Guidance
Children are susceptible to New H1N1 flu, and schools or childcare facilities may act as a point of spread.
Parents and guardians should monitor their school-aged children, and faculty and staff should self-monitor every morning for symptoms of flu-like illness.
Students, faculty and staff who appear to have flu-like illness or become ill during the school day should be isolated promptly in a room separate from other students and sent home.
Students, faculty, and staff who have flu-like illness should stay home for 7 days after symptoms have started or at least 24 hours after symptoms resolve, whichever is longer, seeking medical care if symptoms are severe.
School dismissal is not advised for a suspected or confirmed case of New H1N1 flu, unless absenteeism is so high that the school cannot function.
Any dismissal must be done working closely with the local or state health departments.
Any students sent home from school because they are ill or because school has been dismissed should not attend other childcare or group activities.
Schools and childcare facilities do not need to do extra cleaning (such as washing walls) before children can return.
Schools can help teach students and staff how to reduce the spread of New H1N1 flu through hand hygiene and cough etiquette.
How a pandemic might affect New York
A pandemic influenza outbreak could last many months
and have a major effect on New York City, where
people live, commute, and work so close to one another.
Schools, daycare centers, and businesses may shut down
to reduce the spread of the virus. Public events may be
canceled. Health officials may recommend people with
flu-like symptoms or people who have been exposed to
symptoms stay separate from others.
Many people may be sick at the same time, crowding hospitals and clinics. Stores may be short on supplies like food, water, and gas. Some may have to stay home to care for sick family members. Talk to family and friends about taking care of one another if someone gets sick. Keep sick household members separated from others as much as possible. Those who are sick should wear surgical face masks or something over their mouths and noses to contain germs.
More information
For questions, call the New York State Department's hotline at 1-800-808-1987. New York City residents should call 311. The JCRC will continue to monitor local, state and national health sources and will send out other advisories as necessary. If you need further information feel free to contact David Pollock at the JCRC at pollockd@jcrcny.org or (212) 983-4800, ext. 132.
Swine Flu and You: Provides answers to questions about Swine Influenza
Swine Flu Video Podcast: In this video, Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.
Ounce of Prevention: Tips and streaming video for parents and children about the steps and benefits of effective hand washing
CDC Free Flu Materials: This year’s seasonal flu materials are free for download—no printed versions are available. They may be printed on a standard office printer, or you may use a commercial printer. Emphasis remains on outreach to high-risk groups, as well as parents of all children, health care workers, and people in the workplace.
Prevention Methods
Clean Hands Saves lives: Keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others.
BAM! Body and Mind. Teacher's Corner.: In this activity, students will conduct an experiment on washing their hands. They will learn that "clean" hands may not be so clean after all and the critical importance of washing their hands as a way to prevent the spread of disease.
CDC TV - Put Your Hands Together: (Video) Scientists estimate that people are not washing their hands often or well enough and may transmit up to 80% of all infections by their hands
Cover your Cough Posters: Stop the Spread of Germs that Make You and Others Sick! ... Printable formats of "Cover Your Cough". Posters only available as PDF files.
CDC flu information: Stopping Germs at Home, Work and School. 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.
Information for Schools & Childcare... Cover Your Cough Materials. View larger image. See the Cover Your Cough page on this site for poster and flyer formatted for use in schools. ...
Stopping the Spread of Germs: Stop the Spread of Germs Healthy habits at home, work, & school; Printable Materials, flyers & posters, Cover Your Cough, Germ Stopper Poster. ...
CDC - Be a Germ Stopper: Posters and Materials: For Community and Public Settings Like Schools and Child Care Facilities). ... Cover Your Cough also available for health care settings. ...
Cough Etiquette in Health Care Settings:Tips to prevent the spread of germs from coughing; Information about Personal Protective Equipment Demonstrates the sequences for donning and...
Workplace Planning: Includes flyers and posters, in English, Spanish, Portuguese, French, Vietnamese, Tagalog, Chinese...
Patient Education Materials: This season’s materials reflect outreach to high-risk groups, including caregivers and parents of infants.
Be a germ stopper
"Be a Germ Stopper" posters and screensavers. Simple reminders for good hygiene for use in classrooms, cafeterias or laminated for bathrooms.
See the Stop the Spread of Germs site at www.cdc.gov/germstopper.
Cover Your Cough
See the NYC Cover Your Cough page for poster and flyer formatted for use in schools and other settings (NYC versions in 14 languages, including Hebrew, Russian and Yiddish).
"It's a SNAP" Toolkit
Program materials to help prevent school absenteeism.
Activities for school administrators, teachers, students and others can do to help stop the spread of germs in schools.
See the handcleaning section of the "It's a SNAP" site at www.itsasnap.org/snap/about.asp.
Scrub Club
Kids can learn about health and hygiene and become members of the Scrub Club(tm) at www.scrubclub.org. The site features a fun and educational animated Webisode with seven "soaper-heros" who battle nasty villains who represent germs and bacteria. Kids learn the six key steps to proper handwashing through a webisode, handwashing song, interactive games, and activities for kids, and educational materials for teachers are also available to download.
These publications is not intended to provide comprehensive, institution-specific advice on any aspect of security or emergency planning nor are they meant to replace the advice of a professional in the appropriate field (e.g., health, emergency planning, law, building safety). Some of the topics discussed in these publications are subject to federal, state/provincial and/or local codes and regulations. This publication does not provide a universal guide for regulatory compliance. The material is being provided for educational and informational purposes only, without representation, guarantee or warranty of any kind, and it should not be construed as professional advice. Neither the authors nor JCRC-NY are responsible for any injury, loss or damages to persons or property arising from the use or misuse of this information.
Comments, questions and suggestions are welcome. Send them to info@jcrcny.org.
