Following Monday’s H1N1 pandemic summit, there were two press releases from Minnesota Department of Health (MDH) this week.
H1N1 has officially returned from its summer vacation, where, following a mid-June peak, cases trickled off to sporadic. On Wednesday, MDH officially classified Minnesota’s flu activity as “widespread,” medical lingo for “all over the place.”
The designation is the highest classification of flu activity under the Center for Disease Control’s flu reporting system, which defines widespread as having laboratory-confirmed outbreaks in at least half of the sub-regions in the state. This is different than the initial outbreak in the spring, in which cases were concentrated in the metro area. If you’re keeping a tote board at home, this means it’s time to have the kids color L’Etoile du Nord in brown.
You might wonder, “If the MDH isn’t doing confirmatory testing on routine cases (where “Stay home!” is the motto), how can they know what the true level of flu activity in the state is?”
The answer is that since 97 percent of influenza-like illnesses (ILI) have been proven to be due to H1N1, a person with flu-like symptoms almost certainly has H1N1. Seasonal flu, other viral infections and tick-borne illnesses round out the list.
With this in mind, MDH has a smattering of sentinel clinics throughout the state that are charged with reporting ILI’s. In addition, Minnesota schools have been asked to notify MDH in two specific situations: where flu is affecting three or more children in the same classroom or when absenteeism from the flu reaches 5 percent or more. Over 30 schools statewide have now reported such flu activity.
Not so fast!
On Thursday, MDH tightened its recommendations for how long a child under the age of five with H1 N1 should be kept at home.
MDH is now recommending that parents keep children under 5 at home until seven days after the symptoms first appeared or 24 hours after a child’s symptoms go away, whichever is longer. That’s more restrictive than the current CDC recommendation, which states that anyone infected with H1N1 can return to public life once they’ve had no fever for 24 hours (without the use of fever-reducing medications like acetaminophen or ibuprofen).
These guidelines are based on the knowledge that fever is a reliable indicator that a person is shedding virus in their secretions and is therefore capable of infecting others. Data from H1N1’s inaugural outbreak last spring showed that those who were able to fend off the virus at home had a fever that lasted somewhere between two to four days. Add a fever-free 24 hours onto that and most people will be out of school or work for three to five days.
This 24-hours-without-a-fever rule is a prudent recommendation to curb the spread of the virus, but it’s not airtight or absolute. A few people continue to shed virus in small numbers even after their fever has resolved (the CDC has documented cases where viral shedding lasted for 10 days); and the CDC allows state and local health departments to extend the 24 hour period based on their own assessment of flu activity and risk.
With H1N1 infections now widespread in the state, MDH opted for stricter guidelines to protect younger children for two reasons: they’re at increased risk of having a serious infection and they’re the least capable of controlling their secretions.
“Observing precautions for preventing the spread of influenza is often not very feasible for young children,” Dr. Ruth Lynfield, Minnesota state epidemiologist, noted in the news update. Yes! If you’ve ever cared for preschoolers, you know that enforcing good snot hygiene can be like giving the cat a bath.
“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.”
These tighter guidelines are sure to be trouble to parents who depend on daycare for work, but they make sense. If H1N1 marches through their child’s daycare, soon enough they’ll be scrambling for child care coverage or staying home with their child anyway. And the guidelines apply to children who are routinely cared for at home.
Keeping your sick child out of public places — playgrounds, shopping malls, play dates, etc. — until they’re no longer infective will help keep a lid on this pandemic. And besides, why spread the misery?
No flu for you: More reading
Summer’s over and welcome to the H1N1 flu season