State health officials release guidelines for flu-related school closings, encourage immunocompromised to be ‘vigilant’

LANSING — Officials from the state of Michigan Department of Community Health on Monday said they the state was stepping up its reaction to the increasing number of probable cases of H1N1 influenza in the state. Among the measures, the state issued protocols for schools which have probable cases involving students as well as guidelines for those with immune suppression issues to remain “vigilant.”

Under the state’s plan for schools, the following recommendations were made:

• Schools or child care facilities that have a confirmed or probable case should be dismissed or closed for seven calendar days from the date the local health department was notified of the positive test result. A school or child care facility can consider reopening if no additional confirmed or probable cases have been identified within the seven-day period, but should re-evaluate this with the local health department.

• Siblings of individuals with confirmed or probable cases should remain at home and not attend their school or child care facility during this same seven-day period, especially if they attend a different school or facility.

• If a school or child care facility closes, school or child care-related gatherings should also be canceled for the same seven-day period. Parents and students are encouraged to avoid congregating in large numbers outside of the school setting.

The guidelines were adapted from similar guidelines released by the federal Centers for Disease Control and Prevention in Atlanta late Friday, said Dr. Greg Holzman, MDCH’s chief medical executive for the MDCH. Guidelines from the CDC and the state do not recommend complete sterilization of schools, just cleaning of commonly touched surfaces.

The state said there were 10 confirmed school closing in four counties as of 2 p.m. Monday. State officials were not able to immediately disclose how many of the now 45 probable cases in Michigan are school children, saying that less than 50 percent of the cases were in minors. The CDC has said the average age of infection with H1N1 flu across the country is 16.

When asked if the state expected to see more cases in school age children and the resulting school shut downs, Holzman said: “It is kind of like looking into a crystal ball at this point … My guess we will see more cases.”

In addition to the school closing guidelines, officials are also urging those with conditions that compromise the immune system to remain vigilant.

“This is true with any at-risk population,” medical epidemiologist Eden Wells said in an interview late this afternoon regarding care for special at-risk populations such as the elderly and youth. “But any one who is immuno-suppressed may be at increased risk. We know they certainly could have more with side effects and hospitalization.”

Wells said health officials have implemented stricter monitoring of health care facilities, and are scouring for more severe cases in hospitals. She said there is a concern that those with immune system concerns might develop complications, such as secondary bacterial infections. This, she said, was particularly true with HIV-positive people.

The CDC issued guidelines for HIV positive and immune system compromised individuals Sunday afternoon. That population is being asked to particularly vigilant, Wells said, for symptoms including fever, chills, aches and other flu symptoms and to immediately contact their health care providers.

Wells said the state is unaware if any of the 45 probable cases, or the two confirmed cases in the state, are in people with compromised immune systems.

A probable case is one which has been tested positive for H1N1 at the state lab, but is awaiting confirmation from the CDC. While the CDC lab is backlogged by at least 72 hours, officials said, at least 99 percent of those probable cases nationwide have been confirmed as H1N1 cases. In addition to state lab tests currently being used, MDCH officials announced today the CDC has sent them test kits which are H1N1-specific and those tests should be in use by next week.