School Closures (May Cut Infection Rate By 40%)

Permit high-risk students and staff to stay home

If influenza severity increases, students and staff at high risk for influenza complications may consider staying home from school while influenza transmission is high in their community if they, or their families, are concerned about their ability to avoid influenza at school. The decision about whether to stay home should be made in consultation with their health care provider.  People who elect to stay home from school should also attempt to decrease their exposure in other ways for example, by avoiding large public gatherings. Well students should be expected to continue their education while at home as much as possible.

Schools should prepare for discussions with parents about school safety and should consult with school boards and legal counsel about policy accommodations that might be necessary to allow students and staff at high risk for influenza complications to stay home. Local and state laws and policies also might need to be reviewed for applicability. Policies to be reviewed may be official or unofficial, such as school principals’ awards for students with perfect attendance. Schools should plan now for ways to continue educating students who stay home through methods such as instructional telephone calls, homework packets, internet-based lessons, and other distance-based learning approaches.

School dismissals: reactive and preemptive

In case influenza severity increases, CDC recommends that communities review and prepare to implement their school dismissal plans according to the guidelines outlined below. School and health officials should balance the risks of influenza in their community with the disruption dismissals will cause in both education and the wider community. School officials should work closely and directly with their local and state public health officials to make sound decisions, based on local conditions, and to implement strategies in a coordinated manner.

When communities choose to use school dismissal, education and public health officials should clearly state to parents and their communities the reason for dismissing students and the type of school dismissal they are implementing. There are three types of school dismissals: selective (described above), reactive, and preemptive.

Reactive dismissals might be appropriate when schools are experiencing excessive absenteeism among students or staff, a large number of children are visiting the school health office or being sent home from school during the school day with documented fever, the school is not able to keep potentially infectious people out, or for other reasons that decrease the ability to maintain school functioning. Reactive dismissals might reduce the burden on the local health care system.

As with selective dismissals, the decision to dismiss students should be made locally and should balance the goal of reducing the number of people who become seriously ill or die from influenza with the goal of minimizing social disruption. School officials are encouraged to work collaboratively and communicate with neighboring districts or schools to keep others in the region aware of actions that are taken. Officials might decide to dismiss or not dismiss students from their own schools based on the experiences of their neighbors. The risk to students and staff from an ongoing school-based outbreak if potentially infectious individuals cannot be excluded from school may also lead some jurisdictions to decide to close schools. In this case, school-related mass gatherings also should be cancelled or postponed.

Preemptive dismissals can be used to decrease the spread of influenza virus or to reduce demand on the health care system. If global or national risk assessments indicate an increased level of severity compared with the spring 2009 H1N1 influenza outbreak, CDC might recommend preemptive school dismissals. If schools are dismissed, school-related mass gatherings should be cancelled or postponed. This would include sporting events, school dances, performances, rallies, commencement ceremonies, and other events that bring large groups of people into close proximity with one another.
School dismissal is likely to be more effective in decreasing the spread of influenza virus in the community when used early in relation to the appearance of the virus in the community and when used in conjunction with other strategies (for example, cancellation of community sporting events and other mass gatherings). Cancellation or postponement of community events is a decision of event organizers, local public health officials and other government agencies and should be part of a coordinated community process.

A vaccine for 2009 H1N1 flu will likely become available in fall 2009. For children, at least, protective immunity will require 2 doses of vaccine, separated by at least 3 weeks and an additional 2 weeks for the immune response to develop (that is, approximately 5 weeks after the first vaccination). If an increase in community-wide transmission occurs shortly before vaccine-induced immunity is anticipated, or before a scheduled vacation, some jurisdictions may consider preemptive dismissals.

Resuming classes after a dismissal

The length of time students should be dismissed from school will vary depending on the type of school dismissal as well as the severity and extent of illness.  When the decision is made to dismiss students, CDC recommends doing so for 5 to 7 calendar days. Reactive school dismissals are likely to be of shorter duration than selective or preemptive dismissals. Because the goals of selective dismissals (to protect students and staff at high risk of severe illness or death) and preemptive dismissals (to decrease the spread of influenza virus) are usually different from those of reactive dismissals, the length of time schools are dismissed might be longer.

On a regular basis (for example, weekly) communities that have dismissed students from school should reassess the epidemiology of the disease, the benefits of keeping students home, and the societal repercussions of doing so. Based on this reassessment, communities may decide either to extend the school dismissal or to reopen schools. In the event that CDC recommends preemptive school dismissals, this recommendation also might include a modification to the suggested length of dismissal, based on the severity observed across the nation and globally. Therefore, schools and school boards should plan for more prolonged periods of school dismissal. If schools attempt to continue educational services to all students during a lengthy school dismissal, students with disabilities should receive comparable access to education.

The authority for decision-making regarding school dismissal may reside in multiple sectors of state and local government; these entities must work in a coordinated manner. National, regional, or local data, and the decision-making guidance included in this document, may be useful for determining whether to dismiss schools. 

Reducing adverse effects from school dismissal

As part of a community planning process, school dismissal plans should address possible secondary effects on the community. The planning process should include communicating these plans with all community members affected by school dismissal. These might include effects on critical infrastructure, parents’ job security and income loss, school funding due to funding calculations based on attendance, child nutrition due to the loss of access to the school meals program, loss of access to health services, educational progress, and child safety due to possibly increased unsupervised time. Communities should prepare to address these secondary effects so as to increase the acceptability of and participation in school dismissal. Parents should plan for child care while schools are dismissed, as these decisions may be made very quickly.

Communities should also plan to allow school staff to use school facilities while students are dismissed. Keeping school facilities open may allow teachers to develop and deliver lessons and materials (for example, by using school teleconference lines or other distance-based education delivery systems) and other staff to provide essential services (such as preparation of meals) keeping in mind basic infection control practices.