Subject Albemarle County School Health

Advisory Board Presentation Policy Reference BCF Strategic Plan Goal Reference 5

Date ___October 12 2006____ Enclosures REASON FOR CONSIDERATION Action Information X

Background The Albemarle County School Health Advisory Board assists schools with the development of health policy in the school division and the evaluation of the status of school health including health education the school environment and health services The Health Advisory Board meets at least four times a year and submits a report annually to the School Board regarding health issues in the schools As a result of last yearrsquos presentation the School Board included funding to increase elementary nurses to six hours provide for coaches education and to continue the position of Division Cafeteria Manager in last yearrsquos budget Administrative Consideration (Rationale) The Albemarle County School Health Advisory Board in its presentation to the School Board will highlight its activities during the 2005-06 school year and make its recommendations Suzanne Coffey parent and health professional will give the report Budget Implications (Short and Long Term) Any budget initiatives that are developed as a result of discussions or recommendations of the Health Advisory Board will be brought forward through the regular budgetary process RecommendationFuture DirectionTime Line Receive this report from the Albemarle County School Health Advisory Board for information PREPARED REVIEWED ITEM NUMBER RECOMMENDED

Executive Summary of School HeatlMfjvisory Activities

The Health Advisory Board meE~ts four times a year and submits a reportannually regarding health issues in the schools

We would like to applaud the Board for several significi3nt initiatives this yearApproving the budget ini1iative for 6 hour rlurses in elementary schools

Reinstating the Youth Ri~)k Behavior Survey

Approving the continuation of funding for the Division Cafeteria Manager

Supporting the Coaches Education Program and

Piloting a study to evaluate biodiesel as an alternative fuel for our busfleet

A summary of activities includeDrafted a Student Wellness Policy using data from the School Health

Index (enclosure 1)Developed a school plan to address issues and provide a guided

response to all phases of an influenza parldemic (enclosure 2)Participated in activities c~nd programs to improve child nutritionReceived information reglarding cleaning products and pesticide use

(enclosure 3)Received information reglarding the use 01 biodegradable diesel fuel and

suggested a pilot be corujucted andReceived the results of the biodiesel fuel pilot (enclosure 4)

Recommendations include

Removing Drivers Education from Health Education and teaching it as aseparate course allowing more time to be spent on Health concepts suchas youth drinking and driving and other high risk behaviors (enclosure 5)Discontinuing the $75000 fee charged to the Child Nutrition Program

(enclosure 6)Continuing consideration for switching the County bus fleet to biodieselfuel for its emissions are less carcinogenic and less irritating to therespiratory tracts of our students and staffRequiring ongoing research into the use of bio-tlased cleaning products inour schools to determine if cost is feasible and tlenefits are significantEncourage all schools to participate in the Governors Scorecard and

Replacing the Perfect Attendance Award with awards for excellentattendance as this committee feels strongly that it encourages too manychildren to attend school during the infectious stage of their illness Thisis sensible for any time but holds special relevance now as we have

concerns about pandemic influenza

Enclosure 1JHCF

STUDENT WELLNESS

The Albemarle County School Board recognizes the link between student health and learning and desires to provide a comprehensive program promoting healthy eating and physical activity in Division students Number eleven of the Divisionrsquos Lifelong-Learning Standards is to understand and follow a physically active lifestyle that promotes good health and wellness Albemarle County Public Schools will provide a consistent overarching message in support of the value of wellness practices particularly as they apply to nutrition and physical activity for students and staff Child Nutrition Department (CNP)

The Child Nutrition Department goals are to ensure the nutritional and financial integrity and accountability of cafeteria operations and to enhance the nutrition education of all students Ongoing assessment of the cafeteria operations allows planning to best serve our customers in a cost efficient manner and to support a healthy school climate The Director of Child Nutrition or Child Nutrition staff will conduct periodic audits to ensure compliance of regulations and guidelines for the CNP Nutrition Education Students receive nutrition education that teaches the skills they need to adopt and maintain healthy eating behaviors Division health education curriculum standards and guidelines address both nutrition and physical education Physical Activity

Recognizing the many benefits of physical activity and the research supported notion that people begin to establish lifelong health related attitudes and behaviors in childhood one of the wellness goals of the Albemarle County School District will be to help students establish lifelong healthy physical activity patterns The Coordinator for Health and Physical Education will insure compliance with the Health and Physical Education curricula offered Wellness School staff and support personnel serve as role models and the Division will encourage activities and programs that support healthy lifestyles for all school district employees

Albemarle County Public Schools

JHCF-AP Page 1

Student Wellness

The School Board of the Albemarle County Public Schools has established the following goalspractices to promote student wellness Child Nutrition Goals andor practices

bull Fat sugar and sodium content are included among the nutritional guidelines which are considered within the food purchasing and preparation practices

bull Food service staff receives ongoing training on safety sanitation and food preparation techniques used to comply with the USDA guidelines and to minimize the use of additional fats salt and sugar

bull The Director of Child NutritionChild Nutrition staff monitors cafeteria operations for total quality performance This includes areas of operations such as food safetysanitation food quality quantity and nutritional content marketing and merchandising cleanliness recordkeeping and efficiency

bull Cafeterias are to operate in a manner which provides food items in appropriate quantities and are served in an aesthetically pleasing way

bull School meals will be marketed to appeal to students so they will buy and consume the full meal

bull The Child Nutrition Department will help to promote nutrition education This may include posters and nutritional education material displayed for students in cafeteria web page and menus cafeteria promotions and interaction with students about school nutrition program and healthy eating

bull School menus are available to the public through media release CNP webpage and take-home menus for elementary school students

bull Students are included in assessment surveys and focus groups

Guidelines In addition to following the nutritional guidelines set by USDA and the State of Virginia under the National School lunch program the following nutritional guidelines are implemented within the Albemarle County CNP

1 Milk choices include only fat free and reduced fat milk 2 A minimum of two entrees is offered daily for breakfast and lunch 3 Menus offer a choice of a variety of fruits and vegetables 4 Ready-to-eat cereals and breakfast pastries will contain no more than 35

by weight of sugar 5 Extra grain options that are included with the meal and meet state of

Virginia guidelines such as cake rice crispy treats and brownie will be offered no more than twice per month

6 Cinnamon and donut items will not be offered as a meal component more than twice per month at elementary schools

Albemarle County Public Schools

JHCF-AP Page 2

7 Friedbaked potato items such as French fry products are available only with a meal These are not sold a la carte and no extra servings with a meal

Snack items sold by the Child Nutrition Program 1 Juice drink beverages must contain a minimum of 25 juice 2 The portion size of a snack item will be less than 300 calories per item 3 The portion size will have no more than 35 by weight of sugar (except

fresh dried or canned fruits and vegetables without sweeteners) 4 Ice cream products and cookies that meet the guidelines set by state of

Virginia will be available at elementary and middle schools once per week as a snack Items such as 100 frozen fruit juice bar will be available daily High Schools are allowed to offer ice cream and cookies as a snack daily

5 If chip items are offered they must be baked or reduced fat

Schools Goalspractices

bull No foods are to be sold anywhere in the school in competition with the CNP during lunch and breakfast periods at schools operating on National school lunch or breakfast program Note At schools where the National breakfast program is offered food sales from 6 am until the close of the last breakfast service period must accrue to the school food service department and meet the nutritional guidelines set by National school meal program for Virginia

bull Each school shall ensure that dining is a pleasant experience Noise should be kept to a minimum the facility should be clean and pleasant and adequate time should be provided to eat

bull Daily recess or unstructured play will be provided by each school and restriction of recess for disciplinary reasons will be discouraged

bull Parents will be strongly encouraged to provide healthy food items when packing snacks and lunches

bull Each school will involve the PTO or other parent group in identifying strengths and weaknesses and ideas for achieving wellness goals as applied to nutrition and physical activity

bull Information about school meals and nutrition will be posted and encouraged on the district website

Food SalesVending Machines Any food sale operations on school property during the school day should adhere to the following guidelines With regard to sodas

bull No sale of sodas or iced tea will be allowed during the school day

Albemarle County Public Schools

JHCF-AP Page 3

bull Vending machines will be turned off daily on school days between 600 AM and the end of the school day

With regard to fruit drinks

bull They be allowed during the school day including lunches and at breaks because they meet the Federal School Lunch Guidelines as long as they do not violate the Federal School Lunch program regulation regarding competitive sales

bull Juice drinks will be priced competitively based on juice content (the lower the juice content the higher the price)

With regard to water

bull Vending machines that sell only water will remain on 24 hours a day 7 days a week as long as the ldquoon-timesrdquo do not violate the school lunch regulations regarding competitive sales are not violated (Federal regulation 7CFR21011 and state regulation 8VAC20-580-60)

With regard to snacks bull Food products that meet the Federal School Lunch Guideline will be allowed to

be sold during the school day as long as lunch regulations regarding competitive sales are not violated

bull Food products that meet the Federal School Lunch Guidelines will be in one machine and those not meeting Federal School Lunch Guidelines will be in a separate machine

bull The machine with the items not meeting these Federal School Lunch Guidelines will be equipped with a timer and will be turned off during the school day

bull Those products not meeting Federal School Lunch Guidelines are priced higher

Nutrition Education Goalspractices

bull Schools will provide nutrition education that is interactive and teaches the skills necessary to adopt healthy eating behaviors and will be integrated in the comprehensive health education curriculum in grades K through 10

bull Nutrition education will be incorporated into the core curriculum bull Each school will assign ownership of the comprehensive health curriculum to a

department or particular staff member bull The Coordinator for Health and Physical Education will work with principals to

insure that the delivery of nutrition education by personnel who have appropriate training

bull Parents will receive nutrition information in various ways district newsletters school newsletters and letters sent home addressing specific nutrition issues such as sending healthy snacks and packing healthy lunches

Albemarle County Public Schools

JHCF-AP Page 4

Physical Activity Goalspractices Physical education classes

bull Albemarle County will provide planned and sequential physical education curricula from K through 10 that promote enjoyable lifelong physical activity These curricula will be consistent with the national standards for physical education

bull The PE time period will be spent in physical activity Time waiting for instructions or waiting for a turn will be limited

bull All students must participate ndash not dressing out is not an option Students who refuse to dress out will be penalized in some way other than being excluded from PE class

bull Students will need a note from a doctor to be excluded from more than 1 class of PE (with note from parent) unless there is a clear orthopedic injury Effort will be made to provide injured students with an adapted or modified form of physical activity

bull Lifetime physical activity choices will be offered for upper grade PE classes bull Physical education will emphasize lifetime activities that promote physical

fitness bull Adaptivemodified PE will be ensured for all disabled students

Other school efforts to increase physical activity

bull Instruction that helps students develop the knowledge attitudes behavioral skills and confidence needed to adopt and maintain physically active lifestyles will be incorporated into the comprehensive health education curricula

bull Each school will be encouraged to incorporate physical activity into the school day in ways other than PE

bull Schools andor district will provide information to parents on the benefits of physical activity and suggestions on ways to incorporate physical activity into the familyrsquos daily routine

bull Schools will participate in community based programs bull After and before school programs will have a physical activity requirement bull Other physical activity clubs may be offered at each schoolrsquos discretion bull High schools will offer electives other than the required PE courses bull Field trip planning should include a plan for students to be physically active

during the trip (modify Request for Educational Field Trip to reflect this) bull Schools will provide personnel training for PE teachers class room teachers and

administrators on how to increase physical activity Schools will collaborate with the county and community groups to provide and promote access to safe spaces and facilities for physical activity in the schools and community

bull Schools will encourage and promote a diverse range of developmentally appropriate community sports and recreation programs that are attractive to all

Albemarle County Public Schools

JHCF-AP Page 5

young people by providing information in the form of flyers and other communications with families

bull The use of school grounds as public playgrounds on off hours will be permitted bull The use of school fields and courts by community sports programs are offered to

all students The Division advocates for scholarships to be provided so all students can participate regardless of ability to pay

Approved June 22 2006 Legal Ref 42 USC Section 1751 Note Cross Refs EFB Free and Reduced Price Food Services IGAEIGAF HealthPhysical Education JL Fund Raising and Solicitation

KQ Commercial Promotional and Corporate Sponsorships and Partnerships

Albemarle County Public Schools

Enclosure 2

D R A F T

TEMPLATE ndash PANDEMIC INFLUENZA PLAN

FOR SCHOOLS

Prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee

Chief Author Eileen Gomez RN

Last Updated 83106

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

Executive Summary of School HeatlMfjvisory Activities

The Health Advisory Board meE~ts four times a year and submits a reportannually regarding health issues in the schools

We would like to applaud the Board for several significi3nt initiatives this yearApproving the budget ini1iative for 6 hour rlurses in elementary schools

Reinstating the Youth Ri~)k Behavior Survey

Approving the continuation of funding for the Division Cafeteria Manager

Supporting the Coaches Education Program and

Piloting a study to evaluate biodiesel as an alternative fuel for our busfleet

A summary of activities includeDrafted a Student Wellness Policy using data from the School Health

Index (enclosure 1)Developed a school plan to address issues and provide a guided

response to all phases of an influenza parldemic (enclosure 2)Participated in activities c~nd programs to improve child nutritionReceived information reglarding cleaning products and pesticide use

(enclosure 3)Received information reglarding the use 01 biodegradable diesel fuel and

suggested a pilot be corujucted andReceived the results of the biodiesel fuel pilot (enclosure 4)

Recommendations include

Removing Drivers Education from Health Education and teaching it as aseparate course allowing more time to be spent on Health concepts suchas youth drinking and driving and other high risk behaviors (enclosure 5)Discontinuing the $75000 fee charged to the Child Nutrition Program

(enclosure 6)Continuing consideration for switching the County bus fleet to biodieselfuel for its emissions are less carcinogenic and less irritating to therespiratory tracts of our students and staffRequiring ongoing research into the use of bio-tlased cleaning products inour schools to determine if cost is feasible and tlenefits are significantEncourage all schools to participate in the Governors Scorecard and

Replacing the Perfect Attendance Award with awards for excellentattendance as this committee feels strongly that it encourages too manychildren to attend school during the infectious stage of their illness Thisis sensible for any time but holds special relevance now as we have

concerns about pandemic influenza

Enclosure 1JHCF

STUDENT WELLNESS

The Albemarle County School Board recognizes the link between student health and learning and desires to provide a comprehensive program promoting healthy eating and physical activity in Division students Number eleven of the Divisionrsquos Lifelong-Learning Standards is to understand and follow a physically active lifestyle that promotes good health and wellness Albemarle County Public Schools will provide a consistent overarching message in support of the value of wellness practices particularly as they apply to nutrition and physical activity for students and staff Child Nutrition Department (CNP)

The Child Nutrition Department goals are to ensure the nutritional and financial integrity and accountability of cafeteria operations and to enhance the nutrition education of all students Ongoing assessment of the cafeteria operations allows planning to best serve our customers in a cost efficient manner and to support a healthy school climate The Director of Child Nutrition or Child Nutrition staff will conduct periodic audits to ensure compliance of regulations and guidelines for the CNP Nutrition Education Students receive nutrition education that teaches the skills they need to adopt and maintain healthy eating behaviors Division health education curriculum standards and guidelines address both nutrition and physical education Physical Activity

Recognizing the many benefits of physical activity and the research supported notion that people begin to establish lifelong health related attitudes and behaviors in childhood one of the wellness goals of the Albemarle County School District will be to help students establish lifelong healthy physical activity patterns The Coordinator for Health and Physical Education will insure compliance with the Health and Physical Education curricula offered Wellness School staff and support personnel serve as role models and the Division will encourage activities and programs that support healthy lifestyles for all school district employees

Albemarle County Public Schools

JHCF-AP Page 1

Student Wellness

The School Board of the Albemarle County Public Schools has established the following goalspractices to promote student wellness Child Nutrition Goals andor practices

bull Fat sugar and sodium content are included among the nutritional guidelines which are considered within the food purchasing and preparation practices

bull Food service staff receives ongoing training on safety sanitation and food preparation techniques used to comply with the USDA guidelines and to minimize the use of additional fats salt and sugar

bull The Director of Child NutritionChild Nutrition staff monitors cafeteria operations for total quality performance This includes areas of operations such as food safetysanitation food quality quantity and nutritional content marketing and merchandising cleanliness recordkeeping and efficiency

bull Cafeterias are to operate in a manner which provides food items in appropriate quantities and are served in an aesthetically pleasing way

bull School meals will be marketed to appeal to students so they will buy and consume the full meal

bull The Child Nutrition Department will help to promote nutrition education This may include posters and nutritional education material displayed for students in cafeteria web page and menus cafeteria promotions and interaction with students about school nutrition program and healthy eating

bull School menus are available to the public through media release CNP webpage and take-home menus for elementary school students

bull Students are included in assessment surveys and focus groups

Guidelines In addition to following the nutritional guidelines set by USDA and the State of Virginia under the National School lunch program the following nutritional guidelines are implemented within the Albemarle County CNP

1 Milk choices include only fat free and reduced fat milk 2 A minimum of two entrees is offered daily for breakfast and lunch 3 Menus offer a choice of a variety of fruits and vegetables 4 Ready-to-eat cereals and breakfast pastries will contain no more than 35

by weight of sugar 5 Extra grain options that are included with the meal and meet state of

Virginia guidelines such as cake rice crispy treats and brownie will be offered no more than twice per month

6 Cinnamon and donut items will not be offered as a meal component more than twice per month at elementary schools

Albemarle County Public Schools

JHCF-AP Page 2

7 Friedbaked potato items such as French fry products are available only with a meal These are not sold a la carte and no extra servings with a meal

Snack items sold by the Child Nutrition Program 1 Juice drink beverages must contain a minimum of 25 juice 2 The portion size of a snack item will be less than 300 calories per item 3 The portion size will have no more than 35 by weight of sugar (except

fresh dried or canned fruits and vegetables without sweeteners) 4 Ice cream products and cookies that meet the guidelines set by state of

Virginia will be available at elementary and middle schools once per week as a snack Items such as 100 frozen fruit juice bar will be available daily High Schools are allowed to offer ice cream and cookies as a snack daily

5 If chip items are offered they must be baked or reduced fat

Schools Goalspractices

bull No foods are to be sold anywhere in the school in competition with the CNP during lunch and breakfast periods at schools operating on National school lunch or breakfast program Note At schools where the National breakfast program is offered food sales from 6 am until the close of the last breakfast service period must accrue to the school food service department and meet the nutritional guidelines set by National school meal program for Virginia

bull Each school shall ensure that dining is a pleasant experience Noise should be kept to a minimum the facility should be clean and pleasant and adequate time should be provided to eat

bull Daily recess or unstructured play will be provided by each school and restriction of recess for disciplinary reasons will be discouraged

bull Parents will be strongly encouraged to provide healthy food items when packing snacks and lunches

bull Each school will involve the PTO or other parent group in identifying strengths and weaknesses and ideas for achieving wellness goals as applied to nutrition and physical activity

bull Information about school meals and nutrition will be posted and encouraged on the district website

Food SalesVending Machines Any food sale operations on school property during the school day should adhere to the following guidelines With regard to sodas

bull No sale of sodas or iced tea will be allowed during the school day

Albemarle County Public Schools

JHCF-AP Page 3

bull Vending machines will be turned off daily on school days between 600 AM and the end of the school day

With regard to fruit drinks

bull They be allowed during the school day including lunches and at breaks because they meet the Federal School Lunch Guidelines as long as they do not violate the Federal School Lunch program regulation regarding competitive sales

bull Juice drinks will be priced competitively based on juice content (the lower the juice content the higher the price)

With regard to water

bull Vending machines that sell only water will remain on 24 hours a day 7 days a week as long as the ldquoon-timesrdquo do not violate the school lunch regulations regarding competitive sales are not violated (Federal regulation 7CFR21011 and state regulation 8VAC20-580-60)

With regard to snacks bull Food products that meet the Federal School Lunch Guideline will be allowed to

be sold during the school day as long as lunch regulations regarding competitive sales are not violated

bull Food products that meet the Federal School Lunch Guidelines will be in one machine and those not meeting Federal School Lunch Guidelines will be in a separate machine

bull The machine with the items not meeting these Federal School Lunch Guidelines will be equipped with a timer and will be turned off during the school day

bull Those products not meeting Federal School Lunch Guidelines are priced higher

Nutrition Education Goalspractices

bull Schools will provide nutrition education that is interactive and teaches the skills necessary to adopt healthy eating behaviors and will be integrated in the comprehensive health education curriculum in grades K through 10

bull Nutrition education will be incorporated into the core curriculum bull Each school will assign ownership of the comprehensive health curriculum to a

department or particular staff member bull The Coordinator for Health and Physical Education will work with principals to

insure that the delivery of nutrition education by personnel who have appropriate training

bull Parents will receive nutrition information in various ways district newsletters school newsletters and letters sent home addressing specific nutrition issues such as sending healthy snacks and packing healthy lunches

Albemarle County Public Schools

JHCF-AP Page 4

Physical Activity Goalspractices Physical education classes

bull Albemarle County will provide planned and sequential physical education curricula from K through 10 that promote enjoyable lifelong physical activity These curricula will be consistent with the national standards for physical education

bull The PE time period will be spent in physical activity Time waiting for instructions or waiting for a turn will be limited

bull All students must participate ndash not dressing out is not an option Students who refuse to dress out will be penalized in some way other than being excluded from PE class

bull Students will need a note from a doctor to be excluded from more than 1 class of PE (with note from parent) unless there is a clear orthopedic injury Effort will be made to provide injured students with an adapted or modified form of physical activity

bull Lifetime physical activity choices will be offered for upper grade PE classes bull Physical education will emphasize lifetime activities that promote physical

fitness bull Adaptivemodified PE will be ensured for all disabled students

Other school efforts to increase physical activity

bull Instruction that helps students develop the knowledge attitudes behavioral skills and confidence needed to adopt and maintain physically active lifestyles will be incorporated into the comprehensive health education curricula

bull Each school will be encouraged to incorporate physical activity into the school day in ways other than PE

bull Schools andor district will provide information to parents on the benefits of physical activity and suggestions on ways to incorporate physical activity into the familyrsquos daily routine

bull Schools will participate in community based programs bull After and before school programs will have a physical activity requirement bull Other physical activity clubs may be offered at each schoolrsquos discretion bull High schools will offer electives other than the required PE courses bull Field trip planning should include a plan for students to be physically active

during the trip (modify Request for Educational Field Trip to reflect this) bull Schools will provide personnel training for PE teachers class room teachers and

administrators on how to increase physical activity Schools will collaborate with the county and community groups to provide and promote access to safe spaces and facilities for physical activity in the schools and community

bull Schools will encourage and promote a diverse range of developmentally appropriate community sports and recreation programs that are attractive to all

Albemarle County Public Schools

JHCF-AP Page 5

young people by providing information in the form of flyers and other communications with families

bull The use of school grounds as public playgrounds on off hours will be permitted bull The use of school fields and courts by community sports programs are offered to

all students The Division advocates for scholarships to be provided so all students can participate regardless of ability to pay

Approved June 22 2006 Legal Ref 42 USC Section 1751 Note Cross Refs EFB Free and Reduced Price Food Services IGAEIGAF HealthPhysical Education JL Fund Raising and Solicitation

KQ Commercial Promotional and Corporate Sponsorships and Partnerships

Albemarle County Public Schools

Enclosure 2

D R A F T

TEMPLATE ndash PANDEMIC INFLUENZA PLAN

FOR SCHOOLS

Prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee

Chief Author Eileen Gomez RN

Last Updated 83106

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

Enclosure 1JHCF

STUDENT WELLNESS

The Albemarle County School Board recognizes the link between student health and learning and desires to provide a comprehensive program promoting healthy eating and physical activity in Division students Number eleven of the Divisionrsquos Lifelong-Learning Standards is to understand and follow a physically active lifestyle that promotes good health and wellness Albemarle County Public Schools will provide a consistent overarching message in support of the value of wellness practices particularly as they apply to nutrition and physical activity for students and staff Child Nutrition Department (CNP)

The Child Nutrition Department goals are to ensure the nutritional and financial integrity and accountability of cafeteria operations and to enhance the nutrition education of all students Ongoing assessment of the cafeteria operations allows planning to best serve our customers in a cost efficient manner and to support a healthy school climate The Director of Child Nutrition or Child Nutrition staff will conduct periodic audits to ensure compliance of regulations and guidelines for the CNP Nutrition Education Students receive nutrition education that teaches the skills they need to adopt and maintain healthy eating behaviors Division health education curriculum standards and guidelines address both nutrition and physical education Physical Activity

Recognizing the many benefits of physical activity and the research supported notion that people begin to establish lifelong health related attitudes and behaviors in childhood one of the wellness goals of the Albemarle County School District will be to help students establish lifelong healthy physical activity patterns The Coordinator for Health and Physical Education will insure compliance with the Health and Physical Education curricula offered Wellness School staff and support personnel serve as role models and the Division will encourage activities and programs that support healthy lifestyles for all school district employees

Albemarle County Public Schools

JHCF-AP Page 1

Student Wellness

The School Board of the Albemarle County Public Schools has established the following goalspractices to promote student wellness Child Nutrition Goals andor practices

bull Fat sugar and sodium content are included among the nutritional guidelines which are considered within the food purchasing and preparation practices

bull Food service staff receives ongoing training on safety sanitation and food preparation techniques used to comply with the USDA guidelines and to minimize the use of additional fats salt and sugar

bull The Director of Child NutritionChild Nutrition staff monitors cafeteria operations for total quality performance This includes areas of operations such as food safetysanitation food quality quantity and nutritional content marketing and merchandising cleanliness recordkeeping and efficiency

bull Cafeterias are to operate in a manner which provides food items in appropriate quantities and are served in an aesthetically pleasing way

bull School meals will be marketed to appeal to students so they will buy and consume the full meal

bull The Child Nutrition Department will help to promote nutrition education This may include posters and nutritional education material displayed for students in cafeteria web page and menus cafeteria promotions and interaction with students about school nutrition program and healthy eating

bull School menus are available to the public through media release CNP webpage and take-home menus for elementary school students

bull Students are included in assessment surveys and focus groups

Guidelines In addition to following the nutritional guidelines set by USDA and the State of Virginia under the National School lunch program the following nutritional guidelines are implemented within the Albemarle County CNP

1 Milk choices include only fat free and reduced fat milk 2 A minimum of two entrees is offered daily for breakfast and lunch 3 Menus offer a choice of a variety of fruits and vegetables 4 Ready-to-eat cereals and breakfast pastries will contain no more than 35

by weight of sugar 5 Extra grain options that are included with the meal and meet state of

Virginia guidelines such as cake rice crispy treats and brownie will be offered no more than twice per month

6 Cinnamon and donut items will not be offered as a meal component more than twice per month at elementary schools

Albemarle County Public Schools

JHCF-AP Page 2

7 Friedbaked potato items such as French fry products are available only with a meal These are not sold a la carte and no extra servings with a meal

Snack items sold by the Child Nutrition Program 1 Juice drink beverages must contain a minimum of 25 juice 2 The portion size of a snack item will be less than 300 calories per item 3 The portion size will have no more than 35 by weight of sugar (except

fresh dried or canned fruits and vegetables without sweeteners) 4 Ice cream products and cookies that meet the guidelines set by state of

Virginia will be available at elementary and middle schools once per week as a snack Items such as 100 frozen fruit juice bar will be available daily High Schools are allowed to offer ice cream and cookies as a snack daily

5 If chip items are offered they must be baked or reduced fat

Schools Goalspractices

bull No foods are to be sold anywhere in the school in competition with the CNP during lunch and breakfast periods at schools operating on National school lunch or breakfast program Note At schools where the National breakfast program is offered food sales from 6 am until the close of the last breakfast service period must accrue to the school food service department and meet the nutritional guidelines set by National school meal program for Virginia

bull Each school shall ensure that dining is a pleasant experience Noise should be kept to a minimum the facility should be clean and pleasant and adequate time should be provided to eat

bull Daily recess or unstructured play will be provided by each school and restriction of recess for disciplinary reasons will be discouraged

bull Parents will be strongly encouraged to provide healthy food items when packing snacks and lunches

bull Each school will involve the PTO or other parent group in identifying strengths and weaknesses and ideas for achieving wellness goals as applied to nutrition and physical activity

bull Information about school meals and nutrition will be posted and encouraged on the district website

Food SalesVending Machines Any food sale operations on school property during the school day should adhere to the following guidelines With regard to sodas

bull No sale of sodas or iced tea will be allowed during the school day

Albemarle County Public Schools

JHCF-AP Page 3

bull Vending machines will be turned off daily on school days between 600 AM and the end of the school day

With regard to fruit drinks

bull They be allowed during the school day including lunches and at breaks because they meet the Federal School Lunch Guidelines as long as they do not violate the Federal School Lunch program regulation regarding competitive sales

bull Juice drinks will be priced competitively based on juice content (the lower the juice content the higher the price)

With regard to water

bull Vending machines that sell only water will remain on 24 hours a day 7 days a week as long as the ldquoon-timesrdquo do not violate the school lunch regulations regarding competitive sales are not violated (Federal regulation 7CFR21011 and state regulation 8VAC20-580-60)

With regard to snacks bull Food products that meet the Federal School Lunch Guideline will be allowed to

be sold during the school day as long as lunch regulations regarding competitive sales are not violated

bull Food products that meet the Federal School Lunch Guidelines will be in one machine and those not meeting Federal School Lunch Guidelines will be in a separate machine

bull The machine with the items not meeting these Federal School Lunch Guidelines will be equipped with a timer and will be turned off during the school day

bull Those products not meeting Federal School Lunch Guidelines are priced higher

Nutrition Education Goalspractices

bull Schools will provide nutrition education that is interactive and teaches the skills necessary to adopt healthy eating behaviors and will be integrated in the comprehensive health education curriculum in grades K through 10

bull Nutrition education will be incorporated into the core curriculum bull Each school will assign ownership of the comprehensive health curriculum to a

department or particular staff member bull The Coordinator for Health and Physical Education will work with principals to

insure that the delivery of nutrition education by personnel who have appropriate training

bull Parents will receive nutrition information in various ways district newsletters school newsletters and letters sent home addressing specific nutrition issues such as sending healthy snacks and packing healthy lunches

Albemarle County Public Schools

JHCF-AP Page 4

Physical Activity Goalspractices Physical education classes

bull Albemarle County will provide planned and sequential physical education curricula from K through 10 that promote enjoyable lifelong physical activity These curricula will be consistent with the national standards for physical education

bull The PE time period will be spent in physical activity Time waiting for instructions or waiting for a turn will be limited

bull All students must participate ndash not dressing out is not an option Students who refuse to dress out will be penalized in some way other than being excluded from PE class

bull Students will need a note from a doctor to be excluded from more than 1 class of PE (with note from parent) unless there is a clear orthopedic injury Effort will be made to provide injured students with an adapted or modified form of physical activity

bull Lifetime physical activity choices will be offered for upper grade PE classes bull Physical education will emphasize lifetime activities that promote physical

fitness bull Adaptivemodified PE will be ensured for all disabled students

Other school efforts to increase physical activity

bull Instruction that helps students develop the knowledge attitudes behavioral skills and confidence needed to adopt and maintain physically active lifestyles will be incorporated into the comprehensive health education curricula

bull Each school will be encouraged to incorporate physical activity into the school day in ways other than PE

bull Schools andor district will provide information to parents on the benefits of physical activity and suggestions on ways to incorporate physical activity into the familyrsquos daily routine

bull Schools will participate in community based programs bull After and before school programs will have a physical activity requirement bull Other physical activity clubs may be offered at each schoolrsquos discretion bull High schools will offer electives other than the required PE courses bull Field trip planning should include a plan for students to be physically active

during the trip (modify Request for Educational Field Trip to reflect this) bull Schools will provide personnel training for PE teachers class room teachers and

administrators on how to increase physical activity Schools will collaborate with the county and community groups to provide and promote access to safe spaces and facilities for physical activity in the schools and community

bull Schools will encourage and promote a diverse range of developmentally appropriate community sports and recreation programs that are attractive to all

Albemarle County Public Schools

JHCF-AP Page 5

young people by providing information in the form of flyers and other communications with families

bull The use of school grounds as public playgrounds on off hours will be permitted bull The use of school fields and courts by community sports programs are offered to

all students The Division advocates for scholarships to be provided so all students can participate regardless of ability to pay

Approved June 22 2006 Legal Ref 42 USC Section 1751 Note Cross Refs EFB Free and Reduced Price Food Services IGAEIGAF HealthPhysical Education JL Fund Raising and Solicitation

KQ Commercial Promotional and Corporate Sponsorships and Partnerships

Albemarle County Public Schools

Enclosure 2

D R A F T

TEMPLATE ndash PANDEMIC INFLUENZA PLAN

FOR SCHOOLS

Prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee

Chief Author Eileen Gomez RN

Last Updated 83106

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

JHCF-AP Page 1

Student Wellness

The School Board of the Albemarle County Public Schools has established the following goalspractices to promote student wellness Child Nutrition Goals andor practices

bull Fat sugar and sodium content are included among the nutritional guidelines which are considered within the food purchasing and preparation practices

bull Food service staff receives ongoing training on safety sanitation and food preparation techniques used to comply with the USDA guidelines and to minimize the use of additional fats salt and sugar

bull The Director of Child NutritionChild Nutrition staff monitors cafeteria operations for total quality performance This includes areas of operations such as food safetysanitation food quality quantity and nutritional content marketing and merchandising cleanliness recordkeeping and efficiency

bull Cafeterias are to operate in a manner which provides food items in appropriate quantities and are served in an aesthetically pleasing way

bull School meals will be marketed to appeal to students so they will buy and consume the full meal

bull The Child Nutrition Department will help to promote nutrition education This may include posters and nutritional education material displayed for students in cafeteria web page and menus cafeteria promotions and interaction with students about school nutrition program and healthy eating

bull School menus are available to the public through media release CNP webpage and take-home menus for elementary school students

bull Students are included in assessment surveys and focus groups

Guidelines In addition to following the nutritional guidelines set by USDA and the State of Virginia under the National School lunch program the following nutritional guidelines are implemented within the Albemarle County CNP

1 Milk choices include only fat free and reduced fat milk 2 A minimum of two entrees is offered daily for breakfast and lunch 3 Menus offer a choice of a variety of fruits and vegetables 4 Ready-to-eat cereals and breakfast pastries will contain no more than 35

by weight of sugar 5 Extra grain options that are included with the meal and meet state of

Virginia guidelines such as cake rice crispy treats and brownie will be offered no more than twice per month

6 Cinnamon and donut items will not be offered as a meal component more than twice per month at elementary schools

Albemarle County Public Schools

JHCF-AP Page 2

7 Friedbaked potato items such as French fry products are available only with a meal These are not sold a la carte and no extra servings with a meal

Snack items sold by the Child Nutrition Program 1 Juice drink beverages must contain a minimum of 25 juice 2 The portion size of a snack item will be less than 300 calories per item 3 The portion size will have no more than 35 by weight of sugar (except

fresh dried or canned fruits and vegetables without sweeteners) 4 Ice cream products and cookies that meet the guidelines set by state of

Virginia will be available at elementary and middle schools once per week as a snack Items such as 100 frozen fruit juice bar will be available daily High Schools are allowed to offer ice cream and cookies as a snack daily

5 If chip items are offered they must be baked or reduced fat

Schools Goalspractices

bull No foods are to be sold anywhere in the school in competition with the CNP during lunch and breakfast periods at schools operating on National school lunch or breakfast program Note At schools where the National breakfast program is offered food sales from 6 am until the close of the last breakfast service period must accrue to the school food service department and meet the nutritional guidelines set by National school meal program for Virginia

bull Each school shall ensure that dining is a pleasant experience Noise should be kept to a minimum the facility should be clean and pleasant and adequate time should be provided to eat

bull Daily recess or unstructured play will be provided by each school and restriction of recess for disciplinary reasons will be discouraged

bull Parents will be strongly encouraged to provide healthy food items when packing snacks and lunches

bull Each school will involve the PTO or other parent group in identifying strengths and weaknesses and ideas for achieving wellness goals as applied to nutrition and physical activity

bull Information about school meals and nutrition will be posted and encouraged on the district website

Food SalesVending Machines Any food sale operations on school property during the school day should adhere to the following guidelines With regard to sodas

bull No sale of sodas or iced tea will be allowed during the school day

Albemarle County Public Schools

JHCF-AP Page 3

bull Vending machines will be turned off daily on school days between 600 AM and the end of the school day

With regard to fruit drinks

bull They be allowed during the school day including lunches and at breaks because they meet the Federal School Lunch Guidelines as long as they do not violate the Federal School Lunch program regulation regarding competitive sales

bull Juice drinks will be priced competitively based on juice content (the lower the juice content the higher the price)

With regard to water

bull Vending machines that sell only water will remain on 24 hours a day 7 days a week as long as the ldquoon-timesrdquo do not violate the school lunch regulations regarding competitive sales are not violated (Federal regulation 7CFR21011 and state regulation 8VAC20-580-60)

With regard to snacks bull Food products that meet the Federal School Lunch Guideline will be allowed to

be sold during the school day as long as lunch regulations regarding competitive sales are not violated

bull Food products that meet the Federal School Lunch Guidelines will be in one machine and those not meeting Federal School Lunch Guidelines will be in a separate machine

bull The machine with the items not meeting these Federal School Lunch Guidelines will be equipped with a timer and will be turned off during the school day

bull Those products not meeting Federal School Lunch Guidelines are priced higher

Nutrition Education Goalspractices

bull Schools will provide nutrition education that is interactive and teaches the skills necessary to adopt healthy eating behaviors and will be integrated in the comprehensive health education curriculum in grades K through 10

bull Nutrition education will be incorporated into the core curriculum bull Each school will assign ownership of the comprehensive health curriculum to a

department or particular staff member bull The Coordinator for Health and Physical Education will work with principals to

insure that the delivery of nutrition education by personnel who have appropriate training

bull Parents will receive nutrition information in various ways district newsletters school newsletters and letters sent home addressing specific nutrition issues such as sending healthy snacks and packing healthy lunches

Albemarle County Public Schools

JHCF-AP Page 4

Physical Activity Goalspractices Physical education classes

bull Albemarle County will provide planned and sequential physical education curricula from K through 10 that promote enjoyable lifelong physical activity These curricula will be consistent with the national standards for physical education

bull The PE time period will be spent in physical activity Time waiting for instructions or waiting for a turn will be limited

bull All students must participate ndash not dressing out is not an option Students who refuse to dress out will be penalized in some way other than being excluded from PE class

bull Students will need a note from a doctor to be excluded from more than 1 class of PE (with note from parent) unless there is a clear orthopedic injury Effort will be made to provide injured students with an adapted or modified form of physical activity

bull Lifetime physical activity choices will be offered for upper grade PE classes bull Physical education will emphasize lifetime activities that promote physical

fitness bull Adaptivemodified PE will be ensured for all disabled students

Other school efforts to increase physical activity

bull Instruction that helps students develop the knowledge attitudes behavioral skills and confidence needed to adopt and maintain physically active lifestyles will be incorporated into the comprehensive health education curricula

bull Each school will be encouraged to incorporate physical activity into the school day in ways other than PE

bull Schools andor district will provide information to parents on the benefits of physical activity and suggestions on ways to incorporate physical activity into the familyrsquos daily routine

bull Schools will participate in community based programs bull After and before school programs will have a physical activity requirement bull Other physical activity clubs may be offered at each schoolrsquos discretion bull High schools will offer electives other than the required PE courses bull Field trip planning should include a plan for students to be physically active

during the trip (modify Request for Educational Field Trip to reflect this) bull Schools will provide personnel training for PE teachers class room teachers and

administrators on how to increase physical activity Schools will collaborate with the county and community groups to provide and promote access to safe spaces and facilities for physical activity in the schools and community

bull Schools will encourage and promote a diverse range of developmentally appropriate community sports and recreation programs that are attractive to all

Albemarle County Public Schools

JHCF-AP Page 5

young people by providing information in the form of flyers and other communications with families

bull The use of school grounds as public playgrounds on off hours will be permitted bull The use of school fields and courts by community sports programs are offered to

all students The Division advocates for scholarships to be provided so all students can participate regardless of ability to pay

Approved June 22 2006 Legal Ref 42 USC Section 1751 Note Cross Refs EFB Free and Reduced Price Food Services IGAEIGAF HealthPhysical Education JL Fund Raising and Solicitation

KQ Commercial Promotional and Corporate Sponsorships and Partnerships

Albemarle County Public Schools

Enclosure 2

D R A F T

TEMPLATE ndash PANDEMIC INFLUENZA PLAN

FOR SCHOOLS

Prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee

Chief Author Eileen Gomez RN

Last Updated 83106

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

JHCF-AP Page 2

7 Friedbaked potato items such as French fry products are available only with a meal These are not sold a la carte and no extra servings with a meal

Snack items sold by the Child Nutrition Program 1 Juice drink beverages must contain a minimum of 25 juice 2 The portion size of a snack item will be less than 300 calories per item 3 The portion size will have no more than 35 by weight of sugar (except

fresh dried or canned fruits and vegetables without sweeteners) 4 Ice cream products and cookies that meet the guidelines set by state of

Virginia will be available at elementary and middle schools once per week as a snack Items such as 100 frozen fruit juice bar will be available daily High Schools are allowed to offer ice cream and cookies as a snack daily

5 If chip items are offered they must be baked or reduced fat

Schools Goalspractices

bull No foods are to be sold anywhere in the school in competition with the CNP during lunch and breakfast periods at schools operating on National school lunch or breakfast program Note At schools where the National breakfast program is offered food sales from 6 am until the close of the last breakfast service period must accrue to the school food service department and meet the nutritional guidelines set by National school meal program for Virginia

bull Each school shall ensure that dining is a pleasant experience Noise should be kept to a minimum the facility should be clean and pleasant and adequate time should be provided to eat

bull Daily recess or unstructured play will be provided by each school and restriction of recess for disciplinary reasons will be discouraged

bull Parents will be strongly encouraged to provide healthy food items when packing snacks and lunches

bull Each school will involve the PTO or other parent group in identifying strengths and weaknesses and ideas for achieving wellness goals as applied to nutrition and physical activity

bull Information about school meals and nutrition will be posted and encouraged on the district website

Food SalesVending Machines Any food sale operations on school property during the school day should adhere to the following guidelines With regard to sodas

bull No sale of sodas or iced tea will be allowed during the school day

Albemarle County Public Schools

JHCF-AP Page 3

bull Vending machines will be turned off daily on school days between 600 AM and the end of the school day

With regard to fruit drinks

bull They be allowed during the school day including lunches and at breaks because they meet the Federal School Lunch Guidelines as long as they do not violate the Federal School Lunch program regulation regarding competitive sales

bull Juice drinks will be priced competitively based on juice content (the lower the juice content the higher the price)

With regard to water

bull Vending machines that sell only water will remain on 24 hours a day 7 days a week as long as the ldquoon-timesrdquo do not violate the school lunch regulations regarding competitive sales are not violated (Federal regulation 7CFR21011 and state regulation 8VAC20-580-60)

With regard to snacks bull Food products that meet the Federal School Lunch Guideline will be allowed to

be sold during the school day as long as lunch regulations regarding competitive sales are not violated

bull Food products that meet the Federal School Lunch Guidelines will be in one machine and those not meeting Federal School Lunch Guidelines will be in a separate machine

bull The machine with the items not meeting these Federal School Lunch Guidelines will be equipped with a timer and will be turned off during the school day

bull Those products not meeting Federal School Lunch Guidelines are priced higher

Nutrition Education Goalspractices

bull Schools will provide nutrition education that is interactive and teaches the skills necessary to adopt healthy eating behaviors and will be integrated in the comprehensive health education curriculum in grades K through 10

bull Nutrition education will be incorporated into the core curriculum bull Each school will assign ownership of the comprehensive health curriculum to a

department or particular staff member bull The Coordinator for Health and Physical Education will work with principals to

insure that the delivery of nutrition education by personnel who have appropriate training

bull Parents will receive nutrition information in various ways district newsletters school newsletters and letters sent home addressing specific nutrition issues such as sending healthy snacks and packing healthy lunches

Albemarle County Public Schools

JHCF-AP Page 4

Physical Activity Goalspractices Physical education classes

bull Albemarle County will provide planned and sequential physical education curricula from K through 10 that promote enjoyable lifelong physical activity These curricula will be consistent with the national standards for physical education

bull The PE time period will be spent in physical activity Time waiting for instructions or waiting for a turn will be limited

bull All students must participate ndash not dressing out is not an option Students who refuse to dress out will be penalized in some way other than being excluded from PE class

bull Students will need a note from a doctor to be excluded from more than 1 class of PE (with note from parent) unless there is a clear orthopedic injury Effort will be made to provide injured students with an adapted or modified form of physical activity

bull Lifetime physical activity choices will be offered for upper grade PE classes bull Physical education will emphasize lifetime activities that promote physical

fitness bull Adaptivemodified PE will be ensured for all disabled students

Other school efforts to increase physical activity

bull Instruction that helps students develop the knowledge attitudes behavioral skills and confidence needed to adopt and maintain physically active lifestyles will be incorporated into the comprehensive health education curricula

bull Each school will be encouraged to incorporate physical activity into the school day in ways other than PE

bull Schools andor district will provide information to parents on the benefits of physical activity and suggestions on ways to incorporate physical activity into the familyrsquos daily routine

bull Schools will participate in community based programs bull After and before school programs will have a physical activity requirement bull Other physical activity clubs may be offered at each schoolrsquos discretion bull High schools will offer electives other than the required PE courses bull Field trip planning should include a plan for students to be physically active

during the trip (modify Request for Educational Field Trip to reflect this) bull Schools will provide personnel training for PE teachers class room teachers and

administrators on how to increase physical activity Schools will collaborate with the county and community groups to provide and promote access to safe spaces and facilities for physical activity in the schools and community

bull Schools will encourage and promote a diverse range of developmentally appropriate community sports and recreation programs that are attractive to all

Albemarle County Public Schools

JHCF-AP Page 5

young people by providing information in the form of flyers and other communications with families

bull The use of school grounds as public playgrounds on off hours will be permitted bull The use of school fields and courts by community sports programs are offered to

all students The Division advocates for scholarships to be provided so all students can participate regardless of ability to pay

Approved June 22 2006 Legal Ref 42 USC Section 1751 Note Cross Refs EFB Free and Reduced Price Food Services IGAEIGAF HealthPhysical Education JL Fund Raising and Solicitation

KQ Commercial Promotional and Corporate Sponsorships and Partnerships

Albemarle County Public Schools

Enclosure 2

D R A F T

TEMPLATE ndash PANDEMIC INFLUENZA PLAN

FOR SCHOOLS

Prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee

Chief Author Eileen Gomez RN

Last Updated 83106

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

JHCF-AP Page 3

bull Vending machines will be turned off daily on school days between 600 AM and the end of the school day

With regard to fruit drinks

bull They be allowed during the school day including lunches and at breaks because they meet the Federal School Lunch Guidelines as long as they do not violate the Federal School Lunch program regulation regarding competitive sales

bull Juice drinks will be priced competitively based on juice content (the lower the juice content the higher the price)

With regard to water

bull Vending machines that sell only water will remain on 24 hours a day 7 days a week as long as the ldquoon-timesrdquo do not violate the school lunch regulations regarding competitive sales are not violated (Federal regulation 7CFR21011 and state regulation 8VAC20-580-60)

With regard to snacks bull Food products that meet the Federal School Lunch Guideline will be allowed to

be sold during the school day as long as lunch regulations regarding competitive sales are not violated

bull Food products that meet the Federal School Lunch Guidelines will be in one machine and those not meeting Federal School Lunch Guidelines will be in a separate machine

bull The machine with the items not meeting these Federal School Lunch Guidelines will be equipped with a timer and will be turned off during the school day

bull Those products not meeting Federal School Lunch Guidelines are priced higher

Nutrition Education Goalspractices

bull Schools will provide nutrition education that is interactive and teaches the skills necessary to adopt healthy eating behaviors and will be integrated in the comprehensive health education curriculum in grades K through 10

bull Nutrition education will be incorporated into the core curriculum bull Each school will assign ownership of the comprehensive health curriculum to a

department or particular staff member bull The Coordinator for Health and Physical Education will work with principals to

insure that the delivery of nutrition education by personnel who have appropriate training

bull Parents will receive nutrition information in various ways district newsletters school newsletters and letters sent home addressing specific nutrition issues such as sending healthy snacks and packing healthy lunches

Albemarle County Public Schools

JHCF-AP Page 4

Physical Activity Goalspractices Physical education classes

bull Albemarle County will provide planned and sequential physical education curricula from K through 10 that promote enjoyable lifelong physical activity These curricula will be consistent with the national standards for physical education

bull The PE time period will be spent in physical activity Time waiting for instructions or waiting for a turn will be limited

bull All students must participate ndash not dressing out is not an option Students who refuse to dress out will be penalized in some way other than being excluded from PE class

bull Students will need a note from a doctor to be excluded from more than 1 class of PE (with note from parent) unless there is a clear orthopedic injury Effort will be made to provide injured students with an adapted or modified form of physical activity

bull Lifetime physical activity choices will be offered for upper grade PE classes bull Physical education will emphasize lifetime activities that promote physical

fitness bull Adaptivemodified PE will be ensured for all disabled students

Other school efforts to increase physical activity

bull Instruction that helps students develop the knowledge attitudes behavioral skills and confidence needed to adopt and maintain physically active lifestyles will be incorporated into the comprehensive health education curricula

bull Each school will be encouraged to incorporate physical activity into the school day in ways other than PE

bull Schools andor district will provide information to parents on the benefits of physical activity and suggestions on ways to incorporate physical activity into the familyrsquos daily routine

bull Schools will participate in community based programs bull After and before school programs will have a physical activity requirement bull Other physical activity clubs may be offered at each schoolrsquos discretion bull High schools will offer electives other than the required PE courses bull Field trip planning should include a plan for students to be physically active

during the trip (modify Request for Educational Field Trip to reflect this) bull Schools will provide personnel training for PE teachers class room teachers and

administrators on how to increase physical activity Schools will collaborate with the county and community groups to provide and promote access to safe spaces and facilities for physical activity in the schools and community

bull Schools will encourage and promote a diverse range of developmentally appropriate community sports and recreation programs that are attractive to all

Albemarle County Public Schools

JHCF-AP Page 5

young people by providing information in the form of flyers and other communications with families

bull The use of school grounds as public playgrounds on off hours will be permitted bull The use of school fields and courts by community sports programs are offered to

all students The Division advocates for scholarships to be provided so all students can participate regardless of ability to pay

Approved June 22 2006 Legal Ref 42 USC Section 1751 Note Cross Refs EFB Free and Reduced Price Food Services IGAEIGAF HealthPhysical Education JL Fund Raising and Solicitation

KQ Commercial Promotional and Corporate Sponsorships and Partnerships

Albemarle County Public Schools

Enclosure 2

D R A F T

TEMPLATE ndash PANDEMIC INFLUENZA PLAN

FOR SCHOOLS

Prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee

Chief Author Eileen Gomez RN

Last Updated 83106

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

JHCF-AP Page 4

Physical Activity Goalspractices Physical education classes

bull Albemarle County will provide planned and sequential physical education curricula from K through 10 that promote enjoyable lifelong physical activity These curricula will be consistent with the national standards for physical education

bull The PE time period will be spent in physical activity Time waiting for instructions or waiting for a turn will be limited

bull All students must participate ndash not dressing out is not an option Students who refuse to dress out will be penalized in some way other than being excluded from PE class

bull Students will need a note from a doctor to be excluded from more than 1 class of PE (with note from parent) unless there is a clear orthopedic injury Effort will be made to provide injured students with an adapted or modified form of physical activity

bull Lifetime physical activity choices will be offered for upper grade PE classes bull Physical education will emphasize lifetime activities that promote physical

fitness bull Adaptivemodified PE will be ensured for all disabled students

Other school efforts to increase physical activity

bull Instruction that helps students develop the knowledge attitudes behavioral skills and confidence needed to adopt and maintain physically active lifestyles will be incorporated into the comprehensive health education curricula

bull Each school will be encouraged to incorporate physical activity into the school day in ways other than PE

bull Schools andor district will provide information to parents on the benefits of physical activity and suggestions on ways to incorporate physical activity into the familyrsquos daily routine

bull Schools will participate in community based programs bull After and before school programs will have a physical activity requirement bull Other physical activity clubs may be offered at each schoolrsquos discretion bull High schools will offer electives other than the required PE courses bull Field trip planning should include a plan for students to be physically active

during the trip (modify Request for Educational Field Trip to reflect this) bull Schools will provide personnel training for PE teachers class room teachers and

administrators on how to increase physical activity Schools will collaborate with the county and community groups to provide and promote access to safe spaces and facilities for physical activity in the schools and community

bull Schools will encourage and promote a diverse range of developmentally appropriate community sports and recreation programs that are attractive to all

Albemarle County Public Schools

JHCF-AP Page 5

young people by providing information in the form of flyers and other communications with families

bull The use of school grounds as public playgrounds on off hours will be permitted bull The use of school fields and courts by community sports programs are offered to

all students The Division advocates for scholarships to be provided so all students can participate regardless of ability to pay

Approved June 22 2006 Legal Ref 42 USC Section 1751 Note Cross Refs EFB Free and Reduced Price Food Services IGAEIGAF HealthPhysical Education JL Fund Raising and Solicitation

KQ Commercial Promotional and Corporate Sponsorships and Partnerships

Albemarle County Public Schools

Enclosure 2

D R A F T

TEMPLATE ndash PANDEMIC INFLUENZA PLAN

FOR SCHOOLS

Prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee

Chief Author Eileen Gomez RN

Last Updated 83106

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

JHCF-AP Page 5

young people by providing information in the form of flyers and other communications with families

bull The use of school grounds as public playgrounds on off hours will be permitted bull The use of school fields and courts by community sports programs are offered to

all students The Division advocates for scholarships to be provided so all students can participate regardless of ability to pay

Approved June 22 2006 Legal Ref 42 USC Section 1751 Note Cross Refs EFB Free and Reduced Price Food Services IGAEIGAF HealthPhysical Education JL Fund Raising and Solicitation

KQ Commercial Promotional and Corporate Sponsorships and Partnerships

Albemarle County Public Schools

Enclosure 2

D R A F T

TEMPLATE ndash PANDEMIC INFLUENZA PLAN

FOR SCHOOLS

Prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee

Chief Author Eileen Gomez RN

Last Updated 83106

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

Enclosure 2

D R A F T

TEMPLATE ndash PANDEMIC INFLUENZA PLAN

FOR SCHOOLS

Prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee

Chief Author Eileen Gomez RN

Last Updated 83106

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

2

Table of Contents Topic Page Number Background and Purpose of the Plan 3 Plan Assumptions 4 Authority Coordination and Decision Making during a Pandemic 6 Background on Influenza Disease 7 Pandemic Influenza Preparedness Measures 9 Seasonal Influenza Outbreak Prevention and Response 11 Pandemic Influenza Response 12 Communications Guidelines During a Pandemic 14 Response to High Absenteeism and School Closures 15 Recovery Considerations 16 References 17 Appendix A Evidence for Closing Schools During a Pandemic 18 Appendix B Organizations Represented on the Thomas Jefferson

Pandemic Influenza Public Institutions Advisory Committee 19 Appendix C Emergency Contacts Template Form 20 Appendix D Media Contact List 21 Appendix E Guidelines to Prevent and Control Influenza in the School

Setting 23 Appendix F Sample Letter (s) to Parents 25 Appendix G School Surveillance Form for Influenza and Influenza-like

Illness 35 Appendix H World Health Organization Global Pandemic Phases 36 Appendix I Pandemic Flu Planning Checklist for Individuals and Families 37 Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning 40

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

3

I Background and Purpose of the Plan This plan was developed in response to the Thomas Jefferson Health Districtrsquos call to the community to recognize pandemic influenza as a potential public health emergency that could occur and to take steps to prepare The first community planning meeting was held in November 2005 This plan provides guidance for schools on preparation for and response to a pandemic caused by a novel influenza virus It describes response to seasonal influenza outbreaks as well as a graded response to an influenza pandemic The graded response corresponds with the World Health Organizationrsquos pandemic phases The basic components of the school plan include

bull Basic planning assumptions based on the nature of influenza viruses and past influenza pandemics bull A summary of the persons or organizations that have the authority to make decision related to

pandemic influenza response bull Background on influenza disease and the differences between seasonal influenza outbreaks and an

influenza pandemic bull Action steps that can be taken by schools to prepare for a pandemic through the development of

o Infection control measures that will minimize the spread of disease o Contingency plans to provide education during periods of high absenteeism o Procedures for establishing planning groups that can prepare for continuity of operations

during a pandemic when schools may need to close for a prolonged period of time

bull Response to seasonal influenza outbreaks though prevention including immunizations and infection control measures and containment strategies

bull Graded response to an influenza pandemic through prevention surveillance and containment strategies

bull Guidelines for communications during a pandemic bull Strategies for response to school closings and high absenteeism that could result from a pandemic bull Recovery considerations after a pandemic

The school division will follow the public health recommendations provided by public health authorities and will support community-wide response to an influenza pandemic by

bull Providing health education about influenza and its control to students teachers and staff bull Developing and maintaining clear channels of communication with students teachers and staff as

well as with the health department and other community partners bull Conducting school-based surveillance for influenza and reporting that information to the Thomas

Jefferson Health District

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

4

II Plan Assumptions In November 2005 the US Department of Health and Human Services outlined some basic assumptions based on the nature of human influenza viruses and past influenza pandemics It is important to note however that pandemic influenza would be an emerging disease caused by a novel virus It is not possible to know in advance exactly how the virus will affect humans or what the characteristics of the outbreak will be These assumptions will only serve as a basis for planning not as a prediction for what would occur during a specific disease outbreak

bull Given the current influenza vaccine production process once a novel influenza virus is identified it can take six to eight months to develop and produce an effective vaccine Current research is underway to improve that process but it is expected to take several years

bull Efficient and sustained person-to-person transmission of a novel influenza subtype signals an

imminent pandemic

bull The clinical disease attack rate will likely be 30 or higher in the overall population during the pandemic

o Illness rates would be highest among school-aged children (about 40) o Among working adults an average of 20 would become ill during a community

outbreak

bull Some persons would become infected but not develop clinically significant symptoms Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection

bull Of those who become ill with influenza 50 will seek outpatient medical care If effective

antiviral drugs are available for treatment this percentage may be higher

bull The number of hospitalizations and deaths will depend on the virulence (the degree to which it can make people sick) of the virus This has varied widely among past influenza pandemics

bull Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to

include infants the elderly pregnant women and persons with chronic medical conditions

bull Rates of absenteeism will depend on the severity of the pandemic

o In a severe pandemic absenteeism attributable to illness the need to care for ill family members and fear of infection may reach 40 during the peak weeks of a community outbreak with lower rates of absenteeism during the weeks before and after the peak

o Certain public health measures attempting to slow the spread of disease for example closing schools cancelling large gatherings of people and quarantining household contacts of infected individuals are likely to increase rates of absenteeism

bull The typical incubation period (interval between infection and onset of symptoms) for seasonal

influenza is approximately 2 days

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

5

bull Persons who become infected may shed virus for up to one day before the onset of symproms and therefore may transmit it to others during this period although this would likely be rare

bull The risk of transmission would be greatest during the first two days that a person is symptomatic

for example is febrile

bull In seasonal flu outbreaks children usually shed the greatest amount of virus and therefore pose the greatest risk for transmission

bull On average infected persons would transmit infection to approximately two other people bull In an affected community a pandemic outbreak would last about 6 to 8 weeks

o Multiple waves (periods during which community outbreaks occur across the country) of illness could occur leading to subsequent outbreaks in the same community after a number of months

bull Seasonal influenza outbreaks occur in the fall and winter but the seasonality of a pandemic cannot

be predicted with certainty bull Public health measures regarding vaccination use of antiviral agents and isolationquarantine will

vary based on the characteristics and the stage of the pandemic

bull The local health department will provide guidance to schools on infection control and other measures to consider

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

6

III Authority Coordination and Decision Making During a Pandemic

The public health authority the Thomas Jefferson Health District of the Virginia Department of Health will provide guidance to schools on prevention of and response to both seasonal influenza outbreaks and an influenza pandemic The State Health Commissioner is the executive officer for the State Board of Health with the authority of the board when it is not in session and has the authority to require quarantine isolation immunization decontamination or treatment of any individual or group of individuals when necessary to control the spread of any disease of public health importance (note individuals include companion animals as well as humans) Although the powers granted to the State Health Commissioner pursuant to Article 302 (sect 321-4805 et seq) of Chapter 2 of Title 321 of the Code of Virginia may not be delegated to the district health director many of the activities at the local and district level related to the control of a communicable disease of public health threat will be overseen by the district health director per section C of 12VAC5-90-40 The School Board has the authority to close schools During a pandemic the local government will open an Emergency Operations Center from which it will coordinate the communityrsquos response

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

7

IV Background on Influenza Disease

Influenza illness is caused by influenza viruses In most cases influenza causes fever body aches and respiratory tract infection Complications sometimes associated with influenza can include bacterial pneumonia dehydration and worsening of chronic medical conditions such as congestive heart failure asthma or diabetes Children may get sinus problems and ear infections

There are three types of influenza viruses A B and C but only types A and B infect humans Influenza A viruses are categorized into subtypes and are named according to the specific hemagluttanin (H) and neuraminidase (N) viral proteins they contain for example Influenza A H2N3 Influenza viruses frequently mutate leading to new strains which lead to annual outbreaks of influenza illness Typically five to twenty percent of persons in the United States become infected with influenza each year It is important to differentiate between the effects of seasonal influenza outbreaks and an influenza pandemic The chart on Page 8 summarizes these differences A pandemic is a worldwide outbreak of an emerging disease for which there is no or little existing immunity among the general population Influenza can cause a pandemic when a novel subtype of the Influenza A virus emerges causes significant illness in people and is able to easily spread from person to person This can occur because the virusrsquos segmented genome allows for easy swapping of genetic material when certain animal hosts are co-infected with two different influenza viruses Wild waterfowl are the natural reservoirs for influenza viruses Pigs are common hosts that can be infected with both bird and human influenza viruses allowing for the exchange of genes and the emergence of a novel subtype Some bird influenza viruses can also mutate to become transmissible among persons Vaccination is the primary strategy for preventing and lessening the impact of influenza There is a worldwide network of influenza surveillance systems and information collected through these systems is used to design a new influenza vaccine every year that targets the most prevalent influenza viruses circulating among persons Because of limitations in the current technology used for influenza vaccine production the strains that will be included in the annual vaccine must be chosen several months before influenza season begins In most circumstances the vaccine targets the viruses that predominantly circulate and the vaccine is effective in preventing influenza illness However in some years the viruses change slightly leading to new strains which are not included in the vaccine rendering the vaccine less effective Because these are only slight changes many people will still have some immunity to them Because a novel virus would have to emerge to cause a pandemic the virus would not be one of the circulating viruses and would therefore not have been included in the seasonal influenza vaccine It would also be substantially different from the other circulating influenza viruses so in general people would not have immunity to it Once a novel virus is identified a vaccine must be designed and then manufactured to target it With the current production system this process takes several months Thus containing the spread of the virus to protect people from significant illness becomes a key challenge Isolation and quarantine could be effective in the very early stages of a pandemic but because influenza has a very short incubation period it would be expected to spread very quickly making these measures unmanageable Social distancing techniques may be effective in slowing down the spread of the disease These could include closing schools and taking other measures that would avoid bringing large groups of people together (See Appendix B - Evidence for Closing Schools During a Pandemic)

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

8

SEASONAL FLU COMPARED TO PANDEMIC FLU

Department of Health and Humans Services

SEASONAL FLU

PANDEMIC FLU

Outbreaks follow predictable seasonal patterns occurs annually usually in winter in temperate climates Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968) No previous exposure little or no pre-existing immunity

Healthy adults usually not at risk for serious complications (the very young the elderly and those with certain underlying health conditions at increased risk for serious complications)

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Vaccine developed based on known virus strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average US deaths approximately 36000yr

Number of deaths could be quite high (eg US 1918 death toll approximately 500000)

Symptoms fever cough runny nose muscle pain Deaths often caused by complications such as pneumonia

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (eg some school closing encouragement of people who are sick to stay home)

May cause major impact on society (eg widespread restrictions on travel closings of schools and businesses cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

9

V Pandemic Influenza Preparedness Measures

Action Responsible Party Date

Completed Infections Control Measures Contact vendors of safety and disaster management emergency response products including personal protection equipment such as masks and gloves etc to determine supplies available

School Nurse Program Manager

Maintain a three-month supply of disinfecting solutions in each school including bleach solution hand soap paper towels and alcohol-based hand sanitizer

Director of Building Services Lead custodian for each building

Add one bottle of alcohol-based hand sanitizer to the list of school supplies at all grade levels

Principal

Contingency Plans for Providing Education during Periods of High Absenteeism Instruct teachers at the beginning of the year to have lesson plans in place and require them to update them for each new unit so that in the event of their absence others can proceed with instruction

Principal

Group classes andor teachers by teams so that if team members face prolonged absences classes can be combined

Principal Team leaders

Design systems to provide education through non-traditional methods in the event of prolonged school closures

Principal

Planning for Continuity of Operations during a Pandemic Establish a pandemic influenza planning committee

bull Include those who have expressed interest and at a minimum representation from central administration school nursehealth program manager physician(s) medical supply provider health department and other interested individuals

bull Consult School District (K-12) Pandemic Influenza Planning Checklist at wwwpandemicflugovplanschoolchecklisthtml

Division level

Develop a continuity of operations plan for essential central office functions including payroll (and on-going communication with students and parents)

Central Office Administration

Develop sick and family leave policies specific for a pandemic

Division level

Pandemic Influenza Health Education Teach hand washing and germ hygiene at all grade levels within the first two weeks of school per VA SOLs The curriculum can be viewed at wwwhealthsmartvaorg

Principal

Maintain the school systemrsquos website with up-to-date seasonal influenza and pandemic preparedness messages

Central webmaster School webmasters

10

Ensure language culture and reading level appropriateness in communications by including community leaders representing different language andor ethnic groups on the planning committee asking for their participation in both document planning and the dissemination of public health messages

Pan flu Committee Chair

Communications Ensure that each school keeps its website up-to-date and that each teacher and each team have up-to-date pages

School administrator Team leaders

Include a line requesting e-mail addresses on the yellow Emergency Information Card that is sent home in the beginning of the year (Also include a note that the information will only be used to communicate in the event of an emergency and will not be used for any other purpose without the express permission of the parentguardian)

School administrator Forms amp record keeper

Establish e-mail distribution lists for mass emergency communication

School administrator

Place a question on the Emergency Information Card asking if the family has access to a computer and the internet

Division level administrator

Place those families that do not have access to the internet on a list with their addresses and phone numbers so that communications can be sent via mail or telephone

School administrator

Establish an Emergency Contacts List keep up-to-date and distribute to key personnel ( See Appendix C)

School administrator

Establish a Media Contact Lost and keep up-to-date (See Appendix D)

Division level administrator

Influenza Surveillance Establish system for tracking health-related absenteeism (See Appendix E)

School Nurse Program Manager

Meet with health department epidemiologist to determine and establish reporting procedures

School Nurse Program Manager

11

VI Seasonal Influenza Outbreak Prevention and Response These guidelines will be used for prevention and control of seasonal influenza each year By taking influenza precautions each year the schools will not only decrease illness but will institute routine procedures that may limit the effects of an influenza pandemic Schools will adopt the Guidelines to Prevent and Control Influenza in the School Setting developed by the Thomas Jefferson Health District (See Appendix F) Prevention Schools will encourage influenza vaccination among employees students and family members using both written and verbal communications strategies Influenza vaccine will be offered at nominal cost to employees and their family members Students will be referred to their healthcare providers or to the health department for vaccination In situations of limited vaccine supply the Division will follow the CDCrsquos guidelines for priority groups to receive the first available vaccine The rationale for promoting immunization includes

bull Decreasing illness caused by seasonal influenza bull Decreasing school absenteeism due to seasonal influenza bull Encourages development of vaccine delivery infrastructure which improves capability of

producing vaccines for pandemics bull Increasing immune memory to improve chance of conferring partial immunity to new strains

Schools will send influenza educational materials prepared by the health department to students and employees (See Appendix G) The school administrator will ensure that commonly touched surfaces such as door handles handrails eating surfaces desks phones keyboards etc are cleaned with disinfectant at least twice per day and that hand washing is required of students before eating and at other times as deemed appropriate by teachers and staff

Containment Students and staff will be excluded from schoolwork for signssymptoms of influenza Individuals will be asked to stay home from schoolwork until heshe is without a fever for 24 hours Ill students will be excluded from sports activities choir and other extra-curricular school activities Students who have fever and respiratory symptoms will be dismissed from school by the school nurse Teachers and staff who have fever and respiratory symptoms will be dismissed from school by the principal after input from the school nurse If the school does not have a nurse and the decision is to be made by another staff member the table below may help to distinguish between cold and flu symptoms

Key Differences Between Cold and the Flu Symptoms Cold Flu

Fever Rare Yes (gt100 degF) Headache Rare Yes ndash sudden onset can be severe Aches amp Pains Mild Yes - often severe Extreme Exhaustion Never Yes (may last for weeks or more) Stuffy nose Common Sometimes Sneezing Common Sometimes Sore Throat Common Sometimes Chest Discomfort Mild Common may be severe Cough Common ndash Hacking Often Sometimes may be due to

pneumonia with delayed onset

12

VII Pandemic Influenza Response During an influenza pandemic any guidance provided by the Thomas Jefferson Health District that conflicts with this information will supersede these guidelines The pandemic response stages below are based on the World Health Organizationrsquos Pandemic Phases (See Appendix H) and are organized according to the ldquoPillars of the National Strategyrdquo identified by the Department of Health and Human Services prevention surveillance and containment Pandemic Alert Period - During this period a pandemic has not yet occurred however a novel virus is circulating that has the potential to lead to a pandemic Prevention Follow recommendations listed for seasonal influenza outbreaks Additionally send Pandemic Flu Planning Checklist for Individual and Families (See Appendix I) and other educational materials developed by the Thomas Jefferson Health District to students and staff and add the following links to websites to ensure up-to-date information is available for schools

wwwpandemicflugovwwwcdcgovfluwwwvdhvirginiagovlhdtjpandemic_fluasp

Surveillance Absences will be monitored and the number of cases of influenza-like illness will be reported to the Thomas Jefferson Health District each week Containment Follow recommendations listed for seasonal influenza outbreaks Pandemic Period 6A amp 6B ndash During this period a pandemic is occurring but there are no cases in the community The following measures will be added to the school systemrsquos pandemic response Prevention Refer all individuals to their healthcare providers for pandemic influenza vaccination if available Consider offering vaccination at schools if available and allowable by health department In addition to the germ control measures described for seasonal influenza outbreaks these additional steps will be taken

bull Turn off drinking fountains and make either water coolers with disposable cups or bottled water available

bull Make hand washing compulsory using a combination of washing with soap and water and alcohol-based hand sanitizer at the beginning of each class and before and after snacks and meals

bull Make modifications to reduce the number of commonly touched surfaces o Remove optional commonly touched surfaces such as the number pad to key in cafeteria

accounts o Disinfect computer keypads before each use o Provide individual condiment packages rather than large commonly touched containers o As allowable leave doors open o Disinfect bus seats and doors before each route

bull Require teachers to disinfect door handles and other commonly touched surfaces in the classroom before the start of each class

bull Clean bathroom surfaces 4 times per day and ensure that soap and paper towels are available

11

VI Seasonal Influenza Outbreak Prevention and Response These guidelines will be used for prevention and control of seasonal influenza each year By taking influenza precautions each year the schools will not only decrease illness but will institute routine procedures that may limit the effects of an influenza pandemic Schools will adopt the Guidelines to Prevent and Control Influenza in the School Setting developed by the Thomas Jefferson Health District (See Appendix F) Prevention Schools will encourage influenza vaccination among employees students and family members using both written and verbal communications strategies Influenza vaccine will be offered at nominal cost to employees and their family members Students will be referred to their healthcare providers or to the health department for vaccination In situations of limited vaccine supply the Division will follow the CDCrsquos guidelines for priority groups to receive the first available vaccine The rationale for promoting immunization includes

bull Decreasing illness caused by seasonal influenza bull Decreasing school absenteeism due to seasonal influenza bull Encourages development of vaccine delivery infrastructure which improves capability of

producing vaccines for pandemics bull Increasing immune memory to improve chance of conferring partial immunity to new strains

Schools will send influenza educational materials prepared by the health department to students and employees (See Appendix G) The school administrator will ensure that commonly touched surfaces such as door handles handrails eating surfaces desks phones keyboards etc are cleaned with disinfectant at least twice per day and that hand washing is required of students before eating and at other times as deemed appropriate by teachers and staff

Containment Students and staff will be excluded from schoolwork for signssymptoms of influenza Individuals will be asked to stay home from schoolwork until heshe is without a fever for 24 hours Ill students will be excluded from sports activities choir and other extra-curricular school activities Students who have fever and respiratory symptoms will be dismissed from school by the school nurse Teachers and staff who have fever and respiratory symptoms will be dismissed from school by the principal after input from the school nurse If the school does not have a nurse and the decision is to be made by another staff member the table below may help to distinguish between cold and flu symptoms

Key Differences Between Cold and the Flu Symptoms Cold Flu

Fever Rare Yes (gt100 degF) Headache Rare Yes ndash sudden onset can be severe Aches amp Pains Mild Yes - often severe Extreme Exhaustion Never Yes (may last for weeks or more) Stuffy nose Common Sometimes Sneezing Common Sometimes Sore Throat Common Sometimes Chest Discomfort Mild Common may be severe Cough Common ndash Hacking Often Sometimes may be due to

pneumonia with delayed onset

12

VII Pandemic Influenza Response During an influenza pandemic any guidance provided by the Thomas Jefferson Health District that conflicts with this information will supersede these guidelines The pandemic response stages below are based on the World Health Organizationrsquos Pandemic Phases (See Appendix H) and are organized according to the ldquoPillars of the National Strategyrdquo identified by the Department of Health and Human Services prevention surveillance and containment Pandemic Alert Period - During this period a pandemic has not yet occurred however a novel virus is circulating that has the potential to lead to a pandemic Prevention Follow recommendations listed for seasonal influenza outbreaks Additionally send Pandemic Flu Planning Checklist for Individual and Families (See Appendix I) and other educational materials developed by the Thomas Jefferson Health District to students and staff and add the following links to websites to ensure up-to-date information is available for schools

wwwpandemicflugovwwwcdcgovfluwwwvdhvirginiagovlhdtjpandemic_fluasp

Surveillance Absences will be monitored and the number of cases of influenza-like illness will be reported to the Thomas Jefferson Health District each week Containment Follow recommendations listed for seasonal influenza outbreaks Pandemic Period 6A amp 6B ndash During this period a pandemic is occurring but there are no cases in the community The following measures will be added to the school systemrsquos pandemic response Prevention Refer all individuals to their healthcare providers for pandemic influenza vaccination if available Consider offering vaccination at schools if available and allowable by health department In addition to the germ control measures described for seasonal influenza outbreaks these additional steps will be taken

bull Turn off drinking fountains and make either water coolers with disposable cups or bottled water available

bull Make hand washing compulsory using a combination of washing with soap and water and alcohol-based hand sanitizer at the beginning of each class and before and after snacks and meals

bull Make modifications to reduce the number of commonly touched surfaces o Remove optional commonly touched surfaces such as the number pad to key in cafeteria

accounts o Disinfect computer keypads before each use o Provide individual condiment packages rather than large commonly touched containers o As allowable leave doors open o Disinfect bus seats and doors before each route

bull Require teachers to disinfect door handles and other commonly touched surfaces in the classroom before the start of each class

bull Clean bathroom surfaces 4 times per day and ensure that soap and paper towels are available

12

VII Pandemic Influenza Response During an influenza pandemic any guidance provided by the Thomas Jefferson Health District that conflicts with this information will supersede these guidelines The pandemic response stages below are based on the World Health Organizationrsquos Pandemic Phases (See Appendix H) and are organized according to the ldquoPillars of the National Strategyrdquo identified by the Department of Health and Human Services prevention surveillance and containment Pandemic Alert Period - During this period a pandemic has not yet occurred however a novel virus is circulating that has the potential to lead to a pandemic Prevention Follow recommendations listed for seasonal influenza outbreaks Additionally send Pandemic Flu Planning Checklist for Individual and Families (See Appendix I) and other educational materials developed by the Thomas Jefferson Health District to students and staff and add the following links to websites to ensure up-to-date information is available for schools

wwwpandemicflugovwwwcdcgovfluwwwvdhvirginiagovlhdtjpandemic_fluasp

Surveillance Absences will be monitored and the number of cases of influenza-like illness will be reported to the Thomas Jefferson Health District each week Containment Follow recommendations listed for seasonal influenza outbreaks Pandemic Period 6A amp 6B ndash During this period a pandemic is occurring but there are no cases in the community The following measures will be added to the school systemrsquos pandemic response Prevention Refer all individuals to their healthcare providers for pandemic influenza vaccination if available Consider offering vaccination at schools if available and allowable by health department In addition to the germ control measures described for seasonal influenza outbreaks these additional steps will be taken

bull Turn off drinking fountains and make either water coolers with disposable cups or bottled water available

bull Make hand washing compulsory using a combination of washing with soap and water and alcohol-based hand sanitizer at the beginning of each class and before and after snacks and meals

bull Make modifications to reduce the number of commonly touched surfaces o Remove optional commonly touched surfaces such as the number pad to key in cafeteria

accounts o Disinfect computer keypads before each use o Provide individual condiment packages rather than large commonly touched containers o As allowable leave doors open o Disinfect bus seats and doors before each route

bull Require teachers to disinfect door handles and other commonly touched surfaces in the classroom before the start of each class

bull Clean bathroom surfaces 4 times per day and ensure that soap and paper towels are available

13

bull Use individual supplies such as pencils and glue sticks rather than shared supplies bull School nurses will wear masks gowns gloves and eye protection when examining children with

influenza-like illness and dispose of them after each use o Current recommendations for healthcare workers treating human cases of avian

influenza include a N-95 fitted respirator and for seasonal influenza include a surgical mask Follow specific recommendations about mask use provided by public health authorities during the pandemic

Surveillance No added recommendations Follow those listed for pandemic alert period Containment No added recommendations Follow those listed for pandemic alert period Pandemic Period 6C ndash During this period a pandemic is occurring in the community The following measures will be added to the school systemrsquos pandemic response Prevention

bull Consider offering vaccination at schools if available and allowable by health department If a vaccine exists send letters to employees and students explaining immunization procedures

bull Send letter provided by the Thomas Jefferson Health District describing signs amp symptoms treatment and prevention to employees and students

bull Purchase and provide prearranged protective supplies (masks etc) at the direction of authorities bull Teachers and staff will clean commonly touched surfaces each time a new group enters a room bull Nurse or designee will clean school clinic surfaces using OSHA approved disinfecting solutions

after each patient contact bull Antipyretics (Tylenol Motrin) will not be administered at school unless ordered by a physician for

conditions such as orthopedic injuries or dental pain bull Penalties for absences will be suspended during this time bull The School Nurse Program Manager will inquire as to whether other school districts have already

or are currently experiencing pandemic influenza and contact a member of their crisis team for advice

bull Schools will follow Health Department Directives regarding exclusion quarantine of family membersclose contacts isolation and cancellation of public congregations ldquosnow daysrdquo and school closings

Surveillance No added recommendations Follow those listed for pandemic alert period Containment

bull Any student or staff with influenza-like illness symptoms will be immediately sent home o While waiting for transportation have symptomatic individuals wear a surgical mask and

keep them separated from others o If antiviral agents are available refer ill individuals to a health care provider

bull No student or staff will be permitted to return to school until they have been without fever for 24 hours AND ARE NO LONGER FEELING ILL (HEADACHE CHILLS MUSCLE ACHES ETC) FATIGUE WHICH COMMONLY PERSISTS FOR A WEEK OR TWO AFTER ILLNESS WOULD NOT BE A REASON BY ITSELF FOR EXCLUSION

14

VIII Communications Guidelines During a Pandemic bull Schools will send forms home requesting updated email addresses bull Communications messages should mirror those sent out by the health department so that the

community hears consistent messages

bull Communications will follow the appropriate channels and information will be disseminated electronically or by mail as quickly as possible

o Schools will used pre-prepared mailing lists of families (those with and those without computer and internet access so appropriate communications can be sent to all families)

Computer servers andor mail services may be reduced due to absenteeism during a pandemic so both avenues of communications may be necessary

bull Information will also be provided to local media including radio stations television stations and

newspapers bull Establish or use an already existent telephone hotline for updates on pandemic influenza and

community control measures such as cancellation of activities bull Schools may also be used as conduits for communications from health authorities through

websites email and mass mailings o The Division website will include a page (or link) with up-to-date information on the

pandemic and any special instructions from federal state and local public health officials

bull All school closings and other cancellations will be posted on the school telephone hotline and will also be provided to local media sources including radio television and newspapers

15

IX Response to High Absenteeism and School Closures bull Schools will enact plans for combining classes and other contingencies in the event of significant

student and staff absences bull If schools are ordered closed beyond ldquosnow daysrdquo schools will enact plans for mass homebound

instruction via web based assignmentsinstructions as well as mailings for those with no access to computersinternet

o Teachers prepare packets for independent homebound instruction ndash either assignments or

enrichment activities o Postage and supplies will be procured for teachers to be able to communicate with students

who do not have access to the internet

bull Schools will consider offering food from the National School Lunch Program to students who rely on the program for their nutritional requirements (per recommendation of the United States Dept of Health and Human Services ndash see wwwpandemicflugov)

o Children who rely on the school lunch program can access meals through the USDA

Emergency Plan The plan needs to be activated through the Red Cross o USDA commodities foods might be offered through schools o Elementary schools would be the most appropriate distribution sites since they are more

geographically spread out and middle and high schools might be used for other purposes

bull Schools will reassign nonessential personnel to assist with essential duties bull The Division will enact plan to protect personnel at high risk of complications of influenza (eg

pregnant women immunocompromised persons) by reassigning them to low risk duties or placing them on furlough

bull The Division will work with other local planning groups to determine if school facilities will be

needed as additional spaces for any of a variety of reasons

o If sites are needed schools will provide staff to assist with facilities management

14

VIII Communications Guidelines During a Pandemic bull Schools will send forms home requesting updated email addresses bull Communications messages should mirror those sent out by the health department so that the

community hears consistent messages

bull Communications will follow the appropriate channels and information will be disseminated electronically or by mail as quickly as possible

o Schools will used pre-prepared mailing lists of families (those with and those without computer and internet access so appropriate communications can be sent to all families)

Computer servers andor mail services may be reduced due to absenteeism during a pandemic so both avenues of communications may be necessary

bull Information will also be provided to local media including radio stations television stations and

newspapers bull Establish or use an already existent telephone hotline for updates on pandemic influenza and

community control measures such as cancellation of activities bull Schools may also be used as conduits for communications from health authorities through

websites email and mass mailings o The Division website will include a page (or link) with up-to-date information on the

pandemic and any special instructions from federal state and local public health officials

bull All school closings and other cancellations will be posted on the school telephone hotline and will also be provided to local media sources including radio television and newspapers

15

IX Response to High Absenteeism and School Closures bull Schools will enact plans for combining classes and other contingencies in the event of significant

student and staff absences bull If schools are ordered closed beyond ldquosnow daysrdquo schools will enact plans for mass homebound

instruction via web based assignmentsinstructions as well as mailings for those with no access to computersinternet

o Teachers prepare packets for independent homebound instruction ndash either assignments or

enrichment activities o Postage and supplies will be procured for teachers to be able to communicate with students

who do not have access to the internet

bull Schools will consider offering food from the National School Lunch Program to students who rely on the program for their nutritional requirements (per recommendation of the United States Dept of Health and Human Services ndash see wwwpandemicflugov)

o Children who rely on the school lunch program can access meals through the USDA

Emergency Plan The plan needs to be activated through the Red Cross o USDA commodities foods might be offered through schools o Elementary schools would be the most appropriate distribution sites since they are more

geographically spread out and middle and high schools might be used for other purposes

bull Schools will reassign nonessential personnel to assist with essential duties bull The Division will enact plan to protect personnel at high risk of complications of influenza (eg

pregnant women immunocompromised persons) by reassigning them to low risk duties or placing them on furlough

bull The Division will work with other local planning groups to determine if school facilities will be

needed as additional spaces for any of a variety of reasons

o If sites are needed schools will provide staff to assist with facilities management

15

IX Response to High Absenteeism and School Closures bull Schools will enact plans for combining classes and other contingencies in the event of significant

student and staff absences bull If schools are ordered closed beyond ldquosnow daysrdquo schools will enact plans for mass homebound

instruction via web based assignmentsinstructions as well as mailings for those with no access to computersinternet

o Teachers prepare packets for independent homebound instruction ndash either assignments or

enrichment activities o Postage and supplies will be procured for teachers to be able to communicate with students

who do not have access to the internet

bull Schools will consider offering food from the National School Lunch Program to students who rely on the program for their nutritional requirements (per recommendation of the United States Dept of Health and Human Services ndash see wwwpandemicflugov)

o Children who rely on the school lunch program can access meals through the USDA

Emergency Plan The plan needs to be activated through the Red Cross o USDA commodities foods might be offered through schools o Elementary schools would be the most appropriate distribution sites since they are more

geographically spread out and middle and high schools might be used for other purposes

bull Schools will reassign nonessential personnel to assist with essential duties bull The Division will enact plan to protect personnel at high risk of complications of influenza (eg

pregnant women immunocompromised persons) by reassigning them to low risk duties or placing them on furlough

bull The Division will work with other local planning groups to determine if school facilities will be

needed as additional spaces for any of a variety of reasons

o If sites are needed schools will provide staff to assist with facilities management

16

IX RECOVERY CONSIDERATIONS

The School Board will determine if the school year will be extended into the summer months in the event of prolonged school closures Schools may need to mobilize the services of mental health professionals if the morbidity and mortality numbers are significant and the mental health needs of students and staff exceeds the resources of the schools The community mental health agencies have organized a task force to address this issue and are developing protocols that will be incorporated into the health departmentrsquos pandemic influenza plan

17

XI References

Donowitz Leigh G (Editor) Infection Control in the Child Care Center and Preschool (3rd edition) Baltimore Williams amp Wilkins 1996

US Department of Health and Human Services Pandemic Influenza Plan - November 2005 Virginia Department of Health Emergency Operations Plan Attachment Pandemic Influenza Revised 06-30-2005 httpwwwwhitehousegovhomelandpandemic-influenza-implementationhtml wwwcdcgovmmwrpreviewmmwrhtmlmm4930ahtm wwwpandemicflugovplanoandplanhtml Varghese Reuben MD MPH Health Director amp Caruso Donna RN MSN School Health Bureau Chief Arlington County Department of Health Pandemic Influenza (Flu) Schools Parents and Children Presentation to Arlington Public School Board February 15 2006 United States Department of Agriculture Food and Nutrition Service Disaster Manual Food and Nutrition Service Food Distribution Division Updated September 2005) Department of Health and Human Services CDC Guidelines and Recommendations Preventing the Spread of Influenza in Child Care Settings Guidance for Administrators Care Providers and Other Staff World Health Organization WHO Consultation on Priority Public Health Interventions before and during an Influenza Pandemic Geneva Switzerland March 16-18 2004 CDC Pandemic Influenza Fact Sheet wwwcecgovfluaviangen-infopandemicshtm Avian Influenza Fact Sheet wwwcdcgovfluaviangen-infofactshtm MMWR Guide for Influenza http wwwcdcgovmmwrmguide-fluhtml The Center for Health and Health Care in Schools School Health Issues Flu Season and Schools httpwwwhealthinschoolsorg

17

XI References

Donowitz Leigh G (Editor) Infection Control in the Child Care Center and Preschool (3rd edition) Baltimore Williams amp Wilkins 1996

US Department of Health and Human Services Pandemic Influenza Plan - November 2005 Virginia Department of Health Emergency Operations Plan Attachment Pandemic Influenza Revised 06-30-2005 httpwwwwhitehousegovhomelandpandemic-influenza-implementationhtml wwwcdcgovmmwrpreviewmmwrhtmlmm4930ahtm wwwpandemicflugovplanoandplanhtml Varghese Reuben MD MPH Health Director amp Caruso Donna RN MSN School Health Bureau Chief Arlington County Department of Health Pandemic Influenza (Flu) Schools Parents and Children Presentation to Arlington Public School Board February 15 2006 United States Department of Agriculture Food and Nutrition Service Disaster Manual Food and Nutrition Service Food Distribution Division Updated September 2005) Department of Health and Human Services CDC Guidelines and Recommendations Preventing the Spread of Influenza in Child Care Settings Guidance for Administrators Care Providers and Other Staff World Health Organization WHO Consultation on Priority Public Health Interventions before and during an Influenza Pandemic Geneva Switzerland March 16-18 2004 CDC Pandemic Influenza Fact Sheet wwwcecgovfluaviangen-infopandemicshtm Avian Influenza Fact Sheet wwwcdcgovfluaviangen-infofactshtm MMWR Guide for Influenza http wwwcdcgovmmwrmguide-fluhtml The Center for Health and Health Care in Schools School Health Issues Flu Season and Schools httpwwwhealthinschoolsorg

18

Appendix A Organizations Represented on the Thomas Jefferson Pandemic Influenza Public Institutions Advisory Committee

o Albemarle County Public Schools o City of Charlottesville

o Covenant School

o Jefferson Areas Board on Aging

o St Annersquos Belfield School

o University of Virginia

o University Montessori School

19

Appendix B Evidence for Closing Schools During a Pandemic Emerging Infectious Diseases (vol 12 no 1 pp88-94) published Non pharmaceutical Interventions for Pandemic Influenza National and Community Measures The article is a product of the World Health Organizationrsquos Writing Group An interesting statement in the article notes Apparently no data or analyses exist for recommending illness thresholds or rates of change that will lead to considering closing or reopening schools However the article does note anecdotally that in 1959 the opening of schools after the summer holiday seems to have played an important role in initiating the main epidemic phase It also notes that simultaneous use of multiple measures (eg closing schools public gathering places sporting events etc) caused a reduction of influenza and other respiratory viral infections during the 2003 SARS epidemic in Hong Kong In the discussion it states that when there is increased and sustained transmission in the general public measures to increase social distance will be considered in affected communities depending on the epidemiology of transmission severity of disease and the risk groups affected

20

Appendix C Emergency Contacts Template Form

Organization Contact Name Phone Number E-mail

School Board School Superintendent Building Maintenance Food Services School Nurse Program Transportation Health Department Thomas Jefferson

Health District o Pam Burke

Emergency Planner o Roy Crewz

epidemiologist o Dr Lilian Peake

Director

434-972-6219 pamelaburke vdhvirginiagov roycrewz vdhvirginiagov lilianpeake vdhvirginiagov

County Administrator Localityrsquos Emergency Services Coordinator

County Public Information Officer

PoliceSheriff Fire Rescue UVA Emergency Department

Martha Jefferson Emergency Department

Chamber of Commerce

21

Appendix D Media Contact List

NEWSPAPER TELEVISION RADIO

The Daily Progress PO Box 9030 Charlottesville VA 22906 Phone 434-978-7240 News Receptionist Tiffany Sanchez Fax 434-978-7252 978-7221 Carolyn A Cullen Retail Advertising Manager Email ccullendailyprogresscomwwwdailyprogresscom

The Cavalier Daily ATTENTION Editor University of Virginia PO Box 400703 Charlottesville VA 22904 Phone 434-924-3387 Fax 434-924-7290 Email cavdailycavalierdailycomhttpcavalierdailycom CharlottesvilleAlbemarle Tribune ATTENTION Agnes C White 250 Main Street W 402 PO Box 3428 Charlottesville VA 22903 Phone 434-979-0373 Fax 434-971-5821 Charlottesville Business Journal ATTENTION Chris Saitta Editor 685 Rio Road West Charlottesville VA 22901 PO Box 9030 Charlottesville VA 22906 Phone 434-964-1085 Fax 434-964-1094 csaittadailyprogresscom

C-VILLE Weekly ATTENTION Cathryn Harding Editor 106 East Main Street Charlottesville VA 22902 Phone 434-817-2749 Fax 434-817-2758 Email Editorc-villecomwwwc-villecom

WVIR-TV NBC 29 ATTENTION News Department 503 East Market Street Charlottesville VA 22902 Phone 434-977-7082 Fax 434-220-2905 (News Room) wwwnbc29com WVAW TV 16 ABCATTENTION News Director Bill Varecha ConsultantManager Gray Television Group Inc 999 2nd Street SE Charlottesville VA 22902 Phone 220-1919 Fax 220-0362 Httpwwwwcavtv WCAV TV 19 CBSATTENTION News Director Bill Varecha ConsultantManager Gray Television Group Inc 999 2nd Street SE Charlottesville VA 22902 Phone 242-1919 Fax 220-0398 Httpwwwwcavtv

Adelphia Cable Communications ATTN News Department 400 Westfield Road Charlottesville VA 22901 For PSAs etc contact Cal Tate 995-5905 Phone 951-3500 main Phone 1-800-835-4949 FAX 951-3705 Email caltateadelphianet CHARLOTTESVILLE PUBLIC ACCESS TELEVISION (CPA-TV) Broadcasts on Adelphia Cable Channels 13 amp 14 Cal Tate 995-5905 Email tateccharlottesvilleorgwwwcpatvorg

WINA AM 1070 ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Phone 977-6397 (NEWS) Studio Phone 977-1070 Office Phone 220-2300 FAX 220-2304 wwwwinacom

WWWV ndash 3WV 975 FM ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Main Office 971-4057 Studio Phone 295-3460 FAX 220-2304 www3wvcom WQMZ Lite Rock Z 951 FM ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Studio Phone 220-2395 News Phone 977-6397 (NEWS) Office Phone 220-2300 FAX 220-2304 Email-Studio mailz95net WUVA - 927 Kiss FM ATTENTION News Department 1928 Arlington Blvd Suite 312 Charlottesville VA 22903 Office Phone 817-6880 FAX 817-6884 MAIN OFFICE 1 Morton Drive Charlottesville VA 22903 Studio Phone 293-5447 www927kissfmcom

WCYK ndash Country FM 997 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Studio FAX 978-0723 FAX Business 978-1109 wwwcountry997com WHTE HOT 1019 FM ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Studio Phone 975-1019 Business Phone 978-4408 FAX 978-0723 www1019hotcom WKAV SPORTS RADIO AM 1400 ATTENTION News Department Main Office amp Studio 1140 Rose Hill Drive Charlottesville VA 22903 Phone 220-2300 977-1400 Business Phone 978-4408 WCHV NEWS-TALK AM 1260 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Business Phone 978-4408 Fax 434-978-0723

WKTR Ministry Station 840 AM PO Box 309 Quinque VA 22965 Larry Cobb Vice-President Phone 296-3300 (Charlottesville) or 985-8585 Stanardsville) Fax 757-365-0412

19

Appendix B Evidence for Closing Schools During a Pandemic Emerging Infectious Diseases (vol 12 no 1 pp88-94) published Non pharmaceutical Interventions for Pandemic Influenza National and Community Measures The article is a product of the World Health Organizationrsquos Writing Group An interesting statement in the article notes Apparently no data or analyses exist for recommending illness thresholds or rates of change that will lead to considering closing or reopening schools However the article does note anecdotally that in 1959 the opening of schools after the summer holiday seems to have played an important role in initiating the main epidemic phase It also notes that simultaneous use of multiple measures (eg closing schools public gathering places sporting events etc) caused a reduction of influenza and other respiratory viral infections during the 2003 SARS epidemic in Hong Kong In the discussion it states that when there is increased and sustained transmission in the general public measures to increase social distance will be considered in affected communities depending on the epidemiology of transmission severity of disease and the risk groups affected

20

Appendix C Emergency Contacts Template Form

Organization Contact Name Phone Number E-mail

School Board School Superintendent Building Maintenance Food Services School Nurse Program Transportation Health Department Thomas Jefferson

Health District o Pam Burke

Emergency Planner o Roy Crewz

epidemiologist o Dr Lilian Peake

Director

434-972-6219 pamelaburke vdhvirginiagov roycrewz vdhvirginiagov lilianpeake vdhvirginiagov

County Administrator Localityrsquos Emergency Services Coordinator

County Public Information Officer

PoliceSheriff Fire Rescue UVA Emergency Department

Martha Jefferson Emergency Department

Chamber of Commerce

21

Appendix D Media Contact List

NEWSPAPER TELEVISION RADIO

The Daily Progress PO Box 9030 Charlottesville VA 22906 Phone 434-978-7240 News Receptionist Tiffany Sanchez Fax 434-978-7252 978-7221 Carolyn A Cullen Retail Advertising Manager Email ccullendailyprogresscomwwwdailyprogresscom

The Cavalier Daily ATTENTION Editor University of Virginia PO Box 400703 Charlottesville VA 22904 Phone 434-924-3387 Fax 434-924-7290 Email cavdailycavalierdailycomhttpcavalierdailycom CharlottesvilleAlbemarle Tribune ATTENTION Agnes C White 250 Main Street W 402 PO Box 3428 Charlottesville VA 22903 Phone 434-979-0373 Fax 434-971-5821 Charlottesville Business Journal ATTENTION Chris Saitta Editor 685 Rio Road West Charlottesville VA 22901 PO Box 9030 Charlottesville VA 22906 Phone 434-964-1085 Fax 434-964-1094 csaittadailyprogresscom

C-VILLE Weekly ATTENTION Cathryn Harding Editor 106 East Main Street Charlottesville VA 22902 Phone 434-817-2749 Fax 434-817-2758 Email Editorc-villecomwwwc-villecom

WVIR-TV NBC 29 ATTENTION News Department 503 East Market Street Charlottesville VA 22902 Phone 434-977-7082 Fax 434-220-2905 (News Room) wwwnbc29com WVAW TV 16 ABCATTENTION News Director Bill Varecha ConsultantManager Gray Television Group Inc 999 2nd Street SE Charlottesville VA 22902 Phone 220-1919 Fax 220-0362 Httpwwwwcavtv WCAV TV 19 CBSATTENTION News Director Bill Varecha ConsultantManager Gray Television Group Inc 999 2nd Street SE Charlottesville VA 22902 Phone 242-1919 Fax 220-0398 Httpwwwwcavtv

Adelphia Cable Communications ATTN News Department 400 Westfield Road Charlottesville VA 22901 For PSAs etc contact Cal Tate 995-5905 Phone 951-3500 main Phone 1-800-835-4949 FAX 951-3705 Email caltateadelphianet CHARLOTTESVILLE PUBLIC ACCESS TELEVISION (CPA-TV) Broadcasts on Adelphia Cable Channels 13 amp 14 Cal Tate 995-5905 Email tateccharlottesvilleorgwwwcpatvorg

WINA AM 1070 ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Phone 977-6397 (NEWS) Studio Phone 977-1070 Office Phone 220-2300 FAX 220-2304 wwwwinacom

WWWV ndash 3WV 975 FM ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Main Office 971-4057 Studio Phone 295-3460 FAX 220-2304 www3wvcom WQMZ Lite Rock Z 951 FM ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Studio Phone 220-2395 News Phone 977-6397 (NEWS) Office Phone 220-2300 FAX 220-2304 Email-Studio mailz95net WUVA - 927 Kiss FM ATTENTION News Department 1928 Arlington Blvd Suite 312 Charlottesville VA 22903 Office Phone 817-6880 FAX 817-6884 MAIN OFFICE 1 Morton Drive Charlottesville VA 22903 Studio Phone 293-5447 www927kissfmcom

WCYK ndash Country FM 997 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Studio FAX 978-0723 FAX Business 978-1109 wwwcountry997com WHTE HOT 1019 FM ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Studio Phone 975-1019 Business Phone 978-4408 FAX 978-0723 www1019hotcom WKAV SPORTS RADIO AM 1400 ATTENTION News Department Main Office amp Studio 1140 Rose Hill Drive Charlottesville VA 22903 Phone 220-2300 977-1400 Business Phone 978-4408 WCHV NEWS-TALK AM 1260 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Business Phone 978-4408 Fax 434-978-0723

WKTR Ministry Station 840 AM PO Box 309 Quinque VA 22965 Larry Cobb Vice-President Phone 296-3300 (Charlottesville) or 985-8585 Stanardsville) Fax 757-365-0412

20

Appendix C Emergency Contacts Template Form

Organization Contact Name Phone Number E-mail

School Board School Superintendent Building Maintenance Food Services School Nurse Program Transportation Health Department Thomas Jefferson

Health District o Pam Burke

Emergency Planner o Roy Crewz

epidemiologist o Dr Lilian Peake

Director

434-972-6219 pamelaburke vdhvirginiagov roycrewz vdhvirginiagov lilianpeake vdhvirginiagov

County Administrator Localityrsquos Emergency Services Coordinator

County Public Information Officer

PoliceSheriff Fire Rescue UVA Emergency Department

Martha Jefferson Emergency Department

Chamber of Commerce

21

Appendix D Media Contact List

NEWSPAPER TELEVISION RADIO

The Daily Progress PO Box 9030 Charlottesville VA 22906 Phone 434-978-7240 News Receptionist Tiffany Sanchez Fax 434-978-7252 978-7221 Carolyn A Cullen Retail Advertising Manager Email ccullendailyprogresscomwwwdailyprogresscom

The Cavalier Daily ATTENTION Editor University of Virginia PO Box 400703 Charlottesville VA 22904 Phone 434-924-3387 Fax 434-924-7290 Email cavdailycavalierdailycomhttpcavalierdailycom CharlottesvilleAlbemarle Tribune ATTENTION Agnes C White 250 Main Street W 402 PO Box 3428 Charlottesville VA 22903 Phone 434-979-0373 Fax 434-971-5821 Charlottesville Business Journal ATTENTION Chris Saitta Editor 685 Rio Road West Charlottesville VA 22901 PO Box 9030 Charlottesville VA 22906 Phone 434-964-1085 Fax 434-964-1094 csaittadailyprogresscom

C-VILLE Weekly ATTENTION Cathryn Harding Editor 106 East Main Street Charlottesville VA 22902 Phone 434-817-2749 Fax 434-817-2758 Email Editorc-villecomwwwc-villecom

WVIR-TV NBC 29 ATTENTION News Department 503 East Market Street Charlottesville VA 22902 Phone 434-977-7082 Fax 434-220-2905 (News Room) wwwnbc29com WVAW TV 16 ABCATTENTION News Director Bill Varecha ConsultantManager Gray Television Group Inc 999 2nd Street SE Charlottesville VA 22902 Phone 220-1919 Fax 220-0362 Httpwwwwcavtv WCAV TV 19 CBSATTENTION News Director Bill Varecha ConsultantManager Gray Television Group Inc 999 2nd Street SE Charlottesville VA 22902 Phone 242-1919 Fax 220-0398 Httpwwwwcavtv

Adelphia Cable Communications ATTN News Department 400 Westfield Road Charlottesville VA 22901 For PSAs etc contact Cal Tate 995-5905 Phone 951-3500 main Phone 1-800-835-4949 FAX 951-3705 Email caltateadelphianet CHARLOTTESVILLE PUBLIC ACCESS TELEVISION (CPA-TV) Broadcasts on Adelphia Cable Channels 13 amp 14 Cal Tate 995-5905 Email tateccharlottesvilleorgwwwcpatvorg

WINA AM 1070 ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Phone 977-6397 (NEWS) Studio Phone 977-1070 Office Phone 220-2300 FAX 220-2304 wwwwinacom

WWWV ndash 3WV 975 FM ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Main Office 971-4057 Studio Phone 295-3460 FAX 220-2304 www3wvcom WQMZ Lite Rock Z 951 FM ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Studio Phone 220-2395 News Phone 977-6397 (NEWS) Office Phone 220-2300 FAX 220-2304 Email-Studio mailz95net WUVA - 927 Kiss FM ATTENTION News Department 1928 Arlington Blvd Suite 312 Charlottesville VA 22903 Office Phone 817-6880 FAX 817-6884 MAIN OFFICE 1 Morton Drive Charlottesville VA 22903 Studio Phone 293-5447 www927kissfmcom

WCYK ndash Country FM 997 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Studio FAX 978-0723 FAX Business 978-1109 wwwcountry997com WHTE HOT 1019 FM ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Studio Phone 975-1019 Business Phone 978-4408 FAX 978-0723 www1019hotcom WKAV SPORTS RADIO AM 1400 ATTENTION News Department Main Office amp Studio 1140 Rose Hill Drive Charlottesville VA 22903 Phone 220-2300 977-1400 Business Phone 978-4408 WCHV NEWS-TALK AM 1260 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Business Phone 978-4408 Fax 434-978-0723

WKTR Ministry Station 840 AM PO Box 309 Quinque VA 22965 Larry Cobb Vice-President Phone 296-3300 (Charlottesville) or 985-8585 Stanardsville) Fax 757-365-0412

21

Appendix D Media Contact List

NEWSPAPER TELEVISION RADIO

The Daily Progress PO Box 9030 Charlottesville VA 22906 Phone 434-978-7240 News Receptionist Tiffany Sanchez Fax 434-978-7252 978-7221 Carolyn A Cullen Retail Advertising Manager Email ccullendailyprogresscomwwwdailyprogresscom

The Cavalier Daily ATTENTION Editor University of Virginia PO Box 400703 Charlottesville VA 22904 Phone 434-924-3387 Fax 434-924-7290 Email cavdailycavalierdailycomhttpcavalierdailycom CharlottesvilleAlbemarle Tribune ATTENTION Agnes C White 250 Main Street W 402 PO Box 3428 Charlottesville VA 22903 Phone 434-979-0373 Fax 434-971-5821 Charlottesville Business Journal ATTENTION Chris Saitta Editor 685 Rio Road West Charlottesville VA 22901 PO Box 9030 Charlottesville VA 22906 Phone 434-964-1085 Fax 434-964-1094 csaittadailyprogresscom

C-VILLE Weekly ATTENTION Cathryn Harding Editor 106 East Main Street Charlottesville VA 22902 Phone 434-817-2749 Fax 434-817-2758 Email Editorc-villecomwwwc-villecom

WVIR-TV NBC 29 ATTENTION News Department 503 East Market Street Charlottesville VA 22902 Phone 434-977-7082 Fax 434-220-2905 (News Room) wwwnbc29com WVAW TV 16 ABCATTENTION News Director Bill Varecha ConsultantManager Gray Television Group Inc 999 2nd Street SE Charlottesville VA 22902 Phone 220-1919 Fax 220-0362 Httpwwwwcavtv WCAV TV 19 CBSATTENTION News Director Bill Varecha ConsultantManager Gray Television Group Inc 999 2nd Street SE Charlottesville VA 22902 Phone 242-1919 Fax 220-0398 Httpwwwwcavtv

Adelphia Cable Communications ATTN News Department 400 Westfield Road Charlottesville VA 22901 For PSAs etc contact Cal Tate 995-5905 Phone 951-3500 main Phone 1-800-835-4949 FAX 951-3705 Email caltateadelphianet CHARLOTTESVILLE PUBLIC ACCESS TELEVISION (CPA-TV) Broadcasts on Adelphia Cable Channels 13 amp 14 Cal Tate 995-5905 Email tateccharlottesvilleorgwwwcpatvorg

WINA AM 1070 ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Phone 977-6397 (NEWS) Studio Phone 977-1070 Office Phone 220-2300 FAX 220-2304 wwwwinacom

WWWV ndash 3WV 975 FM ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Main Office 971-4057 Studio Phone 295-3460 FAX 220-2304 www3wvcom WQMZ Lite Rock Z 951 FM ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Studio Phone 220-2395 News Phone 977-6397 (NEWS) Office Phone 220-2300 FAX 220-2304 Email-Studio mailz95net WUVA - 927 Kiss FM ATTENTION News Department 1928 Arlington Blvd Suite 312 Charlottesville VA 22903 Office Phone 817-6880 FAX 817-6884 MAIN OFFICE 1 Morton Drive Charlottesville VA 22903 Studio Phone 293-5447 www927kissfmcom

WCYK ndash Country FM 997 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Studio FAX 978-0723 FAX Business 978-1109 wwwcountry997com WHTE HOT 1019 FM ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Studio Phone 975-1019 Business Phone 978-4408 FAX 978-0723 www1019hotcom WKAV SPORTS RADIO AM 1400 ATTENTION News Department Main Office amp Studio 1140 Rose Hill Drive Charlottesville VA 22903 Phone 220-2300 977-1400 Business Phone 978-4408 WCHV NEWS-TALK AM 1260 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Business Phone 978-4408 Fax 434-978-0723

WKTR Ministry Station 840 AM PO Box 309 Quinque VA 22965 Larry Cobb Vice-President Phone 296-3300 (Charlottesville) or 985-8585 Stanardsville) Fax 757-365-0412

Newspapers continued

The Hook ATTENTION Hawes Spencer Editor 100 Second Street N W Charlottesville VA 22902 Phone 434-295-8700 Fax 434-295-8097 Email editorreadthehookcomwwwreadthehookcom

The Rural Virginian ATTENTION Editor PO Box 9030 Charlottesville VA 22906 Phone 434-978-7200 434-978-7216 Fax 434-978-7252

The Fluvanna Review ATTENTION Editor PO Box 59 Palmyra VA 22963 Phone 589-1704 Fax 589-1704 Email eallencstonenet wwwfluvannareviewcom Greene County Record ATTENTION Editor Main Street POB 66 Stanardsville VA 22923 Phone 985-2315 FAX 985-8356 wwwgreene-newscom Nelson CountyTimes ATTENTION EDITOR 134 Second Street Amherst VA 24521 434-946-7195 editornelsoncountytimescom The Central Virginian ATTENTION EDITOR POB 464 Louisa VA 23093 540-967-0368 540-967-3847 virginianfirstvacom

Television stations continued WHTJ Charlottesville PBS Channel 41 ATTENTION News Department Conni Lombardo Vice-President General Manager 1821 Avon Street Ext Suite 100 POB 2021 Charlottesville VA 22902 Phone 295-7671 293-1393 FAX 295-2813 clombardoideastationsorgwwwideastationsorgwhtj

Radio stations continued

WCJZ-FM Contemp Hit 1075 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Studio Phone 964-1075 Business Phone 978-4408 FAX 978-0723 wwwcharlottesvillejazzcom WFFX ndashFM Oldies 1023 ATTENTION News Department 1150 Pepsi Place Ste 300 (22901) PO Box 7703 Charlottesville VA 22906 Phone 978-1023

WNRN Public Radio 919 FM Mike Friend General Manager Anne Williams PSA Announcements 2250 Old Ivy Road Suite 2 Charlottesville VA 22903 Phone 434-971-4096 Phone 434-979-0919 Studio Line Fax 434-971-6562 wnrnrlcnetwwwwnrnorg WMRA-Charlottesvillersquos NPR Station 1035 FM Olivia Branch Bus Support Rep 100 Court Square 9 PO Box 81 Charlottesville VA 22902 Phone 295-4677 Fax 295-0721 Email wmraavenueorgwmraorg

Radio stations continued WTJU Radio Station 911 FM WTJU News (press releases etc) Chuck Taylor General Manager Sakeena Siddiqi Chief Editor Email Sss5FvirginiaeduOffices B-7 Peabody Hall Studios B-8 Peabody Hall University of Virginia (22902) PO Box 400811 Charlottesville VA 22904-4811 Office Phone 924-0885 Studio Phone 924-3959 434-243-8832 434-924-3418 984-9745 Fax 434-924-8996 wtjunewsvirginiaeduwtjuvirginiaeduwwwwtjuradiovirginiaedu WVAX-AM Talk Radio 1450 AM ATTENTION News Department 1140 Rose Hill Drive Charlottesville VA 22903 Phone 977-6397 (NEWS) Studio Phone 977-1070 Office Phone 220-2300 FAX 220-2304 wvaxcom

22

23

Appendix E Influenza Prevention Strategies Teaching Germ HygieneGuidelines to Prevent and Control Influenza in the School Setting

References for School Staff wwwhealthsmartvaorg for Health SOLs and curriculum support materials Further educational resources include wwwcdcgovncidodopmaterialsopbrochurePDFwwwcdcgovgermstoppermaterialshome_work_schoolpdfwwwscrubcluborg wwwitsasnaporgsnapaboutasp

Key Points When Teaching Germ Hygiene for School Personnel

bull Stay home if you are sick Do not take MotrinAdvil or Tylenol then go to school bull Cough sneeze etiquette Cover your mouth and nose when you cough or sneeze Cough

or sneeze into a tissue then throw the tissue away Wash your hands afterward with soap and water for 20 seconds or use an alcohol-based disinfectant If no tissue is available cough or sneeze into your sleeve

bull Hand washing hand washing hand washing This is one of the most effective ways of

curtailing germ spread Wash hands every time you

o Cough or sneeze o Use the bathroom o Touch surfaces like money doorknobs etc

bull Avoid touching your face eyes and mouth bull Keep a healthy distance when you are sick Avoid close contact with others Try to keep

at least three feet between people

bull Continue with healthy lifestyle

o Good nutrition o Moderate daily exercise o Good sleep patterns

24

School Staff Actions to Protect Students

1) Staff members need to stay home if sick 2) Send sick students to the clinic ndash then home Support decisions of school nurse to send or keep

students home Remind parents to keep students home when sick

3) Notify clinic if notice increases in absences or clustering of symptoms

4) Post hygiene reminders especially near eating areas and toilets

5) Be good germ hygiene role models

6) Educate and encourage respiratory etiquette among staff visitors and students including

bull Using tissues to cover the mouth and nose when coughing bull Disposing of tissues in a trash can after use and washing hands bull Washing hands with soap and water for at least 20 seconds and drying with a paper towel

Using the paper towel to turn off faucet bull Using an alcohol-based hand sanitizer to clean or hands when soap and water are not

available

7) Depending on vaccine availability encourage people to get the influenza vaccine 8) Ensure hand washing supplies are well stocked Keep restrooms fully stocked with soap and

disposable towels Keep trash containers near exit doors Empty trash cans often Ensure that tissues are in the classrooms and provide alcohol-based hand sanitizers in classrooms libraries gymnasiums and other student sites Encourage students to wash their hands before eating and not to share utensils drinking glasses or other personal items

9) Keep shared surfaces clean Daily disinfect environment with an EPA approved disinfectant

including doorknobs desks mats and other potentially contaminated surfaces (10 bleach solution may be used if changed daily)

10) Encourage staff and children to avoid touching eyes nose or mouth

11) Exclude febrile children from the classroom Recommend parents keep children with respiratory

symptoms and fever out of school

25

Appendix F Sample Letter to Parents Dear School Families Influenza or flu season is upon us and there have been many cases diagnosed in the community The following information is being sent to all families The school division is in continuous contact with the local Health Department and is following all guidelines and recommendations The information below was adapted from the Centers for Disease Control and Prevention wwwcdcgovfluindexhtm

Flu symptoms include fever headache chills body aches tiredness dry cough sore throat and nasal congestion

Flu is spread when a person who has the flu coughs sneezes or speaks and sends the flu virus into the air The virus enters the nose throat or lungs of a person and multiplies Flu spreads less frequently when a person touches a surface that has flu viruses on it

Frequent hand washing and coughsneeze etiquette can help prevent illness Wash hands with soap and water for at least 20 seconds or use alcohol based hand sanitizer Cough or sneeze into a tissue throw the tissue away and then wash your hands as described above If a tissue is not available cough or sneeze into your sleeve rather than your hand

If you get the flu rest drink plenty of liquids and avoid alcohol and tobacco

Antibiotics like penicillin will not cure the flu However there are antiviral medications available by prescription that may help shorten the course and severity of influenza and may help prevent infection when begun within 48 hours of the onset of symptoms In wide-spread flu outbreaks these medications may be in short supply and available on a limited basis initially to the priority groups described above

The best way to prevent the flu is to get a flu shot In October 2004 the American flu vaccine supply was cut in half CDC and the US-based influenza vaccine manufacturer prioritized the populations eligible for the limited supply Initially priority populations included hospital staff long-term care providers nursing homes and private providers who care for young children Additional priority populations eligible to receive vaccination with inactivated influenza vaccine included all children aged 6-23 months adults 65 years of age and older persons aged 2 to 64 years with underlying chronic medical conditions residents of nursing homes and long-term care facilities all women who will be pregnant during the influenza season children 6 months to 18 years of age who are on chronic aspirin therapy health care workers with direct patient care out-of home caregivers and household contacts of children under 6 months of age

Over-the-counter medications may relieve symptoms of flu The National Institute for Allergies amp Infectious Diseases recommends acetaminophen (Tylenol) for children aspirin or acetaminophen for adults Decongestants cough suppressants and use of a humidifier can provide symptomatic relief

25

Appendix F Sample Letter to Parents Dear School Families Influenza or flu season is upon us and there have been many cases diagnosed in the community The following information is being sent to all families The school division is in continuous contact with the local Health Department and is following all guidelines and recommendations The information below was adapted from the Centers for Disease Control and Prevention wwwcdcgovfluindexhtm

Flu symptoms include fever headache chills body aches tiredness dry cough sore throat and nasal congestion

Flu is spread when a person who has the flu coughs sneezes or speaks and sends the flu virus into the air The virus enters the nose throat or lungs of a person and multiplies Flu spreads less frequently when a person touches a surface that has flu viruses on it

Frequent hand washing and coughsneeze etiquette can help prevent illness Wash hands with soap and water for at least 20 seconds or use alcohol based hand sanitizer Cough or sneeze into a tissue throw the tissue away and then wash your hands as described above If a tissue is not available cough or sneeze into your sleeve rather than your hand

If you get the flu rest drink plenty of liquids and avoid alcohol and tobacco

Antibiotics like penicillin will not cure the flu However there are antiviral medications available by prescription that may help shorten the course and severity of influenza and may help prevent infection when begun within 48 hours of the onset of symptoms In wide-spread flu outbreaks these medications may be in short supply and available on a limited basis initially to the priority groups described above

The best way to prevent the flu is to get a flu shot In October 2004 the American flu vaccine supply was cut in half CDC and the US-based influenza vaccine manufacturer prioritized the populations eligible for the limited supply Initially priority populations included hospital staff long-term care providers nursing homes and private providers who care for young children Additional priority populations eligible to receive vaccination with inactivated influenza vaccine included all children aged 6-23 months adults 65 years of age and older persons aged 2 to 64 years with underlying chronic medical conditions residents of nursing homes and long-term care facilities all women who will be pregnant during the influenza season children 6 months to 18 years of age who are on chronic aspirin therapy health care workers with direct patient care out-of home caregivers and household contacts of children under 6 months of age

Over-the-counter medications may relieve symptoms of flu The National Institute for Allergies amp Infectious Diseases recommends acetaminophen (Tylenol) for children aspirin or acetaminophen for adults Decongestants cough suppressants and use of a humidifier can provide symptomatic relief

26

Things to keep in mind for school-age children o Do not give aspirin to a child or teenager who has the flu Aspirin use in children with

viral infections can cause Reyes Syndrome ndash a rare but serious condition Ibuprofen (Motrin) and Acetaminophen (Tylenol) may be administered at the advice of your doctor

o Most antihistamines cause sleepiness If a child still has a stuffy nose when she returns to school parents may want to ask their childs doctor to prescribe a non-sedating antihistamine

o Encourage children to cover coughs and sneezes wash hands frequently and keep hands away from eyes nose and mouth

o A sick child is advised to stay at home during the first days of illness when symptoms are most severe and the infection is most contagious Children can return to school when symptoms are improving and no fever has been detected for 24 hours

Please contact your doctor or the nurse at your child(ren)rsquos school if you have any questions

27

Letter 1 Use when a seasonal influenza outbreak in a school has affected a number of individuals in the school community

Dear School Families

Influenza or flu season is upon us and many people within our school community have become sick The flu is spread when a person coughs or sneezes or through direct contact Itrsquos important to cover your mouth and nose when you cough or sneeze and teach your children do the same Wash hands frequently - especially after you throw away tissues

Flu symptoms include a fever headache chills body aches tiredness dry cough sore throat and stuffy nose If you or your child(ren) do get the flu you can call your doctor to find out about medicines that may help relieve the symptoms Remember to rest and drink plenty of liquids

Most importantly a sick child should stay home until heshe is without a fever for 24 hours and no longer feels sick (headache chills muscle aches etc) Tiredness which usually lasts a week or two after the other symptoms resolve is not a reason by itself to stay home from school

Remember itrsquos not too late to get the flu shot Call your doctor or health department for an appointment

28

Letter 2 Use this at any time before pandemic influenza is identified

Dear School Families

Much information has been released about pandemic flu We donrsquot know when and in what form a pandemic may occur but we should all be ready There is no pandemic flu at this time but (insert school districtname) School District is working with others in the community to develop a response plan Enclosed you will find ldquoPandemic Flu ndash What Is It And Should I Be Concernedrdquo It explains ways to reduce the spread of germs from flu colds and other illnesses during the school year Using these suggestions all year long will help you and your family prepare should a pandemic flu strain come to our community If you have internet access and would like more information on pandemic flu please review the following sites

bull wwwpandemicflugov The federal governmentrsquos site where you can get information from the Department of Health and Human Servicesrsquo National Center for Disease Control

bull wwwvdhvirginiagovPandemicFluindexasp Information from the Virginia Department of

Health Should a pandemic flu come to our area the school division will let families know about the outbreak and any changes to the normal school schedule Letrsquos all take steps to get ready for a healthy school year

27

Letter 1 Use when a seasonal influenza outbreak in a school has affected a number of individuals in the school community

Dear School Families

Influenza or flu season is upon us and many people within our school community have become sick The flu is spread when a person coughs or sneezes or through direct contact Itrsquos important to cover your mouth and nose when you cough or sneeze and teach your children do the same Wash hands frequently - especially after you throw away tissues

Flu symptoms include a fever headache chills body aches tiredness dry cough sore throat and stuffy nose If you or your child(ren) do get the flu you can call your doctor to find out about medicines that may help relieve the symptoms Remember to rest and drink plenty of liquids

Most importantly a sick child should stay home until heshe is without a fever for 24 hours and no longer feels sick (headache chills muscle aches etc) Tiredness which usually lasts a week or two after the other symptoms resolve is not a reason by itself to stay home from school

Remember itrsquos not too late to get the flu shot Call your doctor or health department for an appointment

28

Letter 2 Use this at any time before pandemic influenza is identified

Dear School Families

Much information has been released about pandemic flu We donrsquot know when and in what form a pandemic may occur but we should all be ready There is no pandemic flu at this time but (insert school districtname) School District is working with others in the community to develop a response plan Enclosed you will find ldquoPandemic Flu ndash What Is It And Should I Be Concernedrdquo It explains ways to reduce the spread of germs from flu colds and other illnesses during the school year Using these suggestions all year long will help you and your family prepare should a pandemic flu strain come to our community If you have internet access and would like more information on pandemic flu please review the following sites

bull wwwpandemicflugov The federal governmentrsquos site where you can get information from the Department of Health and Human Servicesrsquo National Center for Disease Control

bull wwwvdhvirginiagovPandemicFluindexasp Information from the Virginia Department of

Health Should a pandemic flu come to our area the school division will let families know about the outbreak and any changes to the normal school schedule Letrsquos all take steps to get ready for a healthy school year

28

Letter 2 Use this at any time before pandemic influenza is identified

Dear School Families

Much information has been released about pandemic flu We donrsquot know when and in what form a pandemic may occur but we should all be ready There is no pandemic flu at this time but (insert school districtname) School District is working with others in the community to develop a response plan Enclosed you will find ldquoPandemic Flu ndash What Is It And Should I Be Concernedrdquo It explains ways to reduce the spread of germs from flu colds and other illnesses during the school year Using these suggestions all year long will help you and your family prepare should a pandemic flu strain come to our community If you have internet access and would like more information on pandemic flu please review the following sites

bull wwwpandemicflugov The federal governmentrsquos site where you can get information from the Department of Health and Human Servicesrsquo National Center for Disease Control

bull wwwvdhvirginiagovPandemicFluindexasp Information from the Virginia Department of

Health Should a pandemic flu come to our area the school division will let families know about the outbreak and any changes to the normal school schedule Letrsquos all take steps to get ready for a healthy school year

Insert ldquoPandemic Flu- What is It and Should I be Concernedrdquo PDF

29

30

Letter 3 Confirmation of birds infected with avian flu in the US This does not signal a pandemic but people may fear that it does Dear Parents As you may have heard in the news birds infected with avian (bird) flu have been identified in the United States It is important to know however that there are no known human cases of bird flu in the United States at this time In its current state this bird virus does not spread from person to person Health authorities are carefully monitoring the situation and will let us know if the virus changes to a strain that can easily infect people and spread from person to person Enclosed you will find ldquoStop the Spread of Germsrdquo Please use these tips to prevent the spread of flu viruses and help everyone stay healthy Remember itrsquos not too late to get the flu shot If you have internet access and would like more information on avian or pandemic flu please review the following sites

bull wwwpandemicflugov The federal governmentrsquos site where you can get information from the Department of Health and Human Servicesrsquo National Center for Disease Control

bull wwwvdhvirginiagovpandemicfluindexasp The Virginia Department of Healthrsquos site where you can get information about pandemic flu

Should a pandemic flu come to our area the health department will send information to the school division and we will let families know about any changes to the normal school schedule Letrsquos all take the steps to stay healthy

30

Letter 3 Confirmation of birds infected with avian flu in the US This does not signal a pandemic but people may fear that it does Dear Parents As you may have heard in the news birds infected with avian (bird) flu have been identified in the United States It is important to know however that there are no known human cases of bird flu in the United States at this time In its current state this bird virus does not spread from person to person Health authorities are carefully monitoring the situation and will let us know if the virus changes to a strain that can easily infect people and spread from person to person Enclosed you will find ldquoStop the Spread of Germsrdquo Please use these tips to prevent the spread of flu viruses and help everyone stay healthy Remember itrsquos not too late to get the flu shot If you have internet access and would like more information on avian or pandemic flu please review the following sites

bull wwwpandemicflugov The federal governmentrsquos site where you can get information from the Department of Health and Human Servicesrsquo National Center for Disease Control

bull wwwvdhvirginiagovpandemicfluindexasp The Virginia Department of Healthrsquos site where you can get information about pandemic flu

Should a pandemic flu come to our area the health department will send information to the school division and we will let families know about any changes to the normal school schedule Letrsquos all take the steps to stay healthy

ldquoStop the Spread of Germsrdquo

CONTACT YOUR LOCAL HEALTH DEPARTMENT TO LEARN MORE ABOUT WHAT OUR COMMUNITY IS DOING

31

32

Letter 4 - Use this letter to let parents know that a strain of pandemic flu has appeared in another part of the world (or in the United States) Dear Parents Public health officials are monitoring a new strain of influenza (flu) in ______________ The disease has spread and is now considered a flu pandemic Efforts are being made to keep the virus from spreading Enclosed you will find ldquoPandemic Flu ndash What Is It and Should I Be Concernedrdquo This brochure will give you more information about how you can prepare There are no cases of pandemic flu in Virginia (or in the US as the case may be) at this time however the federal government is encouraging families to prepare Please use the enclosed ldquoPandemic Flu Planning Checklistrdquo to help identify items you may need In preparation we have stepped up our germ prevention effort in the schools We are reminding everyone to wash hands frequently and cover coughs and sneezes Staff will routinely disinfect commonly touched surfaces To keep the flu from spreading we ask you to keep sick children home Staff and children who get sick while at school will be sent home Individuals with a fever should stay at home until they have been without a fever for 24 hours and no longer feel sick (headache chills muscle aches etc) Tiredness which usually lasts a week or two after the other symptoms resolve is not a reason by itself to stay home from school Remember these ways to stop the spread of germs and sickness

bull Stay home when you are sick bull Teach your children to wash hands with soap and water for 20 seconds bull Teach your children to cover coughs and sneezes with a tissue Throw away the tissue and wash

hands If pandemic influenza spreads to Virginia the health department could recommend that schools close for a period of days to weeks Please begin to prepare for that possibility by arranging for child care in your home if needed Please make sure the school has up-to-date contact information for your family such as phone numbers addresses and e-mail addresses If you have internet access and would like more information on avian or pandemic flu please review the following sites

bull wwwpandemicflugov The federal governmentrsquos site where you can get information from the Department of Health and Human Servicesrsquo National Center for Disease Control

bull wwwvdhvirginiagovpandemicfluindexasp The Virginia Department of Healthrsquos site where you can get information about pandemic flu

32

Letter 4 - Use this letter to let parents know that a strain of pandemic flu has appeared in another part of the world (or in the United States) Dear Parents Public health officials are monitoring a new strain of influenza (flu) in ______________ The disease has spread and is now considered a flu pandemic Efforts are being made to keep the virus from spreading Enclosed you will find ldquoPandemic Flu ndash What Is It and Should I Be Concernedrdquo This brochure will give you more information about how you can prepare There are no cases of pandemic flu in Virginia (or in the US as the case may be) at this time however the federal government is encouraging families to prepare Please use the enclosed ldquoPandemic Flu Planning Checklistrdquo to help identify items you may need In preparation we have stepped up our germ prevention effort in the schools We are reminding everyone to wash hands frequently and cover coughs and sneezes Staff will routinely disinfect commonly touched surfaces To keep the flu from spreading we ask you to keep sick children home Staff and children who get sick while at school will be sent home Individuals with a fever should stay at home until they have been without a fever for 24 hours and no longer feel sick (headache chills muscle aches etc) Tiredness which usually lasts a week or two after the other symptoms resolve is not a reason by itself to stay home from school Remember these ways to stop the spread of germs and sickness

bull Stay home when you are sick bull Teach your children to wash hands with soap and water for 20 seconds bull Teach your children to cover coughs and sneezes with a tissue Throw away the tissue and wash

hands If pandemic influenza spreads to Virginia the health department could recommend that schools close for a period of days to weeks Please begin to prepare for that possibility by arranging for child care in your home if needed Please make sure the school has up-to-date contact information for your family such as phone numbers addresses and e-mail addresses If you have internet access and would like more information on avian or pandemic flu please review the following sites

bull wwwpandemicflugov The federal governmentrsquos site where you can get information from the Department of Health and Human Servicesrsquo National Center for Disease Control

bull wwwvdhvirginiagovpandemicfluindexasp The Virginia Department of Healthrsquos site where you can get information about pandemic flu

Insert ldquoPandemic Influenza Planning Checklistrdquo and ldquoPandemic Flu- What is It and Should I be Concernedrdquo PDFrsquos

33

34

Letter 5 Initial pandemic outbreak in the area Use this letter to let parents know schools are open Dear Parents This letter will give you information about a pandemic flu outbreak in Albemarle County Every year some people get sick with the seasonal flu during the fall and winter months This year there is a new flu virus spreading world-wide and in the United States Many people are sick Health officials are calling this event a pandemic Students and school staff within the district have become sick with the pandemic flu schools are experiencing a number of absences At this time the health department tells us that students who are not sick can come to school The schools will remain open We will keep you updated with any important information To keep the pandemic flu from spreading we ask that you keep sick children home Children who get sick while at school will be sent home Children with a fever should stay at home until they have been without a fever for 24 hours This will help prevent spreading the virus to others Please make sure the school has up to date contact information for your family such as phone numbers addresses and email addresses Public health officials want you to protect yourself and your family against pandemic flu Here are some ways to stop the spread of germs and sickness

bull Stay home when you are sick bull Teach your children to wash hands with soap and water for 20 seconds bull Teach your children to cover coughs and sneezes with a tissue Throw away the tissue and wash

hands bull Stay away from shopping malls movie theaters or other places where there are large groups of

people

If you have questions please contact your School Nurse or healthcare provider You can call the school hotline (INSERT NUMBER) If you have internet access you can get information from the school websitersquos pandemic influenza link wwwk12albemarleorg and the Thomas Jefferson Health District site wwwvdhvirginiagovlhdtjpandemic_fluasp If the pandemic flu continues to spread and more students become sick schools may close for days or weeks The purpose of closing schools will be to keep more children from getting sick If schools are closed children should stay at home Begin planning now for childcare in your home Please remember that the health departmentrsquos recommendations may change during the course of a pandemic flu outbreak We will let you know of any changes in the normal school schedule

34

Letter 5 Initial pandemic outbreak in the area Use this letter to let parents know schools are open Dear Parents This letter will give you information about a pandemic flu outbreak in Albemarle County Every year some people get sick with the seasonal flu during the fall and winter months This year there is a new flu virus spreading world-wide and in the United States Many people are sick Health officials are calling this event a pandemic Students and school staff within the district have become sick with the pandemic flu schools are experiencing a number of absences At this time the health department tells us that students who are not sick can come to school The schools will remain open We will keep you updated with any important information To keep the pandemic flu from spreading we ask that you keep sick children home Children who get sick while at school will be sent home Children with a fever should stay at home until they have been without a fever for 24 hours This will help prevent spreading the virus to others Please make sure the school has up to date contact information for your family such as phone numbers addresses and email addresses Public health officials want you to protect yourself and your family against pandemic flu Here are some ways to stop the spread of germs and sickness

bull Stay home when you are sick bull Teach your children to wash hands with soap and water for 20 seconds bull Teach your children to cover coughs and sneezes with a tissue Throw away the tissue and wash

hands bull Stay away from shopping malls movie theaters or other places where there are large groups of

people

If you have questions please contact your School Nurse or healthcare provider You can call the school hotline (INSERT NUMBER) If you have internet access you can get information from the school websitersquos pandemic influenza link wwwk12albemarleorg and the Thomas Jefferson Health District site wwwvdhvirginiagovlhdtjpandemic_fluasp If the pandemic flu continues to spread and more students become sick schools may close for days or weeks The purpose of closing schools will be to keep more children from getting sick If schools are closed children should stay at home Begin planning now for childcare in your home Please remember that the health departmentrsquos recommendations may change during the course of a pandemic flu outbreak We will let you know of any changes in the normal school schedule

35

Appendix G School Surveillance for Influenza or Influenza-like Illness

School Total Enrollment Prepared by Number of Staff

Date

Total Student Absences

Absences due to MD

diagnosed flu

Absences due to flu-like symptoms

Staff Absences (Total)

36

APPENDIX H World Health Organization Global Pandemic Phases Inter-pandemic Period Phase 1 No new influenza virus subtypes have been detected in humans An influenza virus subtype that has caused human infection may be present in animals If present in animals the risk of human infection or disease is considered low Phase 2 No new influenza virus subtypes have been detected in humans However a circulating animal influenza virus subtype poses a substantial risk of human disease Pandemic Alert Period Phase 3 Human infections with anew subtype but no human-to-human spread or at most rare instances of spread to a close contact Phase 4 Small clusters with limited human-to-human transmission but spread is highly localized suggesting that the virus is not well adapted to humans Phase 5 Larger clusters but human-to-human spread is still localized suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk) Pandemic Period - Phase 6 Pandemic Phase 6A increased and sustained transmission in the population elsewhere in the world Pandemic Phase 6B increased and sustained transmission in the United States Pandemic Phase 6C increased and sustained transmission in Virginia Phases assigned letters for purposes of local planning WHO does not differentiate this phase

37

Appendix I Pandemic Flu Planning for Families

Pandemic Flu Planning Checklist for Individuals and Families

You can prepare for an influenza pandemic now You will know both the magnitude of what can happen during a

pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you

and your family This checklist will help you gather the information and resources you may need in case of a flu

pandemic

1 To plan for a pandemic

bull Store a supply of water and food During a pandemic if you cannot get to a store or if stores are out of supplies it will be important for you to have extra supplies on hand This can be useful in other types of emergencies such as power outages and disasters

bull Have any nonprescription drugs and other health supplies on hand including pain relievers stomach remedies cough and cold medicines fluids with electrolytes and vitamins

bull Talk with family members and loved ones about how they would be cared for if they got sick or what will be needed to care for them in your home

bull Volunteer with local groups to prepare and assist with emergency response bull Get involved in your community as it works to prepare for an influenza pandemic

2 To limit the spread of germs and prevent infection

bull Teach your children to wash hands frequently with soap and water and model the correct behavior bull Teach your children to cover coughs and sneezes with tissues and be sure to model that behavior bull Teach your children to stay away from others as much as possible if they are sick Stay home from work

and school if sick

3 Items to have on hand for an extended stay at home

Examples of food and non-perishables

Examples of other health and other supplies

Ready-to-eat canned meats fruits vegetables and soups

Prescribed medical supplies such as glucose and blood-pressure monitoring equipment

Protein or fruit bars Soap and water or alcohol-based hand wash Dry cereal or granola Prescription medicines and non prescription medicines for fever

such as acetaminophen or ibuprofen Peanut butter or nuts Thermometer Dried fruit Anti-diarrhea medication Fluids with electrolytes Crackers Vitamins Bottled water Cleansing agentsoap Canned or jarred baby food and formula Flashlight batteries Pet food Portable radio Manual can opener Trash bags toilet paper disposable diapers

38

Family Emergency Health Information Sheet

It is important to think about health issues that could arise if an influenza pandemic occurs and how they could affect you and your loved ones For example if a mass vaccination clinic is set up in your community you may need to provide as much information as you can about your medical history when you go especially if you have a serious health condition or allergy

Create a family emergency health plan using this information Fill in information for each family member in the space provided Like much of the planning for a pandemic this can also help prepare for other emergencies

Family Member Information

Family

Member

Blood Type Allergies Past Current Medical

Conditions

Current Medications

Dosages

Family Emergency Contacts Form

Contacts NamePhone Number

Local personal emergency contact

Out-of-town personal emergency contact

Hospitals near Work

School

Home

Family physician(s)

State public health department

(See list on wwwcdcgovotherhtmstates)

Pharmacy

Employer contact and emergency information

School contact and emergency information

Religiousspiritual organization

39

36

APPENDIX H World Health Organization Global Pandemic Phases Inter-pandemic Period Phase 1 No new influenza virus subtypes have been detected in humans An influenza virus subtype that has caused human infection may be present in animals If present in animals the risk of human infection or disease is considered low Phase 2 No new influenza virus subtypes have been detected in humans However a circulating animal influenza virus subtype poses a substantial risk of human disease Pandemic Alert Period Phase 3 Human infections with anew subtype but no human-to-human spread or at most rare instances of spread to a close contact Phase 4 Small clusters with limited human-to-human transmission but spread is highly localized suggesting that the virus is not well adapted to humans Phase 5 Larger clusters but human-to-human spread is still localized suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk) Pandemic Period - Phase 6 Pandemic Phase 6A increased and sustained transmission in the population elsewhere in the world Pandemic Phase 6B increased and sustained transmission in the United States Pandemic Phase 6C increased and sustained transmission in Virginia Phases assigned letters for purposes of local planning WHO does not differentiate this phase

37

Appendix I Pandemic Flu Planning for Families

Pandemic Flu Planning Checklist for Individuals and Families

You can prepare for an influenza pandemic now You will know both the magnitude of what can happen during a

pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you

and your family This checklist will help you gather the information and resources you may need in case of a flu

pandemic

1 To plan for a pandemic

bull Store a supply of water and food During a pandemic if you cannot get to a store or if stores are out of supplies it will be important for you to have extra supplies on hand This can be useful in other types of emergencies such as power outages and disasters

bull Have any nonprescription drugs and other health supplies on hand including pain relievers stomach remedies cough and cold medicines fluids with electrolytes and vitamins

bull Talk with family members and loved ones about how they would be cared for if they got sick or what will be needed to care for them in your home

bull Volunteer with local groups to prepare and assist with emergency response bull Get involved in your community as it works to prepare for an influenza pandemic

2 To limit the spread of germs and prevent infection

bull Teach your children to wash hands frequently with soap and water and model the correct behavior bull Teach your children to cover coughs and sneezes with tissues and be sure to model that behavior bull Teach your children to stay away from others as much as possible if they are sick Stay home from work

and school if sick

3 Items to have on hand for an extended stay at home

Examples of food and non-perishables

Examples of other health and other supplies

Ready-to-eat canned meats fruits vegetables and soups

Prescribed medical supplies such as glucose and blood-pressure monitoring equipment

Protein or fruit bars Soap and water or alcohol-based hand wash Dry cereal or granola Prescription medicines and non prescription medicines for fever

such as acetaminophen or ibuprofen Peanut butter or nuts Thermometer Dried fruit Anti-diarrhea medication Fluids with electrolytes Crackers Vitamins Bottled water Cleansing agentsoap Canned or jarred baby food and formula Flashlight batteries Pet food Portable radio Manual can opener Trash bags toilet paper disposable diapers

38

Family Emergency Health Information Sheet

It is important to think about health issues that could arise if an influenza pandemic occurs and how they could affect you and your loved ones For example if a mass vaccination clinic is set up in your community you may need to provide as much information as you can about your medical history when you go especially if you have a serious health condition or allergy

Create a family emergency health plan using this information Fill in information for each family member in the space provided Like much of the planning for a pandemic this can also help prepare for other emergencies

Family Member Information

Family

Member

Blood Type Allergies Past Current Medical

Conditions

Current Medications

Dosages

Family Emergency Contacts Form

Contacts NamePhone Number

Local personal emergency contact

Out-of-town personal emergency contact

Hospitals near Work

School

Home

Family physician(s)

State public health department

(See list on wwwcdcgovotherhtmstates)

Pharmacy

Employer contact and emergency information

School contact and emergency information

Religiousspiritual organization

39

37

Appendix I Pandemic Flu Planning for Families

Pandemic Flu Planning Checklist for Individuals and Families

You can prepare for an influenza pandemic now You will know both the magnitude of what can happen during a

pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you

and your family This checklist will help you gather the information and resources you may need in case of a flu

pandemic

1 To plan for a pandemic

bull Store a supply of water and food During a pandemic if you cannot get to a store or if stores are out of supplies it will be important for you to have extra supplies on hand This can be useful in other types of emergencies such as power outages and disasters

bull Have any nonprescription drugs and other health supplies on hand including pain relievers stomach remedies cough and cold medicines fluids with electrolytes and vitamins

bull Talk with family members and loved ones about how they would be cared for if they got sick or what will be needed to care for them in your home

bull Volunteer with local groups to prepare and assist with emergency response bull Get involved in your community as it works to prepare for an influenza pandemic

2 To limit the spread of germs and prevent infection

bull Teach your children to wash hands frequently with soap and water and model the correct behavior bull Teach your children to cover coughs and sneezes with tissues and be sure to model that behavior bull Teach your children to stay away from others as much as possible if they are sick Stay home from work

and school if sick

3 Items to have on hand for an extended stay at home

Examples of food and non-perishables

Examples of other health and other supplies

Ready-to-eat canned meats fruits vegetables and soups

Prescribed medical supplies such as glucose and blood-pressure monitoring equipment

Protein or fruit bars Soap and water or alcohol-based hand wash Dry cereal or granola Prescription medicines and non prescription medicines for fever

such as acetaminophen or ibuprofen Peanut butter or nuts Thermometer Dried fruit Anti-diarrhea medication Fluids with electrolytes Crackers Vitamins Bottled water Cleansing agentsoap Canned or jarred baby food and formula Flashlight batteries Pet food Portable radio Manual can opener Trash bags toilet paper disposable diapers

38

Family Emergency Health Information Sheet

It is important to think about health issues that could arise if an influenza pandemic occurs and how they could affect you and your loved ones For example if a mass vaccination clinic is set up in your community you may need to provide as much information as you can about your medical history when you go especially if you have a serious health condition or allergy

Create a family emergency health plan using this information Fill in information for each family member in the space provided Like much of the planning for a pandemic this can also help prepare for other emergencies

Family Member Information

Family

Member

Blood Type Allergies Past Current Medical

Conditions

Current Medications

Dosages

Family Emergency Contacts Form

Contacts NamePhone Number

Local personal emergency contact

Out-of-town personal emergency contact

Hospitals near Work

School

Home

Family physician(s)

State public health department

(See list on wwwcdcgovotherhtmstates)

Pharmacy

Employer contact and emergency information

School contact and emergency information

Religiousspiritual organization

39

38

Family Emergency Health Information Sheet

It is important to think about health issues that could arise if an influenza pandemic occurs and how they could affect you and your loved ones For example if a mass vaccination clinic is set up in your community you may need to provide as much information as you can about your medical history when you go especially if you have a serious health condition or allergy

Create a family emergency health plan using this information Fill in information for each family member in the space provided Like much of the planning for a pandemic this can also help prepare for other emergencies

Family Member Information

Family

Member

Blood Type Allergies Past Current Medical

Conditions

Current Medications

Dosages

Family Emergency Contacts Form

Contacts NamePhone Number

Local personal emergency contact

Out-of-town personal emergency contact

Hospitals near Work

School

Home

Family physician(s)

State public health department

(See list on wwwcdcgovotherhtmstates)

Pharmacy

Employer contact and emergency information

School contact and emergency information

Religiousspiritual organization

39

Family Emergency Contacts Form

Contacts NamePhone Number

Local personal emergency contact

Out-of-town personal emergency contact

Hospitals near Work

School

Home

Family physician(s)

State public health department

(See list on wwwcdcgovotherhtmstates)

Pharmacy

Employer contact and emergency information

School contact and emergency information

Religiousspiritual organization

39

40

Appendix J Glossary of Commonly Used Terms in Pandemic Influenza Planning Pandemic A worldwide outbreak of disease Antiviral medications Medicines that can help to lessen the symptoms of the diseases that are caused by viruses such as influenza Contact tracing Looking for people who have been exposed to someone diagnosed with a contagious disease in order to provide them with education or prophylactic medications or vaccine to prevent them from becoming ill as well Highly Pathogenic Avian Influenza (HPAI) Subtypes of avian influenza (bird flu) that causes severe infection and have a high death rate in birds Highly Pathogenic H5N1 A severe strain of avian influenza (bird flu) that is endemic among some birds in Asia and is now spreading among birds in other countries It has been transmitted to some people primarily through contact with infected birds and has caused severe illness and high rates of death Experts are worried that the virus could change so that it spreads more easily from person to person and cause a pandemic Isolation Keeping people who are sick with influenza or who have influenza symptoms separate from healthy people Novel influenza A brand new type of influenza virus to which few or no people are immune Points of Dispensing Locations at which mass vaccinations or mass distribution of medicine would be carried out if vaccine andor antivirals became available Quarantine Keeping people who are not yet ill but who have been exposed to influenza virus separate from people who have not been exposed Snow Days In the context of an influenza pandemic days when schools and other public places will be closed to limit person-to-person contact and reduce the spread of germs Social Distancing The strategy of limiting person-to-person contact to reduce the spread of germs for instance by staying home from work or avoiding public places such as stores

Enclosure 3

Albemarle County Public Schools Health Advisory Meeting

Cleaning Products and Pesticide Use A Status Report September 13 2006

Background In the fall of 2005 Jackie Lombardo ndash a parent of students at both Jouett Middle School and Albemarle High School ndash contacted the Albemarle County Public Schools Building Services Department regarding the use of custodial chemicals pesticides insecticides and herbicides throughout the school division Specifically Ms Lombardo wanted to know whether or not the school division used petroleum-based products (defined below) and if so whether we would be willing to switch to bio-based products (defined below) In April of 2006 Ms Lombardo attended an Albemarle County Public Schools Health Advisory Board meeting where she presented information to the Board regarding the potential negative health effects of petroleum-based products on human health She then asked the Board to consider officially recommending that Building Services switch to solely using bio-based products for cleaning and pesticide herbicide and insecticide use The Deputy Director of Custodial Services and the Environmental Compliance Manager for the School Division are currently in the process of researching the use of bio-based and Green Seal Certified cleaning products and the Custodial Department is planning to test some of these products in several schools The current status of the research completed thus far is compiled in this report Definitions Bio-based product - Relies on plant or animal materials as the main ingredient The plants or animals utilized are a renewable resource With some exceptions bio-based products generally do not contain synthetics toxins or environmentally damaging substances Petroleum-based product ndash Ingredients in these products contain hydrocarbons (HCs) that contain only atoms of carbon and hydrogen They are categorized under two types aliphatic (straight-chained structure) and aromatic (ring structure) Green Seal Certified - Green Seal is an independent nonprofit organization that promotes the manufacture and sale of environmentally responsible consumer products It sets environmental standards and awards a Green Seal of Approval to products that cause less harm to the environment and human health than other similar products Environmental Choice ndash The Environmental Choice Program (ECP) Environment Canadarsquos eco-labeling program provides a market incentive to manufacturers and suppliers of environmentally preferable products and services

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 1 of 4

Quaternary ammonium compound - Any of a group of compounds in which a central nitrogen atom is joined to four organic radicals and one acid radical used as antiseptics solvents and emulsifying agents Quaternary ammonium compounds are generally odorless colorless non-irritating and deodorizing They also have some detergent action and they are good disinfectants Quaternary ammonium compounds are effective against bacteria and somewhat effective against fungi and viruses These compounds are widely used Examples Roccal Germex Hi-Lethol San-O-Fec Warden and Zephiran Note Green Seal Certified chemicals are not necessarily bio-based and vice versa Cleaning Products Prior to Summer 2006 Beginning in 2001 the Custodial Department began using Johnson Wax Professional Stride Citrus Cleaner (floors) Johnson Wax Professional Glance Glass Cleaner (windows and mirrors) and Betco Green Earth Peroxide Cleaner (general purpose cleaner) in 2005 all of which are Green Seal Certified Summer 2006 During the summer of 2006 Broadus Wood Elementary School was chosen to pilot a Green Seal and Environmental Choice Certified floor finish made by a manufacturer called Ultrachem This finish is styrene-free and promises to prolong the need to strip floors Continued Research The Assistant Director of Custodial Services Pam Snyder has contacted David Kincade of Great Neck County Schools in New York regarding the Great Neck School Divisionrsquos use of a bio-based cleaner H202 for all of their school building cleaning Ms Snyder is currently planning a trip to Great Neck County Schools during the fall of 2006 to further learn about the school divisionrsquos experience using H202 to clean the school buildings

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 2 of 4

Disinfection Current Practices Currently the Custodial Department uses a quaternary ammonium disinfectant in the schools for the purpose of limiting the potential spread of infectious organisms and disease and also for eliminating and reducing strong odors that can occur in restrooms Building Services has researched requirements and local practices with respect to the routine use of disinfectants as well as information concerning alternative bio-based disinfectants Building Services would appreciate feedback from the Health Advisory Board members concerning the use of a disinfectant throughout our school buildings Requirements and Local Practices Building Services contacted the Virginia Department of Health (VDH) and the Department of Agriculture to learn whether there is a statewide or local requirement in place governing the use of disinfectants in public schools Both regulating entities reported that they do not regulate or require the use of a disinfectant as part of the routine cleaning process Building Services also contacted the Environmental Services divisions of the UVA Hospital and Martha Jefferson Hospital to learn of any existing policies or practices with regard to the use of a disinfectant Building Services learned that both entities are required by hospital policy to use a quaternary ammonium disinfectant regularly throughout their buildings Both hospitals routinely use Johnson Diversy Virex 256 a quaternary ammonium disinfectant Bio-based Options Ms Jackie Lombardo provided information on a bio-based disinfectant called Benefect The literature on Benefect promises that this disinfectant alternative ldquois technologically proven to kill over 9999 of bacteriardquo (Source httpwwwbenefectcomusaindexhtml) Up to this point Building Services has not been able to verify this through a third party agency Cost Comparison Disinfectants Currently Building Services uses a quaternary ammonium disinfectant Virex which costs approximately 11 cents per gallon As researched by Building Services Benefect which is sold as a ldquoready to userdquo formula costs $4322 per gallon However many users of Benefect suggest using it only for specialty areas such as Nursersquos stations and locker rooms and using H202 for general sanitizing purposes

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 3 of 4

Enclosure 3

Albemarle County Public Schools Health Advisory Meeting

Cleaning Products and Pesticide Use A Status Report September 13 2006

Background In the fall of 2005 Jackie Lombardo ndash a parent of students at both Jouett Middle School and Albemarle High School ndash contacted the Albemarle County Public Schools Building Services Department regarding the use of custodial chemicals pesticides insecticides and herbicides throughout the school division Specifically Ms Lombardo wanted to know whether or not the school division used petroleum-based products (defined below) and if so whether we would be willing to switch to bio-based products (defined below) In April of 2006 Ms Lombardo attended an Albemarle County Public Schools Health Advisory Board meeting where she presented information to the Board regarding the potential negative health effects of petroleum-based products on human health She then asked the Board to consider officially recommending that Building Services switch to solely using bio-based products for cleaning and pesticide herbicide and insecticide use The Deputy Director of Custodial Services and the Environmental Compliance Manager for the School Division are currently in the process of researching the use of bio-based and Green Seal Certified cleaning products and the Custodial Department is planning to test some of these products in several schools The current status of the research completed thus far is compiled in this report Definitions Bio-based product - Relies on plant or animal materials as the main ingredient The plants or animals utilized are a renewable resource With some exceptions bio-based products generally do not contain synthetics toxins or environmentally damaging substances Petroleum-based product ndash Ingredients in these products contain hydrocarbons (HCs) that contain only atoms of carbon and hydrogen They are categorized under two types aliphatic (straight-chained structure) and aromatic (ring structure) Green Seal Certified - Green Seal is an independent nonprofit organization that promotes the manufacture and sale of environmentally responsible consumer products It sets environmental standards and awards a Green Seal of Approval to products that cause less harm to the environment and human health than other similar products Environmental Choice ndash The Environmental Choice Program (ECP) Environment Canadarsquos eco-labeling program provides a market incentive to manufacturers and suppliers of environmentally preferable products and services

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 1 of 4

Quaternary ammonium compound - Any of a group of compounds in which a central nitrogen atom is joined to four organic radicals and one acid radical used as antiseptics solvents and emulsifying agents Quaternary ammonium compounds are generally odorless colorless non-irritating and deodorizing They also have some detergent action and they are good disinfectants Quaternary ammonium compounds are effective against bacteria and somewhat effective against fungi and viruses These compounds are widely used Examples Roccal Germex Hi-Lethol San-O-Fec Warden and Zephiran Note Green Seal Certified chemicals are not necessarily bio-based and vice versa Cleaning Products Prior to Summer 2006 Beginning in 2001 the Custodial Department began using Johnson Wax Professional Stride Citrus Cleaner (floors) Johnson Wax Professional Glance Glass Cleaner (windows and mirrors) and Betco Green Earth Peroxide Cleaner (general purpose cleaner) in 2005 all of which are Green Seal Certified Summer 2006 During the summer of 2006 Broadus Wood Elementary School was chosen to pilot a Green Seal and Environmental Choice Certified floor finish made by a manufacturer called Ultrachem This finish is styrene-free and promises to prolong the need to strip floors Continued Research The Assistant Director of Custodial Services Pam Snyder has contacted David Kincade of Great Neck County Schools in New York regarding the Great Neck School Divisionrsquos use of a bio-based cleaner H202 for all of their school building cleaning Ms Snyder is currently planning a trip to Great Neck County Schools during the fall of 2006 to further learn about the school divisionrsquos experience using H202 to clean the school buildings

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 2 of 4

Disinfection Current Practices Currently the Custodial Department uses a quaternary ammonium disinfectant in the schools for the purpose of limiting the potential spread of infectious organisms and disease and also for eliminating and reducing strong odors that can occur in restrooms Building Services has researched requirements and local practices with respect to the routine use of disinfectants as well as information concerning alternative bio-based disinfectants Building Services would appreciate feedback from the Health Advisory Board members concerning the use of a disinfectant throughout our school buildings Requirements and Local Practices Building Services contacted the Virginia Department of Health (VDH) and the Department of Agriculture to learn whether there is a statewide or local requirement in place governing the use of disinfectants in public schools Both regulating entities reported that they do not regulate or require the use of a disinfectant as part of the routine cleaning process Building Services also contacted the Environmental Services divisions of the UVA Hospital and Martha Jefferson Hospital to learn of any existing policies or practices with regard to the use of a disinfectant Building Services learned that both entities are required by hospital policy to use a quaternary ammonium disinfectant regularly throughout their buildings Both hospitals routinely use Johnson Diversy Virex 256 a quaternary ammonium disinfectant Bio-based Options Ms Jackie Lombardo provided information on a bio-based disinfectant called Benefect The literature on Benefect promises that this disinfectant alternative ldquois technologically proven to kill over 9999 of bacteriardquo (Source httpwwwbenefectcomusaindexhtml) Up to this point Building Services has not been able to verify this through a third party agency Cost Comparison Disinfectants Currently Building Services uses a quaternary ammonium disinfectant Virex which costs approximately 11 cents per gallon As researched by Building Services Benefect which is sold as a ldquoready to userdquo formula costs $4322 per gallon However many users of Benefect suggest using it only for specialty areas such as Nursersquos stations and locker rooms and using H202 for general sanitizing purposes

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 3 of 4

Quaternary ammonium compound - Any of a group of compounds in which a central nitrogen atom is joined to four organic radicals and one acid radical used as antiseptics solvents and emulsifying agents Quaternary ammonium compounds are generally odorless colorless non-irritating and deodorizing They also have some detergent action and they are good disinfectants Quaternary ammonium compounds are effective against bacteria and somewhat effective against fungi and viruses These compounds are widely used Examples Roccal Germex Hi-Lethol San-O-Fec Warden and Zephiran Note Green Seal Certified chemicals are not necessarily bio-based and vice versa Cleaning Products Prior to Summer 2006 Beginning in 2001 the Custodial Department began using Johnson Wax Professional Stride Citrus Cleaner (floors) Johnson Wax Professional Glance Glass Cleaner (windows and mirrors) and Betco Green Earth Peroxide Cleaner (general purpose cleaner) in 2005 all of which are Green Seal Certified Summer 2006 During the summer of 2006 Broadus Wood Elementary School was chosen to pilot a Green Seal and Environmental Choice Certified floor finish made by a manufacturer called Ultrachem This finish is styrene-free and promises to prolong the need to strip floors Continued Research The Assistant Director of Custodial Services Pam Snyder has contacted David Kincade of Great Neck County Schools in New York regarding the Great Neck School Divisionrsquos use of a bio-based cleaner H202 for all of their school building cleaning Ms Snyder is currently planning a trip to Great Neck County Schools during the fall of 2006 to further learn about the school divisionrsquos experience using H202 to clean the school buildings

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 2 of 4

Disinfection Current Practices Currently the Custodial Department uses a quaternary ammonium disinfectant in the schools for the purpose of limiting the potential spread of infectious organisms and disease and also for eliminating and reducing strong odors that can occur in restrooms Building Services has researched requirements and local practices with respect to the routine use of disinfectants as well as information concerning alternative bio-based disinfectants Building Services would appreciate feedback from the Health Advisory Board members concerning the use of a disinfectant throughout our school buildings Requirements and Local Practices Building Services contacted the Virginia Department of Health (VDH) and the Department of Agriculture to learn whether there is a statewide or local requirement in place governing the use of disinfectants in public schools Both regulating entities reported that they do not regulate or require the use of a disinfectant as part of the routine cleaning process Building Services also contacted the Environmental Services divisions of the UVA Hospital and Martha Jefferson Hospital to learn of any existing policies or practices with regard to the use of a disinfectant Building Services learned that both entities are required by hospital policy to use a quaternary ammonium disinfectant regularly throughout their buildings Both hospitals routinely use Johnson Diversy Virex 256 a quaternary ammonium disinfectant Bio-based Options Ms Jackie Lombardo provided information on a bio-based disinfectant called Benefect The literature on Benefect promises that this disinfectant alternative ldquois technologically proven to kill over 9999 of bacteriardquo (Source httpwwwbenefectcomusaindexhtml) Up to this point Building Services has not been able to verify this through a third party agency Cost Comparison Disinfectants Currently Building Services uses a quaternary ammonium disinfectant Virex which costs approximately 11 cents per gallon As researched by Building Services Benefect which is sold as a ldquoready to userdquo formula costs $4322 per gallon However many users of Benefect suggest using it only for specialty areas such as Nursersquos stations and locker rooms and using H202 for general sanitizing purposes

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 3 of 4

Disinfection Current Practices Currently the Custodial Department uses a quaternary ammonium disinfectant in the schools for the purpose of limiting the potential spread of infectious organisms and disease and also for eliminating and reducing strong odors that can occur in restrooms Building Services has researched requirements and local practices with respect to the routine use of disinfectants as well as information concerning alternative bio-based disinfectants Building Services would appreciate feedback from the Health Advisory Board members concerning the use of a disinfectant throughout our school buildings Requirements and Local Practices Building Services contacted the Virginia Department of Health (VDH) and the Department of Agriculture to learn whether there is a statewide or local requirement in place governing the use of disinfectants in public schools Both regulating entities reported that they do not regulate or require the use of a disinfectant as part of the routine cleaning process Building Services also contacted the Environmental Services divisions of the UVA Hospital and Martha Jefferson Hospital to learn of any existing policies or practices with regard to the use of a disinfectant Building Services learned that both entities are required by hospital policy to use a quaternary ammonium disinfectant regularly throughout their buildings Both hospitals routinely use Johnson Diversy Virex 256 a quaternary ammonium disinfectant Bio-based Options Ms Jackie Lombardo provided information on a bio-based disinfectant called Benefect The literature on Benefect promises that this disinfectant alternative ldquois technologically proven to kill over 9999 of bacteriardquo (Source httpwwwbenefectcomusaindexhtml) Up to this point Building Services has not been able to verify this through a third party agency Cost Comparison Disinfectants Currently Building Services uses a quaternary ammonium disinfectant Virex which costs approximately 11 cents per gallon As researched by Building Services Benefect which is sold as a ldquoready to userdquo formula costs $4322 per gallon However many users of Benefect suggest using it only for specialty areas such as Nursersquos stations and locker rooms and using H202 for general sanitizing purposes

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 3 of 4

All-Purpose Cleaners Currently Building Services uses Stride Neutral Cleaner which is 59 cents per gallon and Glance Glass and All Purpose Cleaner which is 72 cents per gallon H202 a multi-tasking cleaner and a Green Certified alternative averages 80 cents per gallon H202 can be mixed with water and used several different ways as an all-purpose cleaner a sanitizer etc The cost differences between bio-based and Green Certified products and traditional cleaning products is an important factor for Building Services to consider in conducting this research and ultimately in deciding which chemicals to use Pesticides amp Herbicides Currently there is one certified pesticide applicator in Building Services This applicator uses a bio-based product called BurnOut II wherever possible for general-purpose turf treatment and weed killing However common petroleum-based pesticides such as Round-Up are currently used when a contractor is hired to treat athletic fields or when the County Department of Parks and Recreation treats School Athletic Fields Building Services is currently in the process of getting more employees certified and trained to apply pesticides and plans to look into the use of bio-based pesticides and herbicides as the training program develops Insecticides Intrastate Pest Control Co Inc currently sprays school kitchens with Suspend on a monthly basis which is labeled for food processing Siege Bait and glue boards are used only on an as-needed basis in other areas of school buildings Conclusion amp Next Steps The Building Services Department plans to continue its research regarding the use of bio-based products in schools Building Services is open to the use of Green Seal Certified and bio-based products in the future provided the testing of these products reveals that they disinfect adequately and are also cost-effective In addition Building Services would appreciate feedback from the Health Advisory Board concerning the viability of considering discontinuing our practice of using quaternary disinfectants

Albemarle County Public Schools Report for Health Advisory Board Printed on 1092006 Page 4 of 4

Enclosure 4

Executive Summary of Biodiesel Fuel Pilot

Three school buses were converted to biodiesel fuel for a testing period of two months Bus 88 was purchased on July 12 2001 bus 181 was purchased on July 17 2002 bus 162 was purchased on July 15 2004 Bus 88 and bus 162 have rural routes while bus 181 has an urban route Since fuel prices fluctuate daily miles per gallon was the measurement used during the testing period Prior to the testing period the three buses were made ready for the use of biodiesel fuel Their tanks were drained filters changes and biodiesel was used for two weeks to flush contaminates from the engines Data suggest that the average of the miles per gallon for the three vehicles on petro diesel is almost the same for biodiesel The cost runs consistently higher at 10 cents per gallon The estimated annualized cost would be an additional $47000 based on the fuel efficiency sited Bus 181 got better fuel mileage while the other two got worse fuel mileage If the results of bus 181 are an anomaly and a 4 decrease in fuel mileage is normal then the worst case scenario would be an additional fuel cost of approximately $82000 for one year The remaining issue is whether or not warranties will be invalidated if biodiesel fuel is used

Enclosure 5

Regina Kirk and Richard Wharam propose Drivers Education as a Separate Course for a full semester and offer the following rationale Pros

1 1 teacher per school ndash total 3 FTEs 2 Greater detail (depth) of material ndash logical order in covering material

(resources available) ndash provide opportunity for integrated presentation of concepts

3 Needs of students with IEPs could be better met 4 More time for simulator use and other resources (speakers ndash Judges Police

Officers etc) 5 Opportunity to do Driver Ed Range Behind the Wheel practice during the day 6 Would still have to have On- road after school driving ndash fee charged 7 5 Elective Credit 8 Age appropriate - Might see more kids delaying the course until later in

school ndash taking closer to actually getting their license ndash more meaningful 9 Easier to hire high school HPE teachers because they would not need the

Driver Ed endorsement 10 Expand the instruction on Alcohol and Substance Abuse 11 Increase instruction time in Health II on other concepts that donrsquot have time

for currently (Aging Suicide Prevention Death and Dying etc) Cons

1 County would have to pay for the FTEs 2 Classroom space (mobile classroom) 3 Students will still have to pay for Behind the Wheel - Would still have to

have On- road after school driving ndash fee charged (currently $165) 4 Some students may not be able to afford the $165 Behind the Wheel fee ndash

some organizations such as Social Services Teen Sight could provide financial assistance ndash currently approximately 10 per school needing scholarship help based on FRL

5 Would still have to have On- road after school driving ndash fee charged

Enclosure 6

ALBEMARLE COUNTY PUBLIC SCHOOLS CHILD NUTRIT ION PROGRAM

180 Lambs Lane Charlottesville Virginia 22901 Phone (434) 295-0566 Fax (434) 295-1403

The Child Nutrition Department functions as a self-sustaining program and currently contributes $75000 annually to the School Boardrsquos operating budget to address overhead costs The Child Nutrition Department also needs to keep a fund reserve of 3 months operational cost to cover any operating deficits or emergency needs This reserve has been used in the past to cover costs related to inclement weather lost income and staffing cost With the suggestion from the School Health Advisory Committee I have listed areas in which the fund transfer could be used to either directly or indirectly support the efforts and goals of the Child Nutrition Department

1 Support the breakfast program - There is no state funding to support the breakfast program Breakfast is an important part of the day and those students who eat breakfast benefit nutritionally and educationally Presently the Child Nutrition Department offers a breakfast program in twenty of our schools Without state funding the Child Nutrition Department struggles with labor and food costs related to the breakfast program Two of the twenty breakfast programs are not part of the federal program which means free and reduced students do not have breakfast available to them Additionally funding to support breakfast would balance out the deficit presently in some of the school breakfast programs and enable us to incorporate federal breakfast programs into schools as funds are available

2 Staffing requirements - Having an additional permanent food service associate floater andor full-time Division Cafeteria Manager would support the Child Nutrition central staff by allowing time for projects geared to improve the program A food service associate costs approximately $12000year and a Division Cafeteria Manager costs approximately $25000year

3 Equipment ndash The purchase of Combi-Ovens (a combination of an oven and steamer) would allow us prepare quality products and could potentially replace fryers at the High Schools Several of our smaller cafeterias are in need of walk-in refrigerator and freezers All cafeterias use computer registers for their daily operations and with the emphasis of a 5-year replacement cycle several will have to be replaced The cost of the ovens is approximately $12000oven and walk-in cooler units are approximately $10000 each

4 Food items - Unfortunately foods that are of a higher nutritional value are more costly Some of these we are able to incorporate into the menu however other food items carry a high food cost Some examples of food items we presently carry are yogurt wheat roll reduced fatreduced sugar ice cream whole grain pizza and some fresh produce If additional funding were available it would help offset the food cost

• ADP47tmp
• • Albemarle County Public Schools Health Advisory Meeting
  • Cleaning Products and Pesticide Use A Status Report
  • September 13 2006
  • Background
  • Definitions
  • Cleaning Products
  • • Prior to Summer 2006
    • Summer 2006
    • Continued Research
    • Disinfection
    • • Current Practices
      • Cost Comparison
      • Disinfectants
      • All-Purpose Cleaners
      • • Pesticides amp Herbicides
        • Insecticides
        • • Conclusion amp Next Steps
          • • ADP51tmp
            • • Guidelines
              • Schools
              • • Nutrition Education
                • • ADP5Btmp
                  • • SEASONAL FLU COMPARED TO PANDEMIC FLU
                    • S
                    • • SEASONAL FLU
                      • PANDEMIC FLU
                      • • The Daily Progress
                        • • The Cavalier Daily
                          • • C-VILLE Weekly
                            • • The Hook
                              • The Rural Virginian
                              • The Fluvanna Review
                              • Adelphia Cable Communications
                              • WWWV ndash 3WV 975 FM
                              • WCJZ-FM Contemp Hit 1075
                              • WNRN Public Radio 919 FM
                              • • WKTR Ministry Station 840 AM
                                • • ADP6Etmp
                                  • • Albemarle County Public Schools Health Advisory Meeting
                                    • Cleaning Products and Pesticide Use A Status Report
                                    • September 13 2006
                                    • Background
                                    • Definitions
                                    • Cleaning Products
                                    • • Prior to Summer 2006
                                      • Summer 2006
                                      • Continued Research
                                      • Disinfection
                                      • • Current Practices
                                        • Cost Comparison
                                        • Disinfectants
                                        • All-Purpose Cleaners
                                        • • Pesticides amp Herbicides
                                          • Insecticides
                                          • • Conclusion amp Next Steps
                                            • • ADP8Atmp
                                              • • ALBEMARLE COUNTY PUBLIC SCHOOLS
                                                • • CHILD NUTRITION PROGRAM

Enclosure 4

Executive Summary of Biodiesel Fuel Pilot

Three school buses were converted to biodiesel fuel for a testing period of two months Bus 88 was purchased on July 12 2001 bus 181 was purchased on July 17 2002 bus 162 was purchased on July 15 2004 Bus 88 and bus 162 have rural routes while bus 181 has an urban route Since fuel prices fluctuate daily miles per gallon was the measurement used during the testing period Prior to the testing period the three buses were made ready for the use of biodiesel fuel Their tanks were drained filters changes and biodiesel was used for two weeks to flush contaminates from the engines Data suggest that the average of the miles per gallon for the three vehicles on petro diesel is almost the same for biodiesel The cost runs consistently higher at 10 cents per gallon The estimated annualized cost would be an additional $47000 based on the fuel efficiency sited Bus 181 got better fuel mileage while the other two got worse fuel mileage If the results of bus 181 are an anomaly and a 4 decrease in fuel mileage is normal then the worst case scenario would be an additional fuel cost of approximately $82000 for one year The remaining issue is whether or not warranties will be invalidated if biodiesel fuel is used

Enclosure 5

Regina Kirk and Richard Wharam propose Drivers Education as a Separate Course for a full semester and offer the following rationale Pros

1 1 teacher per school ndash total 3 FTEs 2 Greater detail (depth) of material ndash logical order in covering material

(resources available) ndash provide opportunity for integrated presentation of concepts

3 Needs of students with IEPs could be better met 4 More time for simulator use and other resources (speakers ndash Judges Police

Officers etc) 5 Opportunity to do Driver Ed Range Behind the Wheel practice during the day 6 Would still have to have On- road after school driving ndash fee charged 7 5 Elective Credit 8 Age appropriate - Might see more kids delaying the course until later in

school ndash taking closer to actually getting their license ndash more meaningful 9 Easier to hire high school HPE teachers because they would not need the

Driver Ed endorsement 10 Expand the instruction on Alcohol and Substance Abuse 11 Increase instruction time in Health II on other concepts that donrsquot have time

for currently (Aging Suicide Prevention Death and Dying etc) Cons

1 County would have to pay for the FTEs 2 Classroom space (mobile classroom) 3 Students will still have to pay for Behind the Wheel - Would still have to

have On- road after school driving ndash fee charged (currently $165) 4 Some students may not be able to afford the $165 Behind the Wheel fee ndash

some organizations such as Social Services Teen Sight could provide financial assistance ndash currently approximately 10 per school needing scholarship help based on FRL

5 Would still have to have On- road after school driving ndash fee charged

Enclosure 6

ALBEMARLE COUNTY PUBLIC SCHOOLS CHILD NUTRIT ION PROGRAM

180 Lambs Lane Charlottesville Virginia 22901 Phone (434) 295-0566 Fax (434) 295-1403

The Child Nutrition Department functions as a self-sustaining program and currently contributes $75000 annually to the School Boardrsquos operating budget to address overhead costs The Child Nutrition Department also needs to keep a fund reserve of 3 months operational cost to cover any operating deficits or emergency needs This reserve has been used in the past to cover costs related to inclement weather lost income and staffing cost With the suggestion from the School Health Advisory Committee I have listed areas in which the fund transfer could be used to either directly or indirectly support the efforts and goals of the Child Nutrition Department

1 Support the breakfast program - There is no state funding to support the breakfast program Breakfast is an important part of the day and those students who eat breakfast benefit nutritionally and educationally Presently the Child Nutrition Department offers a breakfast program in twenty of our schools Without state funding the Child Nutrition Department struggles with labor and food costs related to the breakfast program Two of the twenty breakfast programs are not part of the federal program which means free and reduced students do not have breakfast available to them Additionally funding to support breakfast would balance out the deficit presently in some of the school breakfast programs and enable us to incorporate federal breakfast programs into schools as funds are available

2 Staffing requirements - Having an additional permanent food service associate floater andor full-time Division Cafeteria Manager would support the Child Nutrition central staff by allowing time for projects geared to improve the program A food service associate costs approximately $12000year and a Division Cafeteria Manager costs approximately $25000year

3 Equipment ndash The purchase of Combi-Ovens (a combination of an oven and steamer) would allow us prepare quality products and could potentially replace fryers at the High Schools Several of our smaller cafeterias are in need of walk-in refrigerator and freezers All cafeterias use computer registers for their daily operations and with the emphasis of a 5-year replacement cycle several will have to be replaced The cost of the ovens is approximately $12000oven and walk-in cooler units are approximately $10000 each

4 Food items - Unfortunately foods that are of a higher nutritional value are more costly Some of these we are able to incorporate into the menu however other food items carry a high food cost Some examples of food items we presently carry are yogurt wheat roll reduced fatreduced sugar ice cream whole grain pizza and some fresh produce If additional funding were available it would help offset the food cost

• ADP47tmp
• • Albemarle County Public Schools Health Advisory Meeting
  • Cleaning Products and Pesticide Use A Status Report
  • September 13 2006
  • Background
  • Definitions
  • Cleaning Products
  • • Prior to Summer 2006
    • Summer 2006
    • Continued Research
    • Disinfection
    • • Current Practices
      • Cost Comparison
      • Disinfectants
      • All-Purpose Cleaners
      • • Pesticides amp Herbicides
        • Insecticides
        • • Conclusion amp Next Steps
          • • ADP51tmp
            • • Guidelines
              • Schools
              • • Nutrition Education
                • • ADP5Btmp
                  • • SEASONAL FLU COMPARED TO PANDEMIC FLU
                    • S
                    • • SEASONAL FLU
                      • PANDEMIC FLU
                      • • The Daily Progress
                        • • The Cavalier Daily
                          • • C-VILLE Weekly
                            • • The Hook
                              • The Rural Virginian
                              • The Fluvanna Review
                              • Adelphia Cable Communications
                              • WWWV ndash 3WV 975 FM
                              • WCJZ-FM Contemp Hit 1075
                              • WNRN Public Radio 919 FM
                              • • WKTR Ministry Station 840 AM
                                • • ADP6Etmp
                                  • • Albemarle County Public Schools Health Advisory Meeting
                                    • Cleaning Products and Pesticide Use A Status Report
                                    • September 13 2006
                                    • Background
                                    • Definitions
                                    • Cleaning Products
                                    • • Prior to Summer 2006
                                      • Summer 2006
                                      • Continued Research
                                      • Disinfection
                                      • • Current Practices
                                        • Cost Comparison
                                        • Disinfectants
                                        • All-Purpose Cleaners
                                        • • Pesticides amp Herbicides
                                          • Insecticides
                                          • • Conclusion amp Next Steps
                                            • • ADP8Atmp
                                              • • ALBEMARLE COUNTY PUBLIC SCHOOLS
                                                • • CHILD NUTRITION PROGRAM

Enclosure 5

Regina Kirk and Richard Wharam propose Drivers Education as a Separate Course for a full semester and offer the following rationale Pros

1 1 teacher per school ndash total 3 FTEs 2 Greater detail (depth) of material ndash logical order in covering material

(resources available) ndash provide opportunity for integrated presentation of concepts

3 Needs of students with IEPs could be better met 4 More time for simulator use and other resources (speakers ndash Judges Police

Officers etc) 5 Opportunity to do Driver Ed Range Behind the Wheel practice during the day 6 Would still have to have On- road after school driving ndash fee charged 7 5 Elective Credit 8 Age appropriate - Might see more kids delaying the course until later in

school ndash taking closer to actually getting their license ndash more meaningful 9 Easier to hire high school HPE teachers because they would not need the

Driver Ed endorsement 10 Expand the instruction on Alcohol and Substance Abuse 11 Increase instruction time in Health II on other concepts that donrsquot have time

for currently (Aging Suicide Prevention Death and Dying etc) Cons

1 County would have to pay for the FTEs 2 Classroom space (mobile classroom) 3 Students will still have to pay for Behind the Wheel - Would still have to

have On- road after school driving ndash fee charged (currently $165) 4 Some students may not be able to afford the $165 Behind the Wheel fee ndash

some organizations such as Social Services Teen Sight could provide financial assistance ndash currently approximately 10 per school needing scholarship help based on FRL

5 Would still have to have On- road after school driving ndash fee charged

Enclosure 6

ALBEMARLE COUNTY PUBLIC SCHOOLS CHILD NUTRIT ION PROGRAM

180 Lambs Lane Charlottesville Virginia 22901 Phone (434) 295-0566 Fax (434) 295-1403

The Child Nutrition Department functions as a self-sustaining program and currently contributes $75000 annually to the School Boardrsquos operating budget to address overhead costs The Child Nutrition Department also needs to keep a fund reserve of 3 months operational cost to cover any operating deficits or emergency needs This reserve has been used in the past to cover costs related to inclement weather lost income and staffing cost With the suggestion from the School Health Advisory Committee I have listed areas in which the fund transfer could be used to either directly or indirectly support the efforts and goals of the Child Nutrition Department

1 Support the breakfast program - There is no state funding to support the breakfast program Breakfast is an important part of the day and those students who eat breakfast benefit nutritionally and educationally Presently the Child Nutrition Department offers a breakfast program in twenty of our schools Without state funding the Child Nutrition Department struggles with labor and food costs related to the breakfast program Two of the twenty breakfast programs are not part of the federal program which means free and reduced students do not have breakfast available to them Additionally funding to support breakfast would balance out the deficit presently in some of the school breakfast programs and enable us to incorporate federal breakfast programs into schools as funds are available

2 Staffing requirements - Having an additional permanent food service associate floater andor full-time Division Cafeteria Manager would support the Child Nutrition central staff by allowing time for projects geared to improve the program A food service associate costs approximately $12000year and a Division Cafeteria Manager costs approximately $25000year

3 Equipment ndash The purchase of Combi-Ovens (a combination of an oven and steamer) would allow us prepare quality products and could potentially replace fryers at the High Schools Several of our smaller cafeterias are in need of walk-in refrigerator and freezers All cafeterias use computer registers for their daily operations and with the emphasis of a 5-year replacement cycle several will have to be replaced The cost of the ovens is approximately $12000oven and walk-in cooler units are approximately $10000 each

4 Food items - Unfortunately foods that are of a higher nutritional value are more costly Some of these we are able to incorporate into the menu however other food items carry a high food cost Some examples of food items we presently carry are yogurt wheat roll reduced fatreduced sugar ice cream whole grain pizza and some fresh produce If additional funding were available it would help offset the food cost

• ADP47tmp
• • Albemarle County Public Schools Health Advisory Meeting
  • Cleaning Products and Pesticide Use A Status Report
  • September 13 2006
  • Background
  • Definitions
  • Cleaning Products
  • • Prior to Summer 2006
    • Summer 2006
    • Continued Research
    • Disinfection
    • • Current Practices
      • Cost Comparison
      • Disinfectants
      • All-Purpose Cleaners
      • • Pesticides amp Herbicides
        • Insecticides
        • • Conclusion amp Next Steps
          • • ADP51tmp
            • • Guidelines
              • Schools
              • • Nutrition Education
                • • ADP5Btmp
                  • • SEASONAL FLU COMPARED TO PANDEMIC FLU
                    • S
                    • • SEASONAL FLU
                      • PANDEMIC FLU
                      • • The Daily Progress
                        • • The Cavalier Daily
                          • • C-VILLE Weekly
                            • • The Hook
                              • The Rural Virginian
                              • The Fluvanna Review
                              • Adelphia Cable Communications
                              • WWWV ndash 3WV 975 FM
                              • WCJZ-FM Contemp Hit 1075
                              • WNRN Public Radio 919 FM
                              • • WKTR Ministry Station 840 AM
                                • • ADP6Etmp
                                  • • Albemarle County Public Schools Health Advisory Meeting
                                    • Cleaning Products and Pesticide Use A Status Report
                                    • September 13 2006
                                    • Background
                                    • Definitions
                                    • Cleaning Products
                                    • • Prior to Summer 2006
                                      • Summer 2006
                                      • Continued Research
                                      • Disinfection
                                      • • Current Practices
                                        • Cost Comparison
                                        • Disinfectants
                                        • All-Purpose Cleaners
                                        • • Pesticides amp Herbicides
                                          • Insecticides
                                          • • Conclusion amp Next Steps
                                            • • ADP8Atmp
                                              • • ALBEMARLE COUNTY PUBLIC SCHOOLS
                                                • • CHILD NUTRITION PROGRAM

Enclosure 6

ALBEMARLE COUNTY PUBLIC SCHOOLS CHILD NUTRIT ION PROGRAM

180 Lambs Lane Charlottesville Virginia 22901 Phone (434) 295-0566 Fax (434) 295-1403

The Child Nutrition Department functions as a self-sustaining program and currently contributes $75000 annually to the School Boardrsquos operating budget to address overhead costs The Child Nutrition Department also needs to keep a fund reserve of 3 months operational cost to cover any operating deficits or emergency needs This reserve has been used in the past to cover costs related to inclement weather lost income and staffing cost With the suggestion from the School Health Advisory Committee I have listed areas in which the fund transfer could be used to either directly or indirectly support the efforts and goals of the Child Nutrition Department

1 Support the breakfast program - There is no state funding to support the breakfast program Breakfast is an important part of the day and those students who eat breakfast benefit nutritionally and educationally Presently the Child Nutrition Department offers a breakfast program in twenty of our schools Without state funding the Child Nutrition Department struggles with labor and food costs related to the breakfast program Two of the twenty breakfast programs are not part of the federal program which means free and reduced students do not have breakfast available to them Additionally funding to support breakfast would balance out the deficit presently in some of the school breakfast programs and enable us to incorporate federal breakfast programs into schools as funds are available

2 Staffing requirements - Having an additional permanent food service associate floater andor full-time Division Cafeteria Manager would support the Child Nutrition central staff by allowing time for projects geared to improve the program A food service associate costs approximately $12000year and a Division Cafeteria Manager costs approximately $25000year

3 Equipment ndash The purchase of Combi-Ovens (a combination of an oven and steamer) would allow us prepare quality products and could potentially replace fryers at the High Schools Several of our smaller cafeterias are in need of walk-in refrigerator and freezers All cafeterias use computer registers for their daily operations and with the emphasis of a 5-year replacement cycle several will have to be replaced The cost of the ovens is approximately $12000oven and walk-in cooler units are approximately $10000 each

4 Food items - Unfortunately foods that are of a higher nutritional value are more costly Some of these we are able to incorporate into the menu however other food items carry a high food cost Some examples of food items we presently carry are yogurt wheat roll reduced fatreduced sugar ice cream whole grain pizza and some fresh produce If additional funding were available it would help offset the food cost

• ADP47tmp
• • Albemarle County Public Schools Health Advisory Meeting
  • Cleaning Products and Pesticide Use A Status Report
  • September 13 2006
  • Background
  • Definitions
  • Cleaning Products
  • • Prior to Summer 2006
    • Summer 2006
    • Continued Research
    • Disinfection
    • • Current Practices
      • Cost Comparison
      • Disinfectants
      • All-Purpose Cleaners
      • • Pesticides amp Herbicides
        • Insecticides
        • • Conclusion amp Next Steps
          • • ADP51tmp
            • • Guidelines
              • Schools
              • • Nutrition Education
                • • ADP5Btmp
                  • • SEASONAL FLU COMPARED TO PANDEMIC FLU
                    • S
                    • • SEASONAL FLU
                      • PANDEMIC FLU
                      • • The Daily Progress
                        • • The Cavalier Daily
                          • • C-VILLE Weekly
                            • • The Hook
                              • The Rural Virginian
                              • The Fluvanna Review
                              • Adelphia Cable Communications
                              • WWWV ndash 3WV 975 FM
                              • WCJZ-FM Contemp Hit 1075
                              • WNRN Public Radio 919 FM
                              • • WKTR Ministry Station 840 AM
                                • • ADP6Etmp
                                  • • Albemarle County Public Schools Health Advisory Meeting
                                    • Cleaning Products and Pesticide Use A Status Report
                                    • September 13 2006
                                    • Background
                                    • Definitions
                                    • Cleaning Products
                                    • • Prior to Summer 2006
                                      • Summer 2006
                                      • Continued Research
                                      • Disinfection
                                      • • Current Practices
                                        • Cost Comparison
                                        • Disinfectants
                                        • All-Purpose Cleaners
                                        • • Pesticides amp Herbicides
                                          • Insecticides
                                          • • Conclusion amp Next Steps
                                            • • ADP8Atmp
                                              • • ALBEMARLE COUNTY PUBLIC SCHOOLS
                                                • • CHILD NUTRITION PROGRAM