New Jersey is girding for the return of swine flu this fall, with a series of summits to prepare for possible mass vaccinations against a virus that has killed 10 state residents, including three children.
In a summit next week, emergency responders, health officers and school leaders will discuss the possible use of schools as vaccination sites, a protective measure akin to the anti-polio campaigns of half a century ago.
They’ll also share strategies on how to contain the spread of the H1N1 influenza virus among children, who appear to be particularly susceptible.
One certain topic: whether to close schools. Superintendents who cancelled canceled classes in the spring are reexamining those decisions as more is learned about the flu. A likely focus for the fall: keeping schools open, but making sure ill children stay out of school for a full week after symptoms recede.
“Closing school won’t stop the flu,” said Dr. Peter Wenger, a pediatric infectious disease specialist at the University of Medicine and Dentistry of New Jersey. The virus can spread before symptoms appear, and may not be diagnosed for days after a victim recovers and feels fine.
The federal Centers for Disease Control and Prevention calls for a seven-day isolation period, including at least 24 hours after symptoms end. Parents must be responsible for making sure their children adhere to the guideline, said Dr. Wayne Yankus, Ridgewood’s school medical director and chairman of the school-health committee of the state chapter of the American Academy of Pediatrics.
“We rely on parents to use common sense,” he said, such as telling children that they must stay home and miss out on planned practices, dances or trips — the sort of sacrifices that a frustrated Yankus didn’t see this spring.
“People didn’t keep sick kids home,” Yankus said. “A lot of parents don’t care about society. They care about their child and their child’s entitlement.”
Global barometer
During the summer break, all eyes are on the Southern Hemisphere, where the winter flu season is just getting under way.
Scientists are watching to see if the illness grows more severe. They want to know who is at greatest risk, and whether the virus will become drug-resistant or mutate away from the vaccines that big pharmaceutical companies are scrambling to develop.
The picture so far is “largely reassuring,” Dr. Margaret Chan, the World Health Organization’s secretary general, said at an international health meeting in Mexico last week. “The overwhelming majority of patients experience mild symptoms and make a full recovery within a week.”
However, “some deaths are occurring in perfectly healthy young people,” she said. And some patients deteriorate very quickly, developing life-threatening pneumonia that requires mechanical ventilation.
The disease is still spreading in New Jersey, with 833 confirmed cases and 10 deaths as of Wednesday. Three of the dead were children: boys ages 6, 10 and 15, from Ocean, Sussex and Somerset counties, respectively. State health officials have said that all those who died in New Jersey had underlying health conditions.
Come fall, health officials are bracing for the worst, while hoping for the best. Once kids are back in classrooms, it may start to spread earlier than the typical seasonal flu. The federal government will test vaccines next month, and if approved, schoolchildren would likely receive the shots by mid-October, U.S. Health and Human Services Secretary Kathleen Sebelius said Thursday.
“The worst case is if [the virus] comes roaring back more virulent than it was,” said Dr. Susan Walsh, New Jersey’s deputy commissioner of health. “The best case is that it comes back about the same, maybe drops off a bit.”
So far, more than 80 percent of deaths and severe illnesses in the United States have occurred in people with underlying medical conditions — about the same ratio as seasonal flu. Such conditions include pregnancy, being an infant or over age 65, or having a compromised immune system, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Even if unexpected deaths in young people make up a tiny percentage of all cases, that number could be significant: The great flu pandemic of 1918 infected 20 to 40 percent of the world’s population.
Inconsistency?
Keeping track of ill children is up to local and state health departments, who report every suspected case of swine flu and are in continual communication with local schools. But it’s up to superintendents to decide whether to close schools.
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