CDC may recommend additional measures to help protect students and staff if global and national assessments indicate that influenza is causing more severe disease. In addition, local health and education officials may elect to implement some of these additional measures. Except for school dismissals, these strategies have not been scientifically tested. But CDC wants communities to have tools to use that may be the right measures for their community and circumstances.

• Active screening:
  Schools should check students and staff for fever and other symptoms of flu when they get to school in the morning, separate those who are ill, and send them home as soon as possible. Throughout the day, staff should be vigilant in identifying students and other staff who appear ill.
  See the Technical Report for more details about active screening >>
• High-risk students and staff members stay home:
  People at high-risk of flu complications should talk to their doctor about staying home from school when a lot of flu is circulating in the community. Schools should plan now for ways to continue educating students who stay home through instructional phone calls, homework packets, internet lessons, and other approaches.
  See the Technical Report for more details about high-risk students and staff members staying home
• Students with ill household members stay home:
  Students who have an ill household member should stay home for five days from the day the first household member got sick. This is the time period they are most likely to get sick themselves.
  See the Technical Report for more details about students with ill household members staying home >>
• Increase distance between people at schools:
  CDC encourages schools to try innovative ways of separating students. These can be as simple as moving desks farther apart or canceling classes that bring together children from different classrooms.
  See the Technical Report for more details about increasing distance between people at schools >>
• Extend the period for ill persons to stay home:
  If influenza severity increases, people with flu-like illness should stay home for at least 7 days, even if they have no more symptoms. If people are still sick, they should stay home until 24 hours after they have no symptoms.
  See the Technical Report for more details about extending the period for ill persons to stay home >>
• School dismissals:
  School and health officials should work closely to balance the risks of flu in their community with the disruption dismissals will cause in both education and the wider community. The length of time schools should be dismissed will vary depending on the type of dismissal as well as the severity and extent of illness. Schools that dismiss students should do so for five to seven calendar days and should reassess whether or not to resume classes after that period. Schools that dismiss students should remain open to teachers and staff so they can continue to provide instruction through other means.
  See the Technical Report for more details about school dismissals >>

Reactive dismissals might be appropriate when schools are not able to maintain normal functioning for example, when a significant number and proportion of students have documented fever while at school despite recommendations to keep ill children home.

Preemptive dismissals can be used proactively to decrease the spread of flu. CDC may recommend preemptive school dismissals if the flu starts to cause severe disease in a significantly larger proportion of those affected.

Deciding on a course of action

CDC and its partners will continuously look for changes in the severity of influenza-like illness and will share what is learned with state and local agencies. However, states and local communities can expect to see a lot of differences in disease burden across the country.

Every state and community has to balance a variety of objectives to determine their best course of action to help decrease the spread of influenza. Decision-makers should explicitly identify and communicate their objectives which might be one or more of the following: (a) protecting overall public health by reducing community transmission; (b) reducing transmission in students and school staff; and (c) protecting people with high-risk conditions.

Some strategies can have negative consequences in addition to their potential benefits. In the particular case of school dismissals, decision-makers also must consider and balance additional factors: (a) how to ensure students continue to learn; (2) how to provide an emotionally and physically safe place for students; and (3) how to reduce demands on local health care services. The following questions can help begin discussions and lead to decisions at the state and local levels.

Decision-Makers and Stakeholders

Are all of the right decision-makers and stakeholders involved?

• State and/or local health officials
• State and/or local education officials
• State and/or local homeland security officials
• State and/or local governing officials (e.g., governors, mayors)
• Parent and student representatives
• Representatives of local businesses, the faith community, school-employee unions, and community organizations
• Teachers
• Health care providers and hospitals
• School nurses
• School food service directors
• Vendors that supply schools

Information Collection and Sharing

Can local or state health officials determine and share information about the following?

• Outpatient visits for influenza-like illness
• Hospitalizations for influenza-like illness
• Trends in the numbers of hospitalizations or deaths
• Percent hospitalized patients who require admission to intensive care units (ICU)
• Deaths from influenza
• Groups being disproportionately affected
• Ability of local health care providers and emergency departments to meet increased demand
• Availability of hospital bed, ICU space, and ventilators for influenza patients
• Availability of hospital staff
• Availability of antiviral medications

Can local education agencies or schools determine and share information about the following?

• School absenteeism rates
• Number of visits to school health offices daily
• Number of students with influenza-like illness sent home during the school day

Feasibility

Do you have the resources to implement the strategies being considered?

• Funds
• Personnel
• Equipment
• Space
• Time
• Legal authority or policy requirements

Acceptability

Have you determined how to address the following challenges to implementing the strategies?

• Public concern about influenza
• Lack of public support for the intervention
• People who do not feel empowered to protect themselves
• Secondary effects of strategies (for example, dismissing schools could impact child nutrition, job security, financial support, health service access, and educational progress)