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1.0 Introduction

Since the initial outbreak of the H1N1 influenza A virus {i.e., H1N1) in Mexico City a few weeks ago students have become one of the key hosts for the virus. This is not surprising since schools are a location where people congregate. Such a congregate facility, therefore, is a place where such viruses spread. The case of H1N1 is no different from seasonal influenza in this regard. Colleges and universities may be particularly susceptible since students not only congregate in classrooms, but also live in the close quarters of dormitories and residence halls.

What is different is that H1N1 influenza is a novel virus. It has been reported that it is a combination pig, bird, and human strain – although preliminary genotyping of the virus “suggests that all segments are of swine origin.” (1) As a novel virus, humans do not have any ready immunity to the virus. In addition, there are concerns about the mortality associated with this disease because of the numbers of deaths in Mexico.

Several universities in the United States have confirmed cases of H1N1 influenza in students. Some of the affected universities have either cancelled large campus events or have cancelled classes.

Therefore, in light of these events, other colleges and universities may wish to consider ways to prevent infection and to respond if a student, faculty, or staff member tests positive for H1N1 influenza. Specific recommendations are provided below. Generally, though, the best way to prevent spread of this – and other influenza illnesses – is to practice good basic hygiene.

2.0 Recommendations

2.1 Maintain constant communications with your stakeholders
Communication with all stakeholders is critical at this time. Identify who your stakeholder groups are and the message you want to convey. What is important for each of these groups to hear from you?

Reassure students, faculty, staff, parents, and the media that your institution takes the threat of H1N1 seriously. Make information about flu prevention activities readily accessible on your home page. Some examples of universities providing prominent communication regarding the H1N1 influenza include:

• Harvard Medical School: http://hms.harvard.edu
• University of Delaware: http://www.udel.edu/
• University of Massachusetts at Amherst:
• University of Virginia: http://www.virginia.edu/
• St. John’s University: http://www.stjohns.edu

It is also a good idea to develop pre-planned media statements for use when needed and have them approved by appropriate internal managers.

2.2 Encourage good hygiene habits and regular disinfection of common areas
Encourage the practice of good basic hygiene habits. Remind all students, faculty, and staff of the following:

• Cover your coughs and sneezes with a tissue or with the inside of your elbow – not into your bare hands
• Avoid touching your eyes, nose, and mouth
• Wash hands frequently, especially after coughing or sneezing
• Do not go to class or work if you feel sick, especially if you have a fever
• Avoid contact with other people if you feel sick, especially if you have a fever

Consider increasing daily cleaning efforts to include regular disinfecting of classrooms and common areas.

2.3 Report any and all possible cases of influenza
The Centers for Disease Control and Prevention (CDC) recommends that you:

• Review your plans for responding to a public health emergency and make sure they are up to date
• Know local / state plans for institutions of higher education in the event of a mild or severe disease outbreak. This information may be available from state or local health authorities, (http://www.pandemicflu.gov/plan/states/index.html)
• Ask your campus health center to develop and implement a system to track and report (to the local health department) influenza-like illness (an illness with at least fever and sore throat or cough) among students
• Persons with influenza-like-illness should consult their physician and the institution should consult with their local or state health department for recommendations on identifying persons with H1N1 flu and ways to prevent spread of this virus
• Monitor the postings on the CDC web site and that of your local and state health departments and follow local health department advice about possible closure of colleges and universities
• Contact your local public health department if you have questions or suspected cases

2.4 Pandemic Influenza Plan
[See also CMCG / Litaker Group Situational Brief Documents 0427-02, 0428-01, and 0429-01 for additional planning activities associated with phases 3, 4, and 5 of the WHO alert system]

If your organization has a pandemic influenza plan, it is time to address activities that are aligned with a WHO phase 5 alert. If your plan is not so aligned, consider planning for the following:

• Student, faculty, and staff university-related travel restrictions
• Nonessential staff working from home
• Potential workforce shortages
• Potential supply chain disruptions
• Continued communication with all stakeholders
• Potential cancellation of selected activities
• Alternate procedures for the continuation of learning
• Maintenance of critical operations

Additional guidance on pandemic flu planning for colleges and universities is available on the CDC website at http://www.pandemicflu.gov/plan/school/collegeschecklist.html#2

2.5 Travel Policy
The H1N1 flu is contagious and diffuses similar to other influenza-like illnesses (e.g., through coughing, sneezing, droplets, etc.). University-related travel activities should be reviewed. Traveling to Mexico should be avoided until such time as official travel advisories have been lifted. For domestic and other international travel, you should consider whether there are other means of interaction (e.g., video conference, teleconference, etc.) in lieu of face-to-face meetings. Travel increases the potential for interaction with fellow travelers who may have visited an area in which swine flu is endemic.

2.6 Working from Home
Identify contingency plans and opportunities for staff who are able to work from home. Such plans can build upon current plans for pandemic influenza or at home commuting plans created to address high gasoline prices. Employees who can work from home should be prepared to do so if the H1N1 Influenza A situation worsens. However, now is the time to: (1) identify employees who can work from home; (2) developing the system and guidelines for working from home; (3) ensuring employees have the proper equipment (e.g., laptop, access to the company network, etc.) to work from home; and (4) that personnel policies to allow working from home.

2.7 Workforce Shortages
Organizations are likely to face workforce shortages during influenza pandemic. Some estimate influenza-related illness could approach 25% at any given time and last through multiple waves. Organizations should review plans for employee illness including sick-leave policies, cross-training activities, and efforts to ensure business continuity should key decision makers be ill.

2.8 Supply Chain Disruptions
Supply chain disruptions are likely during influenza pandemic. Colleges and universities should address potential supply chain disruptions at this time by: (1) identifying critical supply needs; (2) discussing the potential for shortages with vendors; (3) identifying opportunities to increase stock of key items prior to a pandemic; and (4) identify opportunities to conserve use of key supplies should both a pandemic and shortages occur.

3.0 Additional Information and Useful Links

3.1 U.S. Department of Education

http://www.edgovblogs.org/duncan/2009/04/public-health-officials-offer-swine-flu-guidance-to-schools/

The above web page has been established by the U.S. Department of Education and contains additional guidance and information for schools related to the swine flu event.

3.2 U.S. Centers for Disease Control

http://www.cdc.gov/h1n1flu/

http://www.cdc.gov/h1n1flu/college-alert.htm

This is a rapidly evolving situation. As more information becomes available and the situation unfolds, guidance is likely to change in the upcoming days and weeks. It is important for people to stay informed by monitoring websites such as the Department of Education and CDC sites referenced above

Previous updates can be found by clicking on the following link:  Previous Updates

4.0 Contact Information

Mr. Robert Bradshaw                                              Dr. John Litaker
Managing Partner                                                   Managing Director
CMCG                                                                   The Litaker Group, LLC
Harrisburg, Pennsylvania                                        Austin, Texas
Phone: (717) 816-1616                                          Phone: (512) 804-5545
Email: Robert.Bradshaw@cmcgllc.com                     Email: jlitaker@litakergroup.com

5.0 Websites of Interest

• Health Canada: www.hc-sc.gc.ca
• Medpage Today: www.medpagetoday.com
• Promed: www.promedmail.com
• U.S. Centers for Disease Control and Prevention: www.cdc.gov
• World Health Organization: www.who.in

1Source: www.promedmail.org. Influenza A (H1N1 “Swine Flu”: Worldwide (04) (28-Apr-09).

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Note: Information in this briefing does not replace or supersede information from official sources