9.2.4.4: Written Plan for Seasonal and Pandemic Influenza

The facility should have a written plan for seasonal and pandemic influenza (flu) to limit and contain influenza-related health hazards to the staff, children, their families and the general public. The plan should include information on:

1. Planning and coordination:
   1. Forming a committee of staff members, parents/guardians, and the child care health consultant to produce/review a plan for dealing with the flu each year including specific plans if there is a flu pandemic;
   2. Reviewing the seasonal flu plan during and after flu season so that key staff could discuss how the program would plan for a more serious outbreak or pandemic;
   3. Assigning one person to identify reliable sources of information regarding the seasonal flu strain or pandemic flu outbreak considering local, state and national resources, monitor public health department announcements and other guidance, and forward key information to staff and parents/guardians as needed (the child care health consultant can be especially helpful with this);
   4. Including the infection control policy and procedure (see below) and a communication plan (see below) in the seasonal flu plan;
   5. Including a communication plan (see below), the infection control policy and procedure (see below), and the child learning and program operations plan (see below) in the pandemic flu plan. In addition the pandemic flu plan should include:
   6. Identification of who in the program’s community has legal authority to close child care programs if there is a public health emergency or pandemic;
   7. A list of key contacts such as representatives at the local/state health departments and agencies that regulate child care and their plans to combat or address seasonal or pandemic influenza (programs can extend an invitation for consultation from these departments when formulating the plan).
   8. Development of a plan of action for addressing key business continuity and programmatic issues relevant to pandemic flu;
   9. Communication to parents/guardians encouraging them to have a back-up plan for care for their children if the program must be closed;
   10. Collaboration with those in charge of the community’s planning to find other sources of meals for low-income children who receive subsidized meals in child care in case of a closure;
   11. Knowledge of services in the community that can help staff, children, and their families deal with stress and other problems caused by a flu pandemic;
   12. Communicate with other child care programs in the area to share information and possibly share expertise and resources.
2. Communications plan:
   1. Developing a plan for keeping in touch during the flu and/or pandemic with staff members and children’s families;
   2. Ensuring staff and families have read and understand the flu and/or pandemic plan and understand why it’s needed;
   3. Communicating reliable information to staff and children’s families on the issues listed below in their languages and at their reading levels:
   4. How to help control the spread of flu by handwashing/cleansing and covering the mouth when coughing or sneezing (see http://www.cdc.gov/flu/school/);
   5. How to recognize a person that may have the flu, and what to do if they think they have the flu (see http://www.pandemicflu.gov);
   6. How to care for family members who are ill (see https://www.cdc.gov/flu/pdf/freeresources/general/influenza_flu_homecare_guide.pdf);
   7. How to develop a family plan for dealing with a flu pandemic (see https://www.cdc.gov/flu/pandemic-resources/index.htm).
3. Infection control policy and procedures:
   1. Developing a plan for keeping children who become ill at the child care facility away from other children until the family arrives, such as a fixed place for holding children who are ill in an area of their usual caregiving room or in a separate room where interactions with unexposed children and staff will be limited;
   2. Establishing and enforcing guidelines for excluding children with infectious diseases from attending the child care facility (1);
   3. Teaching staff, children, and their parents/guardians how to limit the spread of infection (see http://www.cdc.gov/flu/school);
   4. Maintaining adequate supplies of items to control the spread of infection;
   5. Educating families about the influenza vaccine, including that experts recommend yearly influenza vaccine (and an influenza-specific vaccine, for example H1N1, if necessary) for everyone, however, if there is a vaccine shortage, priority should be given to children and adolescents six months through eighteen years of age, caregivers/teachers of all children younger than five years of age, and health care professionals (see http://www.cdc.gov/flu/);
   6. Staff caring for all children should receive annual vaccination against influenza (and an influenza-specific vaccine such as what was used during the 2009 H1N1 pandemic, if necessary) each year, preferably before the start of the influenza season (as early as August or September) and as long as influenza is circulating in the community, immunization should continue through March or April;
   7. Maintaining accurate records when children or staff are ill with details regarding their symptoms and/or the kind of illness (especially when influenza was verified through testing);
   8. Practicing daily health checks of children and adults each day for illness;
   9. Determining guidelines to support staff members to remain home if they think they might be ill and a mechanism to provide paid sick leave so they can stay home until completely well without losing wages.
4. Child learning and program operations:
   1. Plan how to deal with program closings and staff absences;
   2. Support families in continuing their child’s learning if the child care program or preschool is closed;
   3. Plan ways to continue basic functions (meeting payroll, maintaining communication with staff, children, and families) if modifications to program planning are necessary or the program is closed.

The facility should also include procedures for staff and parent/guardian training on this plan.

Some of the above plan components may be beyond the scope of ability in a small family child care home. In this case, the caregiver/teacher should work closely with a child care health consultant to determine what specific procedures can be implemented and/or adapted to best meet the needs of the caregiver/teacher and the families s/he serves.

RATIONALE

Yearly or seasonal influenza is a serious illness that requires specific management to keep children healthy. A pandemic flu is a flu virus that spreads rapidly across the globe because most of the population lacks immunity (1,2). The goals of planning for an influenza pandemic are to save lives and to reduce adverse personal, social, and economic consequences of a pandemic. Pandemics, while rare, are not new. In the twentieth century, three flu pandemics were responsible for more than fifty million deaths worldwide, including more than 20 million deaths in the United States (2).
The 2009 influenza A (H1N1) pandemic was the first in the 21^st century that resulted in between 151,700 and 575,400 deaths worldwide (2). As it is not possible to predict with certainty when the next flu pandemic will occur or how severe it will be, seasonal flu management and preparation is essential to minimize the potentially devastating effects (1-4).

COMMENTS

The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend annual influenza vaccination for children and caregivers/teachers in child care settings (1,2,5,6). Vaccination is the best method for preventing flu and its potentially severe complications in children (1,2,5,6). The CDC and AAP recommend children and adolescents six months through eighteen years of age, for all adults including household contacts, caregivers/teachers of all children younger than five years of age, and health care professionals get the flu vaccine. Certain groups of children are at increased risk for flu complications. Child care health consultants are very helpful with finding and coordinating the local resources for this planning. In addition most state and/or local health departments have resources for pandemic flu planning.

For additional resources, see:

• Centers for Disease Control and Prevention Influenza (Flu): https://www.cdc.gov/flu/
• Children, the Flu and the Flu Vaccine: http://www.cdc.gov/flu/protect/children.htm
• Protecting Against Influenza (Flu): Advice for Caregivers of Young Children: http://www.cdc.gov/flu/protect/infantcare.htm

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.1.1.1 Conduct of Daily Health Check
3.2.2.2 Handwashing Procedure
3.2.3.2 Cough and Sneeze Etiquette
3.6.1.1 Inclusion/Exclusion/Dismissal of Ill Children
3.6.1.2 Staff Exclusion for Illness
3.6.1.4 Infectious Disease Outbreak Control
3.6.2.1 Exclusion and Alternative Care for Children Who Are Ill
7.3.3.1 Influenza Immunizations for Children and Staff
9.2.4.3 Disaster Planning, Training, and Communication
9.4.1.2 Maintenance of Records
Appendix A: Signs and Symptoms Chart
Appendix G: Recommended Childhood Immunization Schedule
Appendix H: Recommended Adult Immunization Schedule

REFERENCES

1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, pp. 43-48. 4^th Edition. Elk Grove Village, IL: American Academy of Pediatrics.
   
2. American Academy of Pediatrics. Influenza In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 476-477
3. Centers for Disease Control and Prevention. 2016. Preventing the flu: Good habits can help stop germs. https://www.cdc.gov/flu/protect/habits.htm.
   
4. American Academy of Pediatrics. 2017. Influenza/pandemics. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Children-and-Disasters/Pages/Influenza-Pandemics.aspx. 
   
5. Centers for Disease Control and Prevention. 2016. Children, the flu, and the flu vaccine. https://www.aap.org/en-us/Documents/disasters_dpac_InfluenzaHandout.pdf. 
   
6. American Academy of Pediatrics. 2015. Influenza prevention and control. Strategies for early education and child care programs. https://www.aap.org/en-us/Documents/disasters_dpac_InfluenzaHandout.pdf.