Influenza—Child Care and Schools

What is influenza?

Influenza is a contagious disease caused by a group of respiratory viruses called influenza viruses .

What are the signs or symptoms?

• Sudden onset of fever

• Headache

• Chills

• Muscle aches and pains

• Sore throat

• Nasal congestion

• Cough

• Mild pinkeye (conjunctivitis)

• Decreased energy

• Abdominal pain, nausea, or vomiting (These are not usually the only symptoms of influenza but rather will be accompanied by respiratory symptoms like runny nose, cough, or sore throat.)

• Croup (illness with barky cough and hoarseness), bronchiolitis (illness with wheezing and runny nose), or pneumonia

What are the incubation and contagious periods?

• Incubation period: 1 to 4 days; average of 2 days

• Contagious period: From the day before signs or symptoms appear until at least 7 days after the onset of flu, although virus shedding can be longer in young children and those with compromised immune systems

How is it spread?

• Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, sneezes, or sings. These droplets can land on or be rubbed into the eyes, nose, or mouth. The droplets do not stay in the air; they usually travel no more than 3 feet and fall onto the ground. This is the most common mode of spread.

• Aerosol transmission can occur from small respiratory droplets expelled after a cough or sneeze. These germ-containing particles can quickly dry out in the air and settle onto surfaces, later attaching to dust particles and becoming airborne again. Air currents can carry the particles and can infect people within confined air spaces.

• Contact with respiratory secretions or contaminated objects from children who carry influenza virus. Influenza can remain on contaminated surfaces for up to 24 hours.

How do you control it?

• Annual immunization according to the most recent immunization schedule at www.aap.org/immunizationschedule and https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/immunization-schedules.html for all people 6 months and older, including all educators.

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Prevent contact with respiratory secretions. Teach children and educators to cough or sneeze into a disposable tissue or their inner elbow/upper sleeve and to avoid covering the nose or mouth with bare hands. After coughing or sneezing, practice hand hygiene to prevent the spread of respiratory droplets. Ensure that anyone who contacts mucus or debris on their skin or surfaces washes their hands and any other contaminated skin immediately. Change or cover clothing soiled with mucus. Dispose of facial tissues that contain nasal secretions after each use.

• Antiviral medications that treat influenza infection are most helpful if given early in the course of illness (first 48 hours of symptom onset).

• Reduce crowding as much as possible.

What are the roles of the educator and the family?

• Influenza is a serious disease that can cause complications, like pneumonia. Every year, children and adults die from influenza and its complications in the United States. Follow the recommendation to immunize all people 6 months and older.

• Avoid aspirin use for anyone with influenza, as it increases the risk of Reye syndrome, a serious complication associated with use of aspirin in individuals infected with influenza.

Exclude from educational setting?

Yes, if

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ). Specifically, the child has fever and behavior change or fever with other signs or symptoms of respiratory illness, like cough, sore throat, sneeze, or runny nose.

Readmit to educational setting?

Yes, when all the following criteria are met:

When exclusion criteria are resolved, fever has been absent for 24 hours after any fever-reducing medicines have been given, respiratory symptoms are improving, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group