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The guidance is designed to decrease exposure to regular seasonal flu and 2009 H1N1 flu while

limiting the disruption of day-to-day activities and the vital learning that goes on in schools. CDC will

continue to monitor the situation and update the current guidance as more information is obtained on

2009 H1N1.

About 55 million students and 7 million staff attend the more than 130,000 public and private schools

in the United States each day. By implementing these recommendations, schools and health officials

can help protect one-fifth of the country’s population from flu. Collaboration is essential: CDC, the

U.S. Department of Education, state and local public health and education agencies, schools, students,

staff, families, businesses, and communities all have active roles to play.

The decision to dismiss students should be made locally and should balance the goal of reducing the

number of people who become seriously ill or die from influenza with the goal of minimizing social

disruption and safety risks to children sometimes associated with school dismissal. Based on the

experience and knowledge gained in jurisdictions that had large outbreaks in spring 2009, the potential

benefits of preemptively dismissing students from school are often outweighed by negative

consequences, including students being left home alone, health workers missing shifts when they must

stay home with their children, students missing meals, and interruption of students’ education. Still,

although the situation in fall 2009 is unpredictable, more communities may be affected, reflecting

wider transmission. The overall impact of 2009 H1N1 should be greater than in the spring, and school

dismissals may be warranted, depending on the disease burden and other conditions

they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines.

They should stay home even if they are using antiviral drugs.

be sent to a room separate from others until they can be sent home. CDC recommends that they

wear a surgical mask, if possible, and that those who care for ill students and staff wear

protective gear such as a mask.

importance of the basic foundations of influenza prevention: stay home when sick, wash hands

frequently with soap and water when possible, and cover noses and mouths with a tissue when

coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).

with the cleaners they typically use. Special cleaning with bleach and other non-detergentbased

cleaners is not necessary.

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complications who become ill with influenza-like illness should speak with their health care

provider as soon as possible. Early treatment with antiviral medications is very important for

people at high risk because it can prevent hospitalizations and deaths. People at high risk

include those who are pregnant, have asthma or diabetes, have compromised immune systems,

or have neuromuscular diseases.

or most students are at high risk (for example, schools for medically fragile children or for

pregnant students) a community might decide to dismiss such a school to better protect these

high-risk students.

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.

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.

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.

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.

of separating students. These can be as simple as moving desks farther apart or canceling

classes that bring together children from different classrooms.

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.

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.

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functioning for example, when a significant number and proportion of students have

documented fever while at school despite recommendations to keep ill children home.

recommend preemptive school dismissals if the flu starts to cause severe disease in a

significantly larger proportion of those affected.

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 that 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.

Information Collection and Sharing

Decision-Makers and Stakeholders

Feasibility

Acceptability