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Reaction to an influenza outbreak: A case study.

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  • Reaction to an influenza outbreak: A case study.

    Reaction to an influenza outbreak: A case study.



    How the public will react to an influenza pandemic has been the subject of much conjecture and debate.

    Putting aside cultural differences (this article from NZ), a recent outbreak of influenza in a US community provides a useful case study.

    The Atlanta Journal-Constitution reported from Burnsville, N.C. As Paul Edelson, an epidemiologist with the Centers for Disease Control and Prevention, headed into the Health Department building in this Black Mountain town, he started to open the door for a woman on crutches. "Wait," she told him. She pulled out a Clorox wipe and swished off the door handle. Dusty Beam, 23, was coming in to get a flu shot. Edelson heads a CDC team investigating an early and fast-moving outbreak of seasonal influenza that has swept the area, infecting mostly youngsters at first and forcing closure of the Yancey County and Mitchell County school systems.

    The episode is an epidemiologist's dream: a microcosm of how flu spreads and its impact on a community. Local health and school authorities, alarmed when absenteeism hit 250 of Yancey County's 2,575 students and up to 45 teachers, shut schools on November 2 when they could not muster enough substitute teachers willing to be exposed to the illness. At midweek, the illness hit neighbouring Mitchell County to the east, and those schools, serving 2,200 students, were also closed after as many as 40 children went home sick within a few hours.

    Friday was a Veterans Day holiday in both districts, and both systems are expected to reopen Monday.

    "We felt a four-day break would be a precautionary measure to keep the flu from spreading to more of our students and faculty members," said Mitchell County school superintendent Brock Womble.

    Lab tests have confirmed the North Carolina outbreak is a run-of-the-mill influenza B virus, which is generally mild, with fever, body aches and dry cough.

    Most patients were well within four to five days, health officials said, although four children were hospitalized.

    At week's end it had not been determined whether the particular strain is covered by this year's flu vaccine; local health officials who complained of not getting any vaccine during October scrambled last week to offer shots as the illness began to affect more adults. Yancey County activated its reverse911 calling system - usually used to notify parents when snow causes school closings - to warn residents not to gather in public.

    Soccer games, volleyball, and church activities were cancelled.

    Folks stayed away from shops and sales were down.

    "Everybody's scared to death of the flu," said Sandi Hogan For parents, the outbreak and school closings meant missing work, getting relatives to watch children, even taking well youngsters to work.

    For elderly folks in the local nursing home, it meant quarantine: no visitors all week. For everyone, it meant precautions to stay well. taking

    "Everybody's scared to death of the flu," said Sandi Hogan, administrative assistant at the Chamber of Commerce.

    "You get people who don't know the difference between this flu and the bird flu."

    For parents, the outbreak and school closings meant missing work, getting relatives to watch children, even taking well youngsters to work. For elderly folks in the local nursing home, it meant quarantine: no visitors all week.

    For the Atlanta-based CDC, it provided a case study in lessons that could be important in a pandemic, such as avian flu.

    For everyone, it meant taking precautions to stay well.

    "I'm paranoid," said Beam, standing outside an examining room with a yellow paper mask across her nose and mouth because a child in the waiting room was coughing.

    Down the hallway, Edelson met with co-workers April Johnson, an investigator in CDC's influenza division in Atlanta and Zack Moore, a Raleigh-based CDC investigator.

    They plan to question school families in coming days.

    The researchers will ask about child care, missed work and forfeited pay to get an idea of what it cost families to have their children out of school.

    They'll also check on what the children did outside school - if they gathered in groups. If officials consider closing schools in case of a pandemic, said Edelson, "it would seem prudent to understand the complications we're introducing into people's lives."

    The researchers also will look at which children got sick and when, and whether there were classes or bus routes in which the illness seemed to occur first and spread.

    And, by looking at doctor visits during the outbreak, they will try to learn if closing the schools helped to curb the spread of the disease.

    North Carolina Health Department officials said school closings are not recommended by the state and were probably not necessary, from an infection-control standpoint.

    "By the time the absentee rate reaches 5 or 10 percent, school closure is ineffective," said Dr. Jeff Engel, North Carolina's state epidemiologist.

    By week's end, the number of sick children seemed to be down, but doctors were reporting more adults sick with flu-like symptoms, said Lynda Kinnane of the Yancey County Health DepartThe flu outbreak began in ment.

    Yancey County about Oct. 26, primarily among children in two elementary schools.

    Because school-age children aren't typically vaccinated, health officials said it is easy for flu to spread in schools.

    East of Burnsville near the Mitchell County line, 96 children were absent from 250-student Micaville Elementary.

    "We were having several substitute teachers come in and they'd get sick, and we were having a hard time finding substitutes for those substitutes," said Yancey school superintendent Barbara Tipton. District officials shut the schools down.#

  • #2
    Re: Reaction to an influenza outbreak: A case study.

    "By the time the absentee rate reaches 5 or 10 percent, school closure is ineffective," said Dr. Jeff Engel, North Carolina's state epidemiologist.
    What precisely is meant by this?

    Obviously it is made from the epidemiological perspective, but I doubt, from a psychological perspective or an economic perspective or a community health perspective it is true.

    Certainly, had the schools remained open, additional children would have been exposed to the flu and, in turn, exposed their families and additional members of the community. There is no medical evidence that I am aware of that supports the notion that the remaining community members were somehow immune from the infection and suspending the infectious route (school children in school) would be ineffective in reducing exposure. By avoiding exposure, the parents of healthy children did not have to take off sick days or lose income by being sick themselves. They did not have to be sick while taking care of sick children.....

    This statement is bizarre from my perspective. Can someone please explain this epidemiological speak!
    Judith --

    What the method does not allow for cannot be proven or disproven using it.

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    • #3
      Re: Reaction to an influenza outbreak: A case study.

      By the time the absentee rate reaches 5 or 10 percent, school closure is ineffective," said Dr. Jeff Engel, North Carolina's state epidemiologist.
      I think he was speaking hypothetically, and not about this particular instance. My interpretation of his statement:

      "By the time the absentee rate reaches 5 or 10 percent, school closure is ineffective [because it is too late to slow the infection throughout the community].
      http://novel-infectious-diseases.blogspot.com/

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      • #4
        Re: Reaction to an influenza outbreak: A case study.

        Regarding hypervigilance and infection rates, we could look at Norovirus on cruiseships. Different companies have different infection rate triggers. Those companies that start an increased rate of disinfection & other measures at a lower infection rate, regularly prevent widespread outbreaks & keep the infection rate lower.

        Early vigilance works.

        .
        "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation

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