Flu Exclusions??

[Blackcat31]

I had a dcm call me yesterday (Monday) and tell me she has the flu. (Type A Influenza). She went to ER on Sunday night and they gave her Tamiflu. She said she would be keeping her 3 yr old dd home for the next few days so that no one is needlessly exposed.

Now she calls me this morning (Tuesday) and says she wants to bring her dd so she, herself, can get some rest. What, if any, are the exclusion policies for this child/family?

Is the dd contagious? Should she be at childcare or is it no big deal since it is her mom who has the flu and not her?

I also have a diabetic in the house and child with severe asthma so I don't know if that makes the circumstances different or not? Any one know the answers to my questions?

[Sunny Day]

I'm not sure about all your questions, but I would tell her she can't come. If she is contagious it is usually before they have symptoms. I'd be super mad if I was one of the other parents and my kid was needlessly exposed to that! I'd give it a couple days for sure.

[ammama]

I don't agree - I don't think you can exclude a child based on the fact that she MIGHT get sick. Be extra vigilant on cleaning and sanitizing, and keep an eye out for symptoms though.

[Blackcat31]

I don't agree - I don't think you can exclude a child based on the fact that she MIGHT get sick. Be extra vigilant on cleaning and sanitizing, and keep an eye out for symptoms though.

I am not worried about the child getting sick, I am worried about the child carrying the virus and bringing it to my child care......it sort of just seems to me that since it is in the home (dcg's) that everyone should stay confined until everyone is better...??? I am not sure how that all works...

[Cat Herder]

I only have time for a short reply, so.....

http://www.cdc.gov/h1n1flu/guidance/exclusion.html

Good luck, Hun, I hope whatever you decide goes smooth...

Grr.. I don't know why it wont work from here... DH came in though.... : ) So here it is....

CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others
October 23, 2009

CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever without the use of fever-reducing medications.
This is a change from the previous recommendation that ill persons stay home for 7 days after illness onset or until 24 hours after the resolution of symptoms, whichever was longer. The new recommendation applies to camps, schools, businesses, mass gatherings, and other community settings where the majority of people are not at increased risk for influenza complications. This guidance does not apply to health care settings where the exclusion period should be continued for 7 days from symptom onset or until the resolution of symptoms, whichever is longer; see Guidelines for infection control for updates about the health care setting. This revision for the community setting is based on epidemiologic data about the overall risk of severe illness and death and attempts to balance the risks of severe illness from influenza and the potential benefits of decreasing transmission through the exclusion of ill persons with the goal of minimizing social disruption. This guidance will continue to be updated as more information becomes available.

Decisions about extending the exclusion period should be made at the community level, in conjunction with local and state health officials. More stringent guidelines and longer periods of exclusion – for example, until complete resolution of all symptoms – may be considered for people returning to a setting where high numbers of high-risk people may be exposed, such as a camp for children with asthma or a child care facility for children younger than 5 years old. High-risk groups for influenza complications include: children younger than 5 years old; persons aged 65 years or older; children and adolescents (younger than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection; pregnant women; adults and children who have asthma, other chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders such as diabetes; adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV); and residents of nursing homes and other chronic-care facilities.

Epidemiologic data collected during spring 2009 found that most people with the 2009 H1N1 influenza virus who were not hospitalized had a fever that lasted 2 to 4 days; this would require an exclusion period of 3 to 5 days in most cases. Those with more severe illness are likely to have a fever for longer periods of time. Although fever is a component of the case definition of influenza-like illness, the epidemiologic data collected during spring 2009 found that a minority of patients infected with the 2009 H1N1 influenza virus with respiratory symptoms did not have a fever.

Sick individuals should stay at home until the end of the exclusion period, to the extent possible, except when necessary to seek required medical care. Sick individuals should avoid contact with others. Keeping people with a fever at home may reduce the number of people who get infected, since elevated temperature is associated with increased shedding of influenza virus. CDC recommends this exclusion period regardless of whether or not antiviral medications are used. People on antiviral treatment may shed influenza viruses that are resistant to antiviral medications.

Many people with influenza illness will continue shedding influenza virus 24 hours after their fevers go away, but at lower levels than during their fever. Shedding of influenza virus, as detected by RT-PCR, can be detected for 10 days or more in some cases. Therefore, when people who have had influenza-like illness return to work, school, or other community settings they should continue to practice good respiratory etiquette and hand hygiene and avoid close contact with people they know to be at increased risk of influenza-related complications. Because some people may shed influenza virus before they feel ill, and because some people with influenza will not have a fever, it is important that all people cover their cough and wash hands often. To lessen the chance of spreading influenza viruses that are resistant to antiviral medications, adherence to good respiratory etiquette and hand hygiene is as important for people taking antiviral medications as it is for others.

Fever-reducing medications, that is, medications containing acetaminophen or ibuprofen, are appropriate for use in individuals with influenza-like illness. Aspirin (acetylsalicylic acid) should not be given to children or teenagers who have influenza; this can cause a rare but serious illness called Reye’s syndrome. The determination of readiness to return to school, businesses, or other community settings should be made when at least 24 hours have passed since the ill person’s temperature first remained normal without the use of these medications.

[heyhun77]

I wouldn't exclude based on the fact that the child may carry it to the other kids in care. The flu like many other illnesses is contagious for several days to a week before symptoms begin so it's likely that they have already been exposed to it even if you exclude. It's also likely that your other families have not stopped attending large-scale events like church, concerts, large gatherings, etc., stopped goingout in public places where others frequently do not cover their cough/sneeze/wash their hands, stopped shopping using carts, stopped holding railings in public places, ect. so they will be just as likely to catch something from those and many other sources as it is to catch something from your dcc whose mother is home sick. Plus, do you really want to see what they act like after being home with sick mom stuck inside with not much to do? I have offered to go pick up kids or find a ride for them when parents are sick because having them here on their regular routine keeps them occupied and gets their parents some much-needed rest. It's a win for everyone. I'd much rather bump up my sanitizing efforts than deal with a child who has been out for a week cooped up in the house with sick parents. JMO

[daycare]

I would not allow it... you have to do all you can to protect everyone... Just remind the mom and I am sure she will understand...

When I have siblings and one is sick with something that is highly contagious, I require that both children are removed from care... Its only time before the other child will get it....

this was also the advice of my county health advisor..

[Blackcat31]

I wouldn't exclude based on the fact that the child may carry it to the other kids in care. The flu like many other illnesses is contagious for several days to a week before symptoms begin so it's likely that they have already been exposed to it even if you exclude. It's also likely that your other families have not stopped attending large-scale events like church, concerts, large gatherings, etc., stopped goingout in public places where others frequently do not cover their cough/sneeze/wash their hands, stopped shopping using carts, stopped holding railings in public places, ect. so they will be just as likely to catch something from those and many other sources as it is to catch something from your dcc whose mother is home sick. Plus, do you really want to see what they act like after being home with sick mom stuck inside with not much to do? I have offered to go pick up kids or find a ride for them when parents are sick because having them here on their regular routine keeps them occupied and gets their parents some much-needed rest. It's a win for everyone. I'd much rather bump up my sanitizing efforts than deal with a child who has been out for a week cooped up in the house with sick parents. JMO

That was my thought too...I figured the child would be better served if her routine was kept the same....and mom would get better quicker if she had time to rest.

My own family physician called me back and told me that if the child had no symptoms there would be no cause for concern.....like you had said they can get the virus or germs from Wal-mart or McDonald's so trying to keep it quarantined is pointless. Dr said allow child but watch for any cold like symptoms and if she gets any to exclude right away...otherwise I don't need to be concerned.

He is very close with my family and is very aware of the health situation of others in my care I was concerned about and said it was okay for child to be here so I feel much better. Thanks for all the replies ladies...