25 August 2006

Pandemic flu- Scottish Executive advice

The Scottish Executive has recently issued advice to schools and group childcare providers about action they should take in the event of an outbreak of pandemic flu.

The Guidance for group Childcare Providers is reproduced here - originals can be found on the Scottish Executive website.

"Guidance to Group Childcare Providers in Scotland
Note: This brief guidance - in Q+A form - is to assist group childcare providers,
including nurseries, playgroups and childminders, in planning for a human flu pandemic.
It should be read in conjunction with the more detailed guidance for local authorities,
schools and other providers of children's services at
www.scottishexecutive.gov.uk/Publications/2006/07/05121544/0 and any relevant
material prepared by the local authority. Where we speak of 'nurseries' here, the term
covers all group childcare settings except childminders.
Is there a serious risk of a flu pandemic, and what impact could it have?
Experts advise that a further flu pandemic is inevitable, but cannot say when it will
happen. When it happens, we would expect it to affect all areas of the UK and have a
very significant impact. Depending on the severity of the pandemic, 25-50% of the
population may be infected at some stage, and 50,000 - 700,000 more people than usual
may die over the course of a pandemic.
Why is the Scottish Executive issuing guidance now?
Following the publication of an overall UK Government contingency plan in 2005, the
Executive is working with local government and other key stakeholders to develop and
refine contingency plans.
All organisations are being encouraged to plan for a flu pandemic. The general advice is
to continue operating as normally as possible during a pandemic. Schools and group
childcare settings are potentially different.
What are the roles of the Scottish Executive, local authorities, nurseries and
childminders?
The Scottish Executive has overall responsibility for contingency planning in Scotland,
and is responsible for national policy decisions (and communicating those to relevant
partners) and the overall co-ordination of activities during a pandemic.
Local authorities and other front-line emergency responders (e.g. police, NHS) must
work in partnership to build their local preparedness; in a pandemic they would work
together in Strategic Co-ordinating Groups to co-ordinate activities in an area. Local
authorities would also communicate information from the Scottish Executive to nurseries
(public, voluntary and private sector), childminders and other children's services,
including schools.
Nurseries and childcare providers should plan for a flu pandemic as part of their general
emergency planning and in the context of their local authority's contingency and
communication planning. Managers (normally at local authority or employer level)
would make the final decision on when to close (and re-open) their setting during a
pandemic taking account of national advice. Childminders should also plan for the flu
pandemic.
Do you expect nurseries to have to close during a pandemic? What about
childminders?
The general advice to all businesses and services is that they should seek to continue
operating as normally as possible during a pandemic - and should plan for much higher
than usual levels of staff absence and other possible disruption arising from the
pandemic.
However, nurseries (and schools) are potentially different from other settings. Children
are highly efficient 'spreaders' of respiratory infections, both among themselves and to
adults in their families. There is some evidence that such infections spread less among
children in holiday periods than in term-time. So, closing schools and nurseries for a
period might significantly reduce the number of children infected.
We will not know until nearer the time, when we know more about the nature of a
pandemic strain of virus, and children's vulnerability to it, whether the Scottish Executive
will advise schools and nurseries to close to children for a period during a pandemic, but
it is a possibility. Any such closure would likely be advised by local authority area, based
on national guidance about whether and when to close and re-open. It is very likely that
all areas would be affected at some stage. Nurseries should therefore plan both for
remaining open during a pandemic and for possible closure.
Because they will generally be looking after fewer children, the position for childminders
is different, and we do not anticipate general advice for them to stop looking after
children. They may however have to close in the event of illness in their own families.
Childminders
There are some things you should do now:
• Read the NHS Scotland leaflet for families available on
http://www.show.scot.nhs.uk/sehd/pandemicflu/Pages/PanFluFamLeaflet.htm
• Have supplies of cleaning materials, soap, hot water, tissues, tissue-disposal
• Be clear what your responsibilities are if there is a flu pandemic - check with your
local authority, SCMA development officer and parents
• Have up to date contact details for parents so that you can let them know whether
you can care for children or not, and if their child falls ill while with you and
needs to be collected before the usual time
Your local authority or Childcare Information Service will tell you when the pandemic is
in your area. Childminders should only look after children if they themselves and their
own children are well, and should not look after children who are infected with pandemic
flu. If you and your own children are well you should carry on as normal, but you must:
• follow the infection control guidance
• arrange for parents to be told if any children in your care show signs of having flu
and for the child to be sent home. Let parents of any other children you care for
know what has happened but so long as the children and you are well you
should continue to care for them as normal
• make sure that any child you care for who has been unwell is fully recovered
before they return to your care;
If you or anyone else in your household feel unwell with flu symptoms you should:
• Not look after other people's children and take sensible precautions for the care of
any children of your own;
• Inform the parents of all the children you care for and ask them to make
alternative arrangements for childcare;
• Not agree to care for any children until you (or if appropriate anyone else in your
household) are fully recovered.
Make sure you have followed the infection control guidance and that you carry on
following that guidance until the pandemic is over.
Nurseries
What do staff do if nurseries close to children?
It will be for employers to decide whether staff would be expected to come into work.
However, staff should not come to work if they are ill, and employers will need to take
account of the fact that some staff are likely to be caring for dependents in the event of a
pandemic.
What does my nursery have to do now, during a pandemic and in between?
Your or your local authority's current emergency planning may already cover some or all
of these points, but you should now ensure that:
• Written plans make clear who would take the decision whether to close the
nursery - either because of Scottish Executive advice that nurseries in an area
should close, or because of reasons specific to the nursery (i.e. too many staff off
ill);
• you have up-to-date contact details for staff and parents;
• you have arrangements to keep a sick child separate from other children (and
minimise their contact with staff) until you can get him or her home or collected
by parents;
• you are able to remain open, if appropriate - your plans should include systems to
minimise the spread of infection if the nursery remains open during a pandemic,
e.g. hand-washing, disposal of tissues etc.
Between now and a pandemic you should review plans regularly, and in the light of any
further advice from the Scottish Executive or your local authority.
Your local authority will tell you when the World Health Organization considers a
pandemic is imminent. At that stage you should work with the local authority to review
plans again, check that you have necessary supplies, and remind staff of key information
- such as that they should not come into work if they have any virus-like symptoms.
In a pandemic, while your nursery remains open, you should
• Take hygiene measures to reduce the risk of infection;
• Ensure that staff showing any signs of infection go home;
• Ensure that children showing signs of infection are taken home or collected by
parents
• Provide any information requested by your local authority (e.g. absence rates).
Who will take decisions on what and how will we be told?
The Scottish Executive will on the basis of medical advice make the decision in principle
whether to advise nurseries in affected areas to close. If this decision is taken, local
authorities will communicate it to nurseries, but they would not necessarily close at that
point. Local authorities - acting on national and local health information - would inform
nurseries when their local area is affected and the advice to close applies.
The decision on closure remains with the nursery owner (for the private sector),
management committee (for the voluntary sector) or local authority (for the public
sector). However, if there is general advice to close childcare settings, employers would
be expected to follow this. They will also decide whether a nursery should close for other
reasons (i.e. lack of staff).
If there is advice to close all nurseries in an area, the local authority would tell nurseries
when this advice will be reviewed; after such a review, the local authority would advise
nurseries whether to remain closed or to re-open and, if they are to re-open, whether any
specific conditions should apply.
Can we expect more guidance from the Scottish Executive
We will review this guidance, and the fuller guidance at
www.scotland.gsi.gov.uk/pandemicfluadvice regularly, and advise you of any changes.
We also expect to issue guidance on infection control later in 2006."

23 February 2006

About the Flu

Influenza (commonly known as the flu) and colds are the most common infections of the respiratory system. People often confuse them, calling a bad cold the "flu,"and vice versa. There are key differences between the two though , even though they are both caused by viruses, and are both likely to occur during the winter months.

The Flu is an infection of the respiratory system caused by the influenza virus.
There are three types of influenza virus: A, B, and C.
Types A and B are the most severe. The viruses change constantly and different strains circulate around the world every year. The body's natural defenses cannot keep up with these changes. Therefore, a person should get a flu shot each year.
Type C causes either a very mild illness, or has no symptoms at all. It does not cause epidemics and does not have the severe public health impact that influenza types A and B do.
An emerging type A strain is the avian influenza virus or bird flu. Bird flu viruses do not usually infect humans, but several cases of human infection with bird flu viruses have occurred since 1997 especially in Asia. The death rate for these reported cases has been about 50 percent. The virus is mainly transmitted to humans by direct contact with live, sick or dead poultry, however, it is thought that a few cases of human-to-human spread of have occurred.
While human-to-human spread has been rare and has not spread beyond one person, scientists are concerned that the virus could one day be able to be spread by human contact causing a worldwide outbreak of disease. Experts from around the world are watching the situation in Asia very closely and are preparing for the possibility that the virus may begin to spread more easily and widely from person to person.

Flu symptoms …
are more severe than those of colds. come on abruptly. include high fever, cough, and body and muscle aches.
Flu illness impacts your daily life by …
leading to school absenteeism. leading to days off from work. leading to complications such as pneumonia requiring hospitalization. affecting all other aspects of normal daily activity.
The Flu Can Be Fatal In:
elderly people; people with chronic diseases; and anyone with a weak immune system.
Many people who become sick with the flu say it is like being hit by a truck. This decrease in quality of life, the shifting nature of the virus, and the danger of life-threatening complications, combine to make the flu a major public health problem.

Flu Symptoms
In Adults…If you have a mild case, the flu may seem a lot like an ordinary cold. But more often, symptoms appear suddenly, and may include:
temperature of 101°F or above
cough
muscle ache
headache
sore throat
chills
tiredness
feeling lousy all over
Most people recover from the flu within one or two weeks, but others, especially the elderly, may feel weak for a long time even after other symptoms go away.
SARS, a potentially more serious illness may start like the flu. Check with your doctor immediately if complications such as difficulty breathing occur in areas where SARS is present.
In Children…Flu symptoms in school-age children and adolescents are similar to those in adults. Children tend to have higher temperatures than adults, ranging from 103°F to 105°F. Flu in preschool children and infants is hard to pinpoint, since its symptoms are so similar to infections caused by other viruses.
If the symptoms mentioned above are present and the flu is in your area, please contact your doctor immediately.
What Can Be Done if You Get the Flu?
TreatmentThere are effective treatments that can reduce the duration of the suffering caused by the flu and improve your quality of life. See your doctor within 2 days of when flu symptoms appear to find out if these and other treatments are right for you.
The following four antiviral medications are available to treat the influenza virus:
Oseltamivir (brand name: Tamiflu®)Zanamivir (brand name: Relenza®)Amantadine (brand name: Symmetrel®)Rimantadine (brand name: Flumadine®)
The first two medications, oseltamivir (Tamiflu®) and zanamivir (Relenza®) are members of a new class of drugs that act against both influenza types A and B, while amantadine (Symmetrel ®) and rimantadine (Flumadine®) are older medications that may be used to treat influenza type A only.
Time is of the essence! Starting treatment with these medications within 2 days after flu symptoms appear will reduce the length of the illness and the severity of symptoms by at least 1 day. Early treatment can lead to faster results, enabling you to resume daily activities in a shorter amount of time.
NOTE: Be sure to tell your doctor if you have a chronic lung disease such as asthma, because some precautions may be necessary if zanamivir (Relenza®) is prescribed. You may need to have a fast-acting reliever bronchodilator on hand in case you have difficulty breathing; if that happens, call your doctor and stop taking zanamivir (Relenza®).
NOTE: Some of the antiviral medications can be prescribed for children over one year of age. Consult your doctor as soon as possible after flu symptoms appear, or whenever a child has a fever.
Symptom ReliefOver-the-counter medications can minimize discomfort associated with flu symptoms, but these medications do not treat the virus infection.
Aspirin should not be used in children under eighteen years old because it may play a role in causing Reye Syndrome, a rare but severe liver and central nervous system condition.
Congestion, cough and nasal discharge are best treated with a decongestant, antihistamine, or in combination. There are many over-the-counter flu remedies that contain both of these ingredients. Check with your doctor if you have chronic medical conditions such as thyroid disease or high blood pressure.
Adequate liquids and nutrition are necessary for rapid recovery and to prevent dehydration. Bed rest is also a good idea. Until symptoms are gone, it is not advisable to go back to full activity.
What Can You Do to Prevent Getting the Flu?
Prevention: FLU VACCINESThere are currently two vaccine options, the flu shot and the nasal spray vaccine. The shot gives more reliable protection and the spray is recommended only for non-high risk groups.The best tool for preventing the flu is the flu vaccine, and the best time to get a flu vaccine is from early October to mid-November. The vaccine can also be given at any point during the flu season, even if the virus has already begun to spread in your community. You need a flu vaccine every year because the virus is constantly changing and new vaccines are developed annually to protect against new strains.
Who Should Get a Flu Shot?
Adults 50 years or older
All children aged 6-23 months.
Adults and children ages 2-64 with chronic medical conditions, especially asthma, other lung diseases, and heart disease.
All women who will be pregnant during the influenza season.
Residents of nursing homes and other chronic care facilities.
Health-care workers involved in direct patient care.

Out-of-home caregivers and household contacts of children less than 6 months old.

Any person who wishes to avoid the flu.

You should NOT get the flu shot this year if…
you are allergic to eggs or any component of the vaccine. The viral material in flu vaccines is grown in eggs.
you have a history of Guillain-Barre Syndrome.
you have an acute illness and a fever. You should not get a flu shot until you are feeling better.
Side Effects and Adverse Reactions to Flu Shots
The flu vaccine is made from a virus that is no longer active. Therefore, no one can catch the flu from a flu shot. Less than one out of three people will develop soreness around the injection site for one or two days. Fever, aches and pains are not common and more severe reactions are rare. A recent American Lung Association study has proven that the flu shot does not increase asthma attacks.Nasal Spray Vaccine
In June 2003, the FDA approved FluMist, an influenza vaccine that is the first nasally administered vaccine in the US. It is being billed as the painless alternative to the traditional flu shot. Unfortunately the FDA has approved FluMist only for healthy people between the ages of 5 and 49. The safety of FluMist has not been established in the elderly and people with chronic underlying medical conditions, such as asthma. These high risk groups should avoid the nasal spray vaccine and stick with the flu shot. A study found that children under 5 should also avoid FluMist since those children had an increased rate of asthma and wheezing within 42 days of vaccination.
NOTE: No vaccine is 100% protective and the flu vaccine is no exception. Sometimes a person who has been vaccinated will still come down with the flu.
Prevention: ANTIVIRAL MEDICATIONS
Antiviral medications are not a substitute for vaccination, although physicians may prescribe them for people who cannot or have not taken the flu shot. Three out of the four antivirals have been approved for preventing the flu during the flu season.Amantadine (Symmetrel®) and rimantadine (Flumadine®) are used against influenza type A virus. Oseltamivir (Tamiflu®) and Zanamivir (Relenza®) can be used to prevent influenza A and B if it is taken before exposure to the virus.Oseltamivir (Tamiflu®) has also been shown to be effective in preventing the onset of the flu after exposure has taken place.
Flu Complications
Pneumonia can be caused by the flu virus or by bacteria that get into the lungs when the body's defense system is weakened by the flu. See a doctor if you…
have difficulty breathing; experience chest pain as a result of coughing; or are coughing up yellow green or bloody phlegm.
Other infections that may be associated with the flu include sinusitis, bronchitis and ear infections.
Post-infectious cough, usually without phlegm, may last for weeks to months after the flu symptoms go away and may keep a person up at night. This cough has been associated with asthma-like symptoms, and can be treated with asthma medications. Consult your doctor if you have this kind of cough.
NOTE: If you or your child has a complication such as pneumonia or a sinus or ear infection, your doctor may prescribe antibiotics. While antibiotics are not useful in treating the flu, they may be necessary to clear up a related sinus or ear infection. Additionally, nasal decongestants and antihistamines can be used to briefly relieve nasal symptoms.

01 February 2006

Useful Links

Cold and Flu TreatmentsTypically, parents are told to just treat the symptoms of a cold or the flu andmake their child comfortable, because these common infections are caused by ...pediatrics.about.com/cs/ commoninfections/a/flu_treatments.htm - 31k - Cached - Similar pages
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