Flu & Influenza‐Like Illness (ILI) – FAQ’s for the Emerson Community

These questions address both phone and e‐mail inquiries received by the CHW over the last several weeks as well as concerns raised in the media. Answers are based on documents and guidance provided by the CDC, Massachusetts Department of Public Health (MDPH) and Boston Public Health Commission (BPHC) as well as Emerson policy and procedure.

Emerson College and the Center for Health & Wellness (CHW) are committed to providing students, parents and the Emerson community with updated information as the flu season progresses and strive to minimize the risk of infection on campus by following the guidelines for colleges and universities promoted by the CDC, MDPH and the BPHC. We encourage you to practice healthy habits and seek your partnership in combating this public health threat because this year your health and wellness determines the health and wellness of the Emerson community.
Jane Powers, APRN‐BC, MSN Director, Center for Health &Wellness

FAQ’s at a Glance:

1. What is “Influenza‐Like Illness” (ILI)?
   
2. Does Emerson test for H1N1/ILI?
   
3. How is ILI treated?
   
4. What is self‐isolation?
   
5. How long can an infected person spread this virus to others?
   
6. What is the best way to protect against ILI?
   
7. Are vaccine shortages expected?
   
8. When will the seasonal and H1N1 vaccine be available on campus?
   
9. What is the seasonal flu vaccine?
   
10. What is the H1N1 flu vaccine?
    
11. How will these vaccinations provide protection?
    
12. Who should be vaccinated?
    
13. Who are the initial target groups?
    
14. How is Emerson affected by the CDC plan?
    
15. Who should not be vaccinated?
    
16. What are the vaccine side effects and what should I expect?
    
17. There seems to be debate/controversy about being vaccinated. What do you think?
    
18. I think I have the flu. What should I do?
    

1. What is “Influenza‐Like Illness” (ILI)?
Influenza‐Like illness is the term created by the CDC to define a set of viral symptoms that include a temperature of 100°F ( 37.7°C) and either a cough or sore throat. There are additional symptoms of flu such as fatigue, muscle/joint aches, headache and occasionally nausea or vomiting that make up the common presentation, however only those that are underlined are needed to make the diagnosis.

2. Does Emerson test for H1N1 / ILI?
No, clinicians at the CHW are not performing testing for H1N1. This decision is based on the guidance of the CDC and MDPH which report poor accuracy with rapid tests. Definitive testing is being performed at the state laboratory “only where confirmatory results will impact the clinical management of a patient or where there is a clear public health benefit.” Generally these individuals are hospitalized with severe symptoms or have complicated underlying medical conditions. Sentinel sites in the state perform random testing to monitor the predominant strains of the circulating viruses. The data from state testing guides our clinical decision making. Emerson is not a sentinel site.

3. How is ILI treated?
Since ILI is caused by viruses, antibiotics are not an effective or appropriate treatment. Treatment measures fall into the symptom relief category: fever and body ache reducing medications (acetaminophen, ibuprophen), fluids to prevent dehydration, gargling with warm saltwater or black tea to relieve sore throat, cough medications, and rest. Self‐isolation to minimize spread of infection to others is also part of the treatment plan. Individuals with underlying medical conditions who become ill or are exposed to ILI may need to be treated with anti‐viral medication to minimize the severity of symptoms and potential complications. The CDC has issued specific guidelines on the use of anti‐viral treatment. If you are ill or have been exposed to someone with an ILI and have an underlying medical condition that places you at risk, contact the health care clinician treating your condition or a member of the CHW clinical staff for guidance.

4. What is self‐isolation?
Self‐isolation is a public health measure recommended by the CDC to limit exposure of an infected individual to uninfected members of the community in order to minimize spread of infection. This is one part of the prevention strategy Emerson has adopted for all students, staff and faculty to minimize spread of infection and exposure of the virus to members of the Emerson community, especially to those who might be at increased risk due to a chronic medical condition or weakened immune system. Those with flu‐like illness should practice self‐isolation: they should not attend classes or work, should not travel and should limit interactions with other people, except to seek medical care, for at least 4 days from the start of their symptoms and until 24 hours after they no longer have a fever, or signs of a fever, without the use of fever‐reducing medicines (BPHC). They should stay away from others during this time period even if they are taking antiviral drugs for treatment of the flu. This measure is especially important in colleges and universities because of the density of students sharing living and classroom settings. Your co‐operation with this measure can make a difference on the impact ILI will have within the Emerson community.

5. How long can an infected person spread this virus to others?
People infected with seasonal and 2009 H1N1 flu shed virus through cough and sneeze droplets and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected
with the H1N1 virus. The infectivity of the virus also increases as the infected person’s temperature rises and the length of time and proximity a well person is exposed to an infected individual.

6. What is the best way to protect against ILI?
A flu vaccine is the single best way to protect against influenza illness. This season, there are two separate vaccines , one to protect against seasonal flu viruses and the second, a 2009 H1N1 vaccine to protect against the 2009 H1N1 influenza virus (sometimes called “swine flu”).
While immunization is an important key to prevention, the focus at this time while infection rates are low continues to be on prevention through promotion of healthy habits, early recognition of symptoms and self‐isolation.

Dr. James C. Turner, president of the American College Health Association (ACHA) and executive director of the department of student health at the University of Virginia noted in a recent ACHA communication that, “Waves of ILI appear to occur in local and regional areas over a six to seven week time interval. Many outbreaks will have waned significantly by the time H1N1 vaccine becomes widely available. Therefore, the next two to three months represent a critical period for achieving high rates of vaccination among college students before the next wave starts this winter."

While we are awaiting the vaccine and throughout the entire flu season practicing healthy habits such as hand washing, cough/sneeze etiquette, avoiding those that are ill, eating a well‐balanced diet and getting adequate sleep are measures that will keep your immune system in top shape.

7. Are vaccine shortages expected?
No shortage of either seasonal flu or 2009 H1N1 vaccine is expected, but vaccine availability and demand has been unpredictable and initially the vaccine has been available in limited quantities. Because the amount of vaccine available at first will be small, the CDC’s Advisory Committee on Immunization Practices (ACIP) made recommendations regarding which people should be prioritized until the vaccines are available in greater quantities.

Once the demand for vaccine for the target groups has been met at the local level, ACIP recommends that programs and providers begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk of H1N1 infection among persons 65 and older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, ACIP recommends that programs and providers should offer vaccination to all members of the community who wish to receive it.

Currently distribution of the seasonal flu vaccine has been delayed by the manufacturers in order to distribute the H1N1 vaccine. Surveillance data indicates that the H1N1 strain is more prevalent in the community at this time and that vaccination efforts should be directed to those populations that are most vulnerable.

8. When will the seasonal and H1N1 vaccine be available on campus?
Seasonal Flu
The College has received and has administered 100% of its initial supply of seasonal influenza vaccine for students. An additional 300 doses are on order from a commercial manufacturer. We do not have a specific date for vaccine delivery, nor do we know the amount we will receive. We will notify students by e‐mail and through the e‐campus and CHW website postings (www.emerson.edu/health_center) when we receive the vaccine and establish clinic dates. The vaccine will be administered without charge to students. The Human Resources & Affirmative Action office has sponsored two on campus clinics for faculty and staff. The Office of Human Resources & Affirmative Action will sponsor another clinic for seasonal flu vaccine for faculty and staff on November 17th. Employees are encouraged to contact their primary care providers or the flu website noted below.

A listing of local resources to obtain a seasonal influenza vaccine is available on the CHW website; contact the site to check on vaccine availability. Another resource for locating a flu clinic is: www.flu.masspro.org .

H1N1 Flu
The Massachusetts Department of Public Health (MDPH) has informed the CHW that we should expect our first supply of H1N1 vaccine for students in late November. We do not have a specific date for vaccine delivery, nor do we know the amount we will receive. We will notify students by e‐mail through the e‐campus and CHW website postings (www.emerson.edu/health_center) when we receive the vaccine and establish clinic dates. The vaccine will be administered without charge to students. Emerson is not eligible to receive H1N1 for faculty and staff members. Contact your primary care provider’s office or local health department for information on availability.

Arrangements are being made for students at the LA and Kasteel Well campuses to provide opportunities for students to become vaccinated against seasonal and H1N1 viruses.

9. What is the seasonal flu vaccine?
The seasonal flu shot is an inactivated vaccine (containing killed virus) that is comprised of several different strains of influenza virus. The CDC determines the composition of the vaccine based on monitoring which viruses will be the most likely to cause influenza infection. The virus combination changes yearly based on the predominant strains predicted worldwide. You need to be vaccinated each year in order to be protected.

10. What is the H1N1 Flu vaccine?
The 2009 H1N1 flu shot is an inactivated vaccine (containing killed H1N1 virus). The indications for who can get the 2009 H1N1 flu shot are the same as for seasonal flu shots. The flu shot is approved for use in people 6 months of age and older, including healthy people, people with chronic medical conditions and pregnant women. The same manufacturers who produce seasonal flu shots are producing 2009 H1N1 flu shots for use in the United States this season. The 2009 H1N1 flu vaccine is being made in the same way that the seasonal flu vaccine is made.

11. How will these vaccinations provide protection?
About 2 weeks after either vaccination, antibodies that provide protection against seasonal influenza/ 2009 H1N1 influenza virus infection will develop in your body. The antibodies will help your immune system if you are exposed to the viruses to prevent illness. No vaccine provides 100% protection so following the healthy prevention habits is still key to reducing your risk of infection.

The 2009 H1N1 vaccine will not protect against seasonal influenza viruses nor will the seasonal vaccine prevent infection with the H1N1 virus. It is recommended that you receive both vaccinations in order to maximize your protection.

12. Who should get vaccinated?
CDC’s Advisory Committee on Immunization Practices (ACIP), a panel made up of medical and public health experts, met July 29, 2009, to make recommendations on who should receive the 2009 H1N1 vaccine when it becomes available. They recommend that vaccination efforts should focus first on people who are at higher risk for 2009 H1N1 influenza or related complications, are likely to come in contact with influenza viruses as part of their occupation and could transmit influenza viruses to others in medical care settings, or are close contacts of infants younger than 6 months (who are too young to be vaccinated).

13.Who are the initial target groups?
When vaccines are first available, the ACIP recommends that programs and providers administer the vaccine to people in the following five target groups (order of target groups does not indicate priority):

• pregnant women
• people who live with or provide care for infants younger than 6 months (e.g., parents, siblings, and day care providers)
• health care and emergency medical services personnel
• people 6 months through 24 years of age (the majority of college students are in this risk group)
• people 25 years through 64 years of age who have chronic medical conditions

14. How is Emerson affected by the CDC plan?
It is important to understand that the H1N1 vaccine distribution is being managed by the CDC and the MDPH. These agencies are responsible for determining the priority based on specific guidelines of the most vulnerable populations. College age students 18‐24 are part of this distribution schedule and are considered one of the targeted at‐risk populations, regardless of their health status. Depending on the amount and specific formulation of H1N1 vaccine Emerson is provided it may also be necessary to prioritize distribution to those at highest risk within this group such as to students with chronic diseases such as asthma or heart or immune‐suppression diseases. By accepting the vaccine we must agree to administer the vaccine according to the CDC/MDPH guidelines. We will post Immunization Clinics and information on the CHW website and send e‐mails to all students at their Emerson e‐mail account when we receive our shipment.

15.Who should not be vaccinated?
There are some people who should not get any flu vaccine without first consulting a physician. These include:

• People who have a severe allergy to chicken eggs
  People who have had a severe reaction to an influenza vaccination
• People who developed Guillain‐Barre syndrome (a neurological /paralyzing condition) within 6 weeks of getting an influenza vaccine previously
  
• Children younger than 6 months of age (influenza vaccine is not approved for this age group).
  
• People who have a moderate‐to‐severe illness with a fever at the time of planned immunization (they should wait until they recover to get vaccinated)

16. What are the vaccine side effects and what should I expect?
The same side effects typically associated with the seasonal flu vaccine are expected with the 2009 H1N1 flu vaccine. T he viruses in the flu vaccine are killed (inactivated), so you cannot get the flu from being vaccinated. Some minor side effects that could occur from either vaccination are:

• Soreness, redness, or swelling where the shot was given
  
• Fever (low grade)
  
• Aches

If these problems occur, they begin soon after the shot, are usually mild, and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no serious problems from it. However, on rare occasions, flu vaccination can cause serious problems including severe allergic reactions.

17. There seems to be debate/controversy about being vaccinated. What do you think?
If there is a risk of serious complications of flu vaccination (a debatable question), it’s an exceedingly low risk and much lower than that of contracting influenza and developing complications, including death, even if you are a healthy individual. Preventing influenza in college students is especially important this year because young adults are among the most vulnerable to H1N1 infection. Since people with influenza spend about 24 hours being infectious before they become symptomatic, self‐isolation at the onset of symptoms isn’t an effective enough strategy for protecting our community.

18. I think I have the flu. What should I do?

• Take your temperature. If it is over 100°F (37.7°C) and you have either a cough or sore throat with/without other common flu symptoms you meet the criteria for an ILI.
  
• Follow the guidance on the CHW web page in particular the MDPH “The Flu & You‐ Caring for People at Home”.
  
• Contact a health care clinician if you have any of the symptoms listed in the “When to Seek Medical Care” section of the H1N1 Prevention and Preparedness posting on the CHW web page.
  
• If you live off campus you should practice self‐isolation by remaining at home and out of class, work, athletics and social gatherings and avoiding travel by public transportation until your temperature has been 99.5 or less without the use of fever lowering medication for of 24 hours and a minimum of 4 days have passed since the start of your symptoms. ( BPHC)
  
• If you live on campus in Boston you will need to contact a family member or other local emergency contact so that you can recuperate off campus for the recommended isolation period noted above. Emerson has limited resources to provide isolation space on campus and we do not have an infirmary or clinical staff to provide 24/7 medical supervision to ill students. If you are ill with ILI symptoms and do not have a local emergency contact call the CHW at 617‐824‐8666 (M‐F) during normal business hours and the Office of Residential Life at 617‐824‐ after hours and weekends/holidays for additional guidance.
  
• If you are studying and living at the Kasteel or LA external programs follow the clinical guidance provided on our website and contact your program director for specific measures for self‐isolation to reduce the risk of transmission to others.
  
• Contact your faculty regarding your absence. The CHW and Academic Affairs have provided the faculty with information and guidance concerning ILI and the handling of class absences during periods of illness.
  
• Emerson staff and faculty who are ill with an ILI should contact their department supervisor and department chair, respectively, and follow the self‐isolation measures outlined in # 4 above.