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Preventing the Spread of Influenza (the Flu) in Child Care Settings: Guidance for Administrators, Care Providers, and Other Staff

Symptoms

Symptoms of flu include fever (usually high), headache, tiredness, cough, sore throat, runny or stuffy nose,and muscle aches. Nausea, vomiting, and diarrhea also can occur, but are much more common in children than adults.

Spread of the Flu

Flu viruses spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

Preventing Spread of the Flu in Child Care Settings

The single best way to protect yourself and others against influenza is to get a flu vaccination each year. Two kinds of flu vaccine are available in the United States:

The "flu shot" — an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions (such as asthma, diabetes, or heart disease). See also Questions & Answers: Seasonal Flu Shot.
The nasal-spray flu vaccine — a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for “live attenuated influenza vaccine” or FluMist®). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age† who are not pregnant.

October or November is the best time to get vaccinated, but getting vaccinated in December or even later can still be beneficial since most influenza activity occurs in January or later in most years. Though it varies, flu season can last as late as May.

About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body. Vaccination, along with other measures, also may help to decrease the spread of influenza among children in the child care setting and among care providers.

Recommend influenza vaccination for children and care providers in child care settings.

Influenza vaccine is recommended for:

Children age 6 months until their 5th birthday
People who care for children 0 up to 5 years of age
People who live with children 0 up to 5 years of age
- Children less than 6 months old are not eligible for the flu vaccine, but are at high risk of influenza complications. The best way to protect children less than 6 months of age is to vaccinate everyone around them.
People of any age who have medical conditions (such as asthma, diabetes, or heart disease) that place them at increased risk for serious influenza-related complications.

All children aged 6 months–8 years should receive two doses of flu vaccine if they have not been vaccinated previously at any time. Also, children aged 6 months–8 years who received only one dose in their first year of vaccination should receive two doses the following year. For more information see CDC's Childhood Immunization Schedule.

Remind children and care providers to wash their hands or use alcohol-based hand rubs, and make sure that supplies are available.

Encourage care providers and children to use soap and water to wash hands when hands are visibly soiled, or an alcohol-based hand rub when soap and water are not available, and hands are not visibly soiled.
Encourage care providers to wash their hands to the extent possible between contacts with infants and children, such as before meals or feedings, after wiping the child’s nose or mouth, after touching objects such as tissues or surfaces soiled with saliva or nose drainage, after diaper changes, and after assisting a child with toileting.
Encourage care providers to wash the hands of infants and toddlers when the hands become soiled.
Encourage children to wash hands when their hands have become soiled. Teach children to wash hands for 15-20 seconds (long enough for children to sing the “Happy Birthday” song twice).
Oversee the use of alcohol-based hand rubs by children and avoid using these on the sensitive skin of infants and toddlers.
Rub hands thoroughly until the alcohol has dried, when using alcohol-based hand rub.
Keep alcohol-based hand rubs out of the reach of children to prevent unsupervised use.
Ensure that sink locations and restrooms are stocked with soap, paper towels or working hand dryers.
Ensure that each child care room and diaper changing area is supplied with alcohol-based hand rub when sinks for washing hands are not readily accessible. Alcohol-based hand rubs are not recommended when hands are visibly soiled.

Keep the child care environment clean and make sure that supplies are available.

Clean frequently touched surfaces, toys, and commonly shared items at least daily and when visibly soiled.
Use an Environmental Protection Agency (EPA)-registered household disinfectant labeled for activity against bacteria and viruses, an EPA-registered hospital disinfectant, or EPA-registered chlorine bleach/hypochlorite solution. Always follow label instructions when using any EPA-registered disinfectant. If EPA-registered chlorine bleach is not available and a generic (i.e., store brand) chlorine bleach is used, mix ¼ cup chlorine bleach with 1 gallon of cool water.
Keep disinfectants out of the reach of children.

Remind children and care providers to cover their noses and mouths when sneezing or coughing.

Advise children and care providers to cover their noses and mouths with a tissue when sneezing or coughing, and to put their used tissue in a waste basket.
Make sure that tissues are available in all nurseries, child care rooms, and common areas such as reading rooms, classrooms, and rooms where meals are provided.
Encourage care providers and children to wash their hands or use an alcohol-based hand rub as soon as possible, if they have sneezed or coughed on their hands.

Observe all children for symptoms of respiratory illness, especially when there is increased influenza in the community.

Observe closely all infants and children for symptoms of respiratory illness. Notify the parent if a child develops a fever (100˚F. or higher under the arm, 101˚F. orally, or 102˚F. rectally) or chills, cough, sore throat, headache, or muscle aches. Send the child home, if possible, and advise the parent to contact the child’s doctor.

Encourage parents of sick children to keep their children home. Encourage sick care providers to stay home.

Encourage parents of sick children to keep the children home and away from the child care setting until the children have been without fever for 24 hours, to prevent spreading illness to others. Similarly, encourage sick care providers to stay home.

Consult your local health department when increases in respiratory illness occur in the child care setting.

Consult with your local or state health department for recommendations to prevent the spread of respiratory illness.

Resources

The following resources provide information about flu that may be adapted for use in the child care setting:

CDC Resources

State and Local Health Departments

Some state and/or local health departments have information for child care centers. Contact the local or state health department by phone or the state health department through the state's web site.

Other Resources

The National Resource Center for Health and Safety in Child Care has developed guidance for child care programs: Caring for Our Children: National Health and Safety Performance Standards Guidelines for Out-of-Home Child Care Programs, Second Edition.

* "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.

† On October 24, 2007 CDC's Advisory Committee on Immunization Practices (ACIP) recommended expanding the use of the nasal influenza vaccine LAIV (FluMist®) to include healthy children ages 2-4 years old (24-59 months old) without a history of asthma or recurrent wheezing. The vaccine continues to be recommended for healthy persons ages 5-49 years who are not pregnant.

Page last updated October 26, 2007
Content Source: Coordinating Center for Infectious Diseases (CCID)
National Center for Immunization and Respiratory Diseases (NCIRD)

Seasonal Flu