Monday, July 27, 2009


SWINE FLU GOES TO CAMP. WILL IT GO TO SCHOOL NEXT? The summertime outbreak provides an education for school districts and universities, whose administrators are bracing for illness.

By Seema Mehta and Nicole Santa Cruz from the LA Times

July 27, 2009 - Hundreds of children have been sent home from summer camps across Southern California in recent weeks with flu-like symptoms, and camp counselors and directors are taking precautions to prevent the spread of the H1N1, or swine flu, virus in cabins and mess halls.

But officials say the sight of children arriving at sleep-away camps armed with the anti-viral medication Tamiflu is probably just a harbinger of what awaits schools in coming weeks as students move into dormitories, and elementary and secondary students begin classes.

Health officials predict a resurgence of the flu in the fall, and a vaccine effective against H1N1 is not expected to be available until long after the start of school.

School districts and universities are on alert, working with health officials to launch education campaigns, stockpile medical supplies and discuss worst-case scenarios.

State education officials are developing plans to provide lessons and meals for low-income children in case elementary and secondary schools close.

School closures would occur only by order of the superintendent or the county health department and only if so many children were sick that it was impractical to keep classes running, said Dr. Kimberly Uyeda, director of student medical services at the Los Angeles Unified School District.

UC campuses are stockpiling supplies, from paper masks and hand sanitizer to food and water. Officials are going over worst-case scenarios in case of campus-wide outbreaks. Officials are considering screening students for fever when they check into dorms.

"If we prepare for the worst, then we're going to get a better outcome," said Grace Crickette, chief risk officer for the University of California.

For now, sleep-over camps provide a look at what schools may face.

Before children are allowed to board camp-bound buses, nurses check temperatures and medical histories, hoping to ensure they are flu-free. Visitors days have been canceled at some camps, and makeshift infirmaries were created in some dining halls and lawns. High-fives and hand-holding are out, replaced by fist bumps and elbow-linking. Hand sanitizer is everywhere.

"We're all getting habitual with our Purell," said Jordanna Flores, executive director of Camp Alonim in Simi Valley, which has sent 160 children home in recent weeks. Many have since recovered and returned to camp.

Flu symptoms have been mild, but the virus is highly contagious, particularly when children are in close proximity.

Some organizations that cater to children with health issues, including the American Lung Assn. and the Muscular Dystrophy Assn., canceled camps because of concerns about the virus.

"It's not worth the risk," said Bob Mackle, a spokesman for the Muscular Dystrophy Assn. "It was a heartbreaking decision for us, and it was a tough decision."

Most camps remain open, according to the American Camp Assn. No organization has a complete list of outbreaks, but there have been anecdotal reports from across the country, notably in the Northeast, which has a deep tradition of sleep-away camps.

The California Department of Public Health has received reports of outbreaks at 16 camps in eight counties, though department officials suspect the number is higher.

At Camp Ramah in the Ojai Valley, 80 campers and staff members were sent home with flu-like symptoms in the first session; many have returned. Twenty-nine eventually tested positive for the flu, said Rabbi Daniel Greyber, the camp director. The camp canceled its annual visitors day, which typically attracts as many as 2,000 people, and instead brought in a petting zoo.

Once campers left, workers deep-cleaned the bunks, beds and bathrooms. The 600 campers attending the second session, which began Thursday, were advised to pack Tamiflu.

"We hope it's a proactive thing that we can do to minimize the flu within the camp," Greyber said.

Education is equally important. Greyber demonstrated proper coughing and sneezing etiquette (into the elbow or on the sleeve, not into the hands). Campers produced skits about "Swine '09."

But for some children who fell ill, the situation was traumatic.

At Camp Alonim, health center coordinator Cindy Petrak said some campers wept when they learned they would have to leave their healthy friends and siblings for seven days to recover.

"It felt like Ellis Island," she said.

On a recent day, children lined up in an infirmary to have their temperatures taken. Parents of any who had fevers were called to pick them up. As many as 20 campers rested on a grassy lawn, sitting on white sheets with their luggage, waiting for their rides home.

Austin, a sixth-grader from Encino, had a fever and a sore throat when he was sent home. He said he was sad to miss bunk night, when his cabin-mates picked the evening activities. When he returned, he said, he was happy that friends noticed his absence. "They all recognized I was back," he said.

Some camps have been spared, including Camp Paintrock and Blue Sky Meadow.

Camp Paintrock sends Los Angeles children to Wyoming for a four-week youth leadership development program. About half a dozen of the 60 campers had flu-like symptoms, but none tested positive for the flu.

Blue Sky Meadow, a science camp for Los Angeles area children in Big Bear, checked campers' temperatures and health histories before students boarded buses to the camp. Families of children who had not been feeling well recently were told to select another week to attend.

"It's sort of a healthy-campers-are-happy-campers philosophy," said Madeline Hall, director of the Los Angeles County Education Foundation, which runs Blue Sky Meadow.

Parents are trying to take the flu in stride.

"I think when kids are at camp, living in close quarters, there's always a chance. If one kid gets sick, all the kids get sick," said Mara Sperling, whose 12-year-old daughter Ella left last week for Gindling Hilltop Camp in Malibu. "It's one of the hazards of going to sleep-away camp."

Susan Freudenheim's 14-year-old daughter Rachel Core is attending Camp Alonim, where Tamiflu will be given to the entire cabin, with parents' permission, if two children in a cabin get sick.

She declined because she fears there could be a Tamiflu shortage and that unnecessary medication could lead to the development of a drug-resistant strain of the virus. Health officials, including the Centers for Disease Control and Prevention, advise against giving the drug to healthy people.

Freudenheim, managing editor of the Jewish Journal of Greater Los Angeles, which has covered the outbreaks extensively, hopes her daughter stays healthy.

"It would be a disaster if she came home," said the former editor at the Los Angeles Times. "She'd have nothing to do, be sick alone at home, and I'm working full-time."

Educators plan to work in the coming weeks to prevent the spread of the virus in classrooms and dorms, but they said it ultimately comes down to education and personal responsibility.

"Wash your hands, wash your hands, wash your hands," said Crickette.


● Flu shot isn't for H1N1: The approved seasonal vaccine doesn't protect against swine flu. But you should get it anyway.

By Melissa Healy From the Los Angeles Times

July 25, 2009 -- With the so-called swine flu continuing to spread across the United States and the world, the Food and Drug Administration announced recently that it has given the go-ahead for the final preparation and distribution of a vaccine for the coming flu season.

But that vaccine will not protect against swine flu, more officially known as the novel influenza A (H1N1) virus. That virus has sickened almost 45,000 and killed more than 300 in the United States since the spring. Those numbers are only confirmed cases, however; the true number of people affected is much higher.

"The FDA continues to work with manufacturers, international partners and other government agencies to facilitate the availability of a safe and effective vaccine against the 2009 H1N1 virus," said the FDA announcement.

Six vaccine manufacturers will be producing the 2009-2010 influenza vaccine. And the vaccines will contain the strains of three viruses -- one of them an "H1N1-like" virus identified as A/Brisbane/59/2007. The strain in the seasonal flu preparation is not the same as the so-called swine flu, however and, therefore, is not expected to carry any protection against it.

So where the heck is that swine flu vaccine? And, in the meantime, why would you go to the trouble to get yourself vaccinated against a flu vaccine that doesn't protect you from the dreaded swine flu?

In meetings with state and local officials earlier this month, Health and Human Services Secretary Kathleen Sebelius said she expects a new swine flu vaccine to be available for distribution by mid-October -- fully six to seven weeks after American schoolchildren will have flocked back to the germ pools of their classrooms. Sebelius hasn't formally approved a nationwide vaccination campaign, which would detail which populations should get priority in the use of still-scarce vaccine. But she's expected to do so soon.

Time is of the essence. To get the vaccine to the public even by late October, several labs and companies have been rushing to develop and test formulations since late spring. The results of human trials testing the vaccine's safety and effectiveness at producing an immune response are not expected before early September.

In a teleconference earlier this month, the members of the National Biodefense Science Board, a federal advisory board, made clear they think the process should be accelerated. The board's members said vaccine makers should be asked to begin the preliminary steps toward producing vaccine on Aug. 15, before safety and effectiveness data are available.

That would have the effect of moving up the date by which vaccine would be available for distribution to mid-September rather than mid-October. But an acceleration of the process could also add an element of uncertainty about the safety of a vaccine that might be mandatory for virtually all schoolchildren.

The board, established by a 2006 law to advise the Department of Health and Human Services on matters of pandemic illness and other public health emergencies, recommended that the federal government "set a goal of having several tens of millions of doses available by Sept. 15."

Amid all the concern about swine flu, there may seem little point to getting the seasonal flu vaccine for which the FDA is giving the go-ahead now.

But as Dr. Aaron Glatt, a spokesman for the Infectious Diseases Society of America, pointed out: Seasonal flu may be the enemy we know, but it's still a deadly enemy. And it's not likely to take the season off just because the novel H1N1 strain is out there too.

"The real reason to get vaccinated for seasonal flu is because seasonal flu kills people," he said.

Dr. William Schaffner, chairman of Vanderbilt University School of Medicine's department of preventive medicine added that, in a season likely to be challenging for physicians, public health officials and patients, those who get their seasonal flu vaccination (shot or mist) will help simplify a complex and moving picture.

"We may actually have a double-barreled influenza season out there," said Schaffner. Patients who have gotten their seasonal flu shots are less likely to take up hospital beds and the time and attention of labs and physicians, he said. And that, in turn, can "kind of clear the decks" for those on the front lines battling swine flu, Schaffner added.

The patient who comes in with flu symptoms and has had a seasonal flu shot also might be a little easier to diagnose and treat, said Schaffner. A physician would be quicker to presume swine flu and to prescribe antiviral medications such as Tamiflu, which is no longer very effective against seasonal flu.

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