People at high risk for developing flu-related complications
Most people who get the flu (either seasonal or 2009 H1N1) will have mild illness, will not need medical care or antiviral drugs, and will recover in less than two weeks. Some people, however, are more likely to get flu complications that result in being hospitalized and occasionally result in death. Pneumonia, bronchitis, sinus infections and ear infections are examples of flu-related complications. The flu can also make chronic health problems worse. For example, people with asthma may experience asthma attacks while they have the flu, and people with chronic congestive heart failure may have worsening of this condition that is triggered by the flu. The list below includes the groups of people more likely to get flu-related complications if they get sick from influenza.
There are two main reasons why people age 65 and older are not included in the groups recommended to get the initial doses of 2009 H1N1 vaccine:
1. People age 65 and older are least likely to get sick with this virus, and,
2. There will be limited amounts of vaccine available at first, so the first doses are recommended to go to those who are most likely to get infected and become very ill.
There has been very little 2009 H1N1 illness in people 65 and older since the 2009 H1N1 virus emerged. This has been true both in the United States and in the Southern Hemisphere during their flu season. Studies of who is most likely to be infected with 2009 H1N1 show that people 65 and older are the least likely to get sick with this virus. (One analysis showed that only 1.3 people for every 100,000 people 65 and older are had been infected with 2009 H1N1. This is compared to 26.7 per 100,000 of those five years to 24 years of age and 22.9 per 100,000 in those younger than 5 years old. Rates among younger persons were 15 to 20 times higher. This has been true both in the United States and in the Southern Hemisphere during their flu season.) Laboratory tests on blood samples indicate that older people likely have some pre-existing immunity to the 2009 H1N1 flu virus.
The U.S. government has purchased 250 million doses of 2009 H1N1 vaccine, so anyone who wants to get the vaccine will have the opportunity to do so. While people 65 and older are not included in the groups recommended to get the earliest doses of vaccine, they can get the 2009 H1N1 influenza vaccine as soon as the high risk groups have had the opportunity to be vaccinated. Some communities and providers will offer the 2009 H1N1 vaccine to people 65 and over sooner than others, depending on how quickly they meet the needs of the initial prioritized populations. While the early doses of 2009 H1N1 vaccine are being given to those in high risk groups, CDC's priority for people 65 and older is to have them get their seasonal flu vaccine first, and to seek medical advice quickly if they develop flu-like symptoms this season. This will determine whether they need medical evaluation and possible treatment with antiviral medications.
Children less than five years-of- age are at increased risk of complications from influenza (flu); the risk is greater among children less than two-years- old. Importantly, infants less than 6 months of age represent a particularly vulnerable group because they are too young to receive the seasonal or 2009 H1N1 influenza vaccine; as a result, individuals responsible for caring for these children constitute a high-priority group for early vaccination. Influenza vaccination is the primary means of preventing flu. Additionally, infection control measures are recommended to reduce the spread of flu. However, early childhood settings present unique challenges for infection control due to the highly vulnerable population, close interpersonal contact, shared toys and other objects, and limited ability of young children to understand or practice good respiratory etiquette and hand hygiene. Thus, parents, early childhood providers, and public health officials should be aware that, even under the best of circumstances, transmission of infectious diseases such as flu cannot be completely prevented in early childhood or other settings. No policy can keep everyone who is potentially infectious out of these settings.
The purpose of this document is to provide updated guidance for reducing the spread of influenza in early childhood settings. The CDC provides recommendations assuming that severity of illness is similar to what was seen during the spring and summer of 2009 through the 2009-2010 flu season, as well as recommendations that could be added if the severity of illness worsens.
However, influenza is unpredictable, and CDC will provide periodic updates of these assessments and may recommend additional strategies if they are needed.
Also, because conditions may vary from community to community, early childhood providers should also look to their state and local health officials for information and guidance specific to their location.
The CDC may recommend additional strategies to help decrease the spread of flu if global, national, or regional assessments indicate that flu is causing more severe disease. In addition, state and local health officials may choose to use additional strategies.
Although the following strategies have not been scientifically tested in early childhood settings, they are grounded on basic principles of infection control. Implementation of these strategies is likely to be more difficult and to have more disruptive effects than the previously described strategies.
If flu severity increases, people at high risk of flu complications may consider staying home from work or school while a lot of flu is circulating in their community. Such people should make this decision after consulting with their doctor.
Early childhood providers should review their leave policies to remove barriers to staff staying home if necessary.