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Flu on campus: What works, what doesn’t

Cramped living quarters on college campuses increase students’ chances of being infected with all kinds of flu, but scrupulous hand hygiene and simple face masks may help some stay healthy, at least until swine flu vaccines become available next month, health experts say.

Last week, U.S. colleges and universities reported a 21 percent increase in new cases of influenza-like illness, or 6,432 cases, at 253 schools tracked by the American College Health Association.

So far this academic year, there have been 13,434 reported cases of flu-like illness, most of which are presumed to be swine flu because seasonal flu has not gotten under way. Many schools have just begun classes.

At the University of Michigan, researchers are tallying results from a two-year study on how best to protect students from flu-like illness.

In the first year of the study, the team found wearing face masks and using alcohol-based hand sanitizer helped cut the risk of flu by as much as 50 percent.

“There was a significant reduction in influenza-like illness,” Allison Aiello, an assistant professor of epidemiology, said in a telephone interview.

Aiello said in the first year of their study, the flu season was light, but results of the second year, expected to be published in the next few months, would give a better picture of how masks and hand sanitizer worked against lab-confirmed cases of flu.

“With college students, the concern is that students are living in the residence halls, which can be quite crowded,” Aiello said.

“They sleep there. They eat there. They study there. If there is an outbreak of influenza, it can be quite concentrated and go through the population quite quickly,” she added.

Being sprayed with droplets from someone’s cough poses the biggest infection threat from the flu, accounting for more than half of all cases, followed closely by touching a contaminated object, which accounts for about a third, according to a study published this week in the journal Risk Analysis.

Aiello said there were things campuses could do to reduce the risk of infection, including asking students to practice the non-pharmaceutical interventions until swine flu vaccines are ready in mid- to late October.

“When the vaccinations are available, we recommend students get seasonal flu vaccine, but also the novel H1N1 vaccine,” she said.

Manufacturers and governments have been scrambling for vaccines to target the new H1N1 flu strain, which was declared a pandemic in June. The World Health Organization said it could infect as many as one-third of the world’s population, or 2 billion people.

How to fight flu spread

The World Health Organization issued the following guidelines on Saturday about ways to prevent and fight flu, especially in poor areas where medical facilities may lack staff, beds and drugs:

Social distancing

· “Social distancing, respiratory etiquette, hand hygiene, and household ventilation, are at present the most feasible measures available to reduce or delay disease (morbidity) caused by pandemic influenza.”

· This includes keeping at least an arm’s length distance from other people, minimizing public gatherings, and covering coughs and sneezes.

· Once pandemic flu becomes widespread in a community, however, the WHO said that “interventions to isolate patients and quarantine contacts would probably be ineffective, not a good use of limited health resources, and socially disruptive.”

· “Routine mask use in public places should be permitted but is not expected to have an impact on disease prevention.”

Mild cases treated at home

· “During a pandemic, very high numbers of patients presenting to the health-care facility will necessitate home treatment,” the WHO said.

· “In the case of mild illness, patients should be provided with supportive care at home by a designated caregiver and only referred to health care facilities if they deteriorate or develop danger signs.”

· Such danger signs may include: weakness or inability to stand, lethargy, unconsciousness, convulsions, very difficult or obstructed breathing or shortness of breath, inability to drink fluids, high fever.

· Treatment at home should entail rest, fluids, medication for fever, and good nutrition, with patients kept separate from other people except one designated carer who should wash their hands and household surfaces frequently.

· It is more important in the home that the patient wears a mask than the caregiver. The mask need not be worn all day and only when close contact with the caregiver is anticipated.

· If enough masks are available, caregivers should also use them to cover their mouth and nose during close contact.

· Windows should be kept open to allow good ventilation.

In health clinics:

· Medical facilities with limited resources and beds should aggressively triage patients and ensure those with respiratory symptoms are kept separately from other patients

· Essential medical services should be continued, while elective medical services should be temporarily suspended.

· Admission criteria may change depending on bed availability, but should be reserved for severe cases most likely to benefit from treatment.

· “Health facilities should anticipate a very high demand for treatment,” the WHO said. “Based on current estimates, agencies should anticipate that up to 10 percent of those who fall ill may require inpatient treatment.”

· The WHO recommends this order of priority for antiviral drugs: a) treatment of sick health-care and other essential staff, b) treatment of sick individuals from the community, c) post-exposure treatment for essential staff at high risk, d) pre-exposure prophylaxis for critical staff with anticipated high-risk exposure