Influenza (Flu) Prevention – Specific Groups

Preventing the Spread of Flu in Childcare Settings

Educators, staff, and parents can help slow the spread of colds and flu. Always remind children to:
• Cover their nose and mouth with a tissue when they cough or sneeze—have them throw the tissue away after they use it.
• Wash their hands often with soap and water, especially after they cough or sneeze. If water is not near, use an alcohol-based hand cleaner.
• Remind them to not to touch their eyes, nose, or mouth—germs often spread this way.

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

The main way that flu is spread is from person to person through coughs and sneezes. This can happen when droplets from the cough or sneeze of an infected person travel through the air and reach the mouth or nose of people nearby.

Sometimes flu can be spread when a person touches droplets, nose drainage, or saliva from an infected person, or a soiled object, and then touches one’s own (or someone else’s) nose or mouth before washing hands.

Vaccination against the flu each fall remains the primary way to prevent this disease. Vaccination, along with other measures, also may help to decrease the spread of influenza among children in the childcare setting and among care providers.

Encourage influenza vaccination for children and care providers in child care settings.
Influenza vaccine is recommended for all children 6-23 months of age, care providers or children 0-23 months of age in the child care setting, and persons older the age of 2 who have high-risk medical conditions for influenza-related complications.

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) and 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.

Preventing the Spread of Flu in the Workplace
Businesses, employers and employees can help prevent the spread of colds and flu in the workplace.

Vaccination against the flu each fall remains the primary way to prevent this disease. In addition to vaccination, the following simple actions, can help decrease the spread of respiratory illnesses like the flu.

Avoid close contact.
Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
Stay home when you are sick.
When you are sick or have flu symptoms, stay home, get plenty of rest, and check with a health care provider as needed.
Cover your mouth and nose.
Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
Clean your hands.
Washing your hands often will help protect you from germs. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used.
Avoid touching your eyes, nose or mouth.
Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

HIV/AIDS and Flu
HIV (human immunodeficiency virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). HIV kills or damages cells in the body’s immune system, gradually destroying the body’s ability to fight infection and certain cancers. An estimated 850,000 to 950,000 people are infected with HIV in the United States.

People with HIV/AIDS are considered at increased risk from serious influenza-related complications. Studies have shown an increased risk for heart- and lung-related hospitalizations in people infected with HIV during influenza season as opposed to other times of the year, and a higher risk of influenza-related death in HIV-infected people.

Other studies have indicated that influenza symptoms might be prolonged and the risk of influenza-related complications higher for certain HIV-infected people. Vaccination with a flu shot has been shown to produce an immune response against influenza viruses in certain people infected with HIV.

Because influenza can result in serious illness, HIV-infected persons are recommended for vaccination. During the setting of the current vaccine shortage, people with HIV/AIDS are among the priority groups that should get flu shots this season.

Questions & Answers

Should people with HIV/AIDS receive the inactivated influenza vaccine?
People with chronic underlying medical conditions, including HIV/AIDS, should receive inactivated influenza vaccine (the flu shot) during the influenza season. People with HIV/AIDS are considered at increased risk from serious influenza-related complications and should be vaccinated. Persons with advanced HIV disease may have a poor response to immunization. Therefore, chemoprophylaxis (use of antiviral medications for prevention) should be considered for these patients if they are likely to be exposed to people with influenza.

Are there people with HIV/AIDS who should NOT receive the inactivated influenza vaccine?
Contraindications to the use of inactivated influenza vaccine (the flu shot) in persons with HIV/AIDS are the same as those for uninfected persons ― a history of severe allergy (i.e., anaphylactic allergic reaction) to hens’ eggs, or a history of onset of Guillain-Barre syndrome during the 6 weeks after vaccination.

Can people with HIV/AIDS receive the live attenuated flu vaccine (LAIV, sold commercially as FluMist)?
No. Persons with HIV/AIDS and persons with other medical conditions are not recommended to receive the live influenza vaccine. LAIV contains a weakened form of the live influenza virus. LAIV is approved for use only among healthy persons between the ages of 5 and 49 years.

When should people with HIV/AIDS be prescribed antiviral medications for chemoprophylaxis (prevention)?
Persons at high risk of serious influenza-related complications should be given antiviral medications if they are likely to be exposed to other people with influenza. For example, when a family or household member is diagnosed with influenza, the exposed person with HIV/AIDS should be given chemoprophylaxis for 7 days.

Vaccinated and unvaccinated HIV-infected persons who are residents of institutions experiencing an influenza outbreak should be given chemoprophylaxis for the duration of the outbreak or until discharge. People with advanced HIV disease who are not expected to mount an adequate antibody response to influenza vaccination should consider chemoprophylaxis with antiviral medications for the duration of influenza activity in the community, if antiviral medications are available in adequate supply locally.

There are no published data on interactions between anti-influenza agents such as amantidine and rimantidine and drugs used in the management of HIV infected persons. Patients should be observed for adverse drug reactions to anti-influenza chemoprophylaxis agents, especially when neurologic conditions or renal insufficiency is present.

Should health-care workers who have contact with HIV/AIDS patients be vaccinated?
Influenza vaccination is recommended for health-care workers who are involved in direct care of HIV- infected patients. Health-care workers who are healthy, less than 50 years of age, and are not pregnant may receive the nasal-spray flu vaccine (LAIV/FluMist).