A number of area schools are wondering if the second round of increased influenza-like illness (ILI) is coming their way in the near future as the Centers for Disease Control and Prevention (CDC) reports "high activity" in 29 states, including Minnesota.
While widespread throughout the state, ILI is not yet spreading at an alarming rate within many of the area school districts. Lakeview and Tracy Area Public School districts both saw a spike in the number of ILI around the start of Christmas break, which for most area schools, was on or just after Dec. 21.
"We were hit a little harder before Christmas break," TAPS nurse Mary Carter said. "I'm sure there's flu in the area, and we're still having calls come in that tell us a lab has confirmed influenza, but we're not seeing real high absence records."
Lakeview Superintendent Chris Fenske said he also saw a similar pattern in his district a few weeks back.
"I believe we had around 15 percent of our kids sick on the 21st of December," he said. "There were 47 districts that reported outbreaks the day before, so it was probably a good time for vacation."
According to Weekly Influenza & Respiratory Activity reports, ILI in Minnesota schools is arriving more abruptly and much earlier than the last two years. The number of school outbreaks surged from zero to more than 50 from Week 48 to Week 50 in the year. By the end the December, that number dramatically fell to below 10.
"Influenza, in my experience over the years, is unpredictable for the most part," said Kim Jeppesen, state Department of Health regional epidemiologist. "For so many years, we've kind of been lulled into thinking that it doesn't hit until late February, but we know that the flu season can hit basically around Thanksgiving time to St. Patrick's Day."
During the 2011-12 flu season, school outbreak numbers were fewer than 10 at any given time and were, for the majority of the time, flatlined at zero. Two years ago, the only significant outbreak occurred gradually, from Week 3 to Week 6, where it hit its peak of 30 school outbreaks before gradually declining.
"It's unpredictable on how it will play out," Jeppesen said. "We can't predict where it'll hit or how hard it'll hit. We're seeing some school outbreaks, but it's not as bad as they have been in other years. But it is still early."
Since the start of the 2012-13 season, 138 outbreaks of ILI in schools have been reported, including five this past week (Week 1, Dec. 30, 2012-Jan. 5, 2013).
"It does seem to be earlier than the true influenza season, but it can be anywhere from October to March or April," Marshall Public School lead nurse Deb Herrmann said. "The peak is February or March, but we're taught to be ready for it anytime."
Herrmann said the Marshall district has not seen big numbers yet, and she's hoping that they won't for the remainder of the flu season.
"We're doing quite well in this school now," she said. "There's not too much of an influx of influenza. We have more stuff with the gastrointestinal things. But you just don't know if you're in a pocket that is still going to be hit yet."
As of this past Wednesday, Herrmann said, there were confirmed influenza cases at three of the Marshall buildings.
"Park Side, Marshall Middle School and Marshall High School each had two confirmed," Herrmann said. "But really, we're seeing more gastrointestinal things like nausea, vomiting, diarrhea and headaches. We're not seeing much upper respiratory issues like coughs and not a lot of temperatures."
Fenske also reported that while he's not seeing extremely high numbers of ILI, there is still a variety of things going on at Lakeview Public School.
"We have some kids home with flu-like symptoms, like cough, congestion, those kinds of things," he said. "But nothing like the Friday before Christmas break."
Carter reported that since the virus always changes, it's not always easy to distinguish what you're dealing with.
"We have sick kids, which we do all winter long," she said. "But our absent numbers are not quite as bad as before Christmas when we had kids out with a stomach virus and flu-like symptoms. I hope that was our peak, but you never know. Right now, we're seeing a mixed bag of things."
With influenza cases rapidly spreading throughout the state, preventative measures become an important topic of discussion in school environments. Herrmann pointed out that she's hoping that people recognize the signs of influenza and keep their children home, which is the biggest key, she said.
"Don't send them to activities or to school if they have a temperature over 100 degrees, have a cough or sore throat and they need to medicate," Herrmann said. "A student should be temperature-free for 24 hours without being medicated before they come back to school. When we have kids coming to school when they're not supposed to, they end up spreading it to all the healthy kids."
This past weekend, Herrmann said she was impressed to hear that a number of dance teams kept their student athletes home because of illnesses.
"I talked to organizers who said a couple of teams canceled because they had too many kids on the team who were sick," she said. "It's unfortunate to the kids who like to compete, but I'd rather have them keep kids home and get them better than to risk spreading it around more."
A temperature, Herrmann said, is a sign that something is going on inside one's body.
"People shouldn't just medicate and then send their kids to school," she said. "Their body is still fighting something. The child should be in bed, sleeping and recovering."
Like other area school nurses, Herrmann tracks illnesses and encourages parents to communicate with schools when their child is sick. She also keeps in touch with area medical providers. Hearing news of two Minnesota teenagers dying of the flu this season definitely hits home, she said, even though there's no real evidence to suggest that teens are more susceptible to this year's virus.
"The flu can basically kill anybody," Jeppesen said. "It's not that unusual, but when we have children dying, it kind of pops up and we take notice. We don't like to see them die for any reason."
Carter said there have been some reports of students with high fever, aches and cough, which are sometimes accompanied by headaches and a runny nose. But when people get influenza, she said, they're really sick.
"We know it's in the area," she said. "If you have it, you should rest, stay home from work or school, drink lots of fluids and take ibuprofen or Tylenol. If you're short of breath or have concerns, call your doctor. Otherwise, basically stay home and take care of yourself."
There are also a number of other ways to help prevent the spread of germs, the educators said.
"We're really encouraging handwashing," Fenske said. "We have hand sanitizers in classrooms, in computer labs and in lunch lines."
Along with handwashing, Herrmann also suggested coughing into a sleeve, getting lots of rest and drinking plenty of fluids.
"We try to be very vigilant," she said.
Herrmann and Carter are also hoping that the higher-than-normal number of students who received flu shots this year, beginning at the end of September and early part of October, will also help deter any outbreaks in the future. Both licensed nurses felt that this year's flu shot was a good match to the virus.
"We had quite a few kids who got flu shots this year," Carter said. "Public Health worked with schools to get shots to the kids. In Tracy, it was run through our local clinic, Sanford Tracy."
To accommodate students, Carter said, extra hours were even offered through the clinic.
"I think a fair number did participate," she said. "I heard quite a few parents and students talking about taking advantage of it."
Marshall partnered with ACMC and Southwest Health and Human Services Public Health Division to offer flu shots to students in the district.
"They came into the schools, and if a student had a signed parent permission sheet, they could get it right at the school," Herrmann said. "That might have helped us be where we're at now because we had pretty good participation in that."
The same flu-shot process has been done successfully for the past four or five years, Herrmann said, though there's always room for improvement.
"I think parents are appreciative of the service," she said. "If the family had insurance, it was billed to their insurance. If not, then the clinic took care of it or gave a discounted rate. It was a fairly good turnout, but I would like to see it even higher."
Jeppesen said it wasn't too late to still get a flu shot this season, though it takes approximately 10 days for the vaccine to kick in and for your body to start building antibodies.