As the country braces for what officials predict will be an extremely long flu season, nurses in the Southeast are already on the front lines and in the heat of battle. In schools, on college campuses, in clinics, and in hospital EDs, nurses report larger than usual — though in most cases not overwhelming — numbers of people coming in with respiratory illnesses and fevers.
“I think it’s going to be an unbelievable flu season,” says Amy Garcia, RN, executive director of the National Association of School Nurses. “Because when the seasonal flu gets here, we’ll be hit with that as well.”
About 97% of flu viruses now circulating in the country are pandemic H1N1, formerly known as swine flu, according to the Centers for Disease Control and Prevention in Atlanta. “During the last two weeks of August, influenza activity increased in the southeastern United States to levels … usually seen during winter seasonal influenza peaks,” the CDC reports in a study of summer influenza activity. “This increase might signal that other areas of the country also will have early influenza activity during the 2009-10 influenza season.”
Though flu is unpredictable, and no one knows why it hits certain areas at certain times, one thought is that children in the Southeast returned to school earlier than in other parts of the country and began spreading the illness. Young people appear to be most likely to become infected with H1N1. The elderly, who are usually susceptible to seasonal flu, do not appear as likely to contract it, according to CDC reports, and may have some immunity from an earlier strain of the virus.
School nurses and nurses at campus heath centers in the Southeast, Alaska, and other areas say they have seen large numbers of students with flu symptoms since the start of school. One of the largest outbreaks happened at Washington State University soon after classes began. Some 2,500 cases have been reported there.
“It’s happening much earlier,” says Ellen Rivera, RN, nursing supervisor at Elson Health Center at the University of Virginia in Charlottesville. “Usually the flu season doesn’t start until January or February.” This year the center had 76 diagnosed cases in the first two-and-a-half weeks of school, she says.
CDC studies of the virus in the southern hemisphere show it has not become more virulent, though some studies show it may spread more rapidly than seasonal flu. School and campus health center nurses say most cases they are seeing are mild and usually involve calling parents or sending students back to bed, but they are especially concerned about young people with underlying conditions, including asthma and diabetes.
Sarah Butler, RN, MSN, CDE, NCSN, an education director at NASN, has firsthand experience with the importance of educating parents about when their children should see a provider for treatment, and following up to be sure the child is seen. Her 17-year-old son, a healthy athlete with controlled asthma, got the flu and within 48 hours was struggling to breathe, she says. He developed a bacterial infection, was treated with antibiotics, and recovered, but she was surprised at how quickly the illness progressed.
“It really takes vigilance,” she says. “The parents really need education so they can pick up those signs that the condition might accelerate.”
Making parents understand the importance of keeping sick children home from school has been one of the biggest challenges for Celia Roberts, RN, ADN, district head nurse for the Lafayette County School District in Oxford, Miss. Roberts had 34 confirmed flu cases in the first week-and-a-half of classes at her three schools. She has sent children with fevers home to have them reappear two days later, taking Tylenol, despite being told to stay home for at least a week.
“We’ve got parents with no phones,” she says. “Communication is very difficult.”
CDC officials say when the H1N1 vaccine does become available — probably in mid- October — schools will be important sites for vaccinations, though plans for these will be up to state and local health departments. School nurses will work with health departments to set up school vaccination clinics, Garcia says, but depending on their student load — nurses in some school districts are responsible for upwards of 2,000 students—they may act as supervisors, education coordinators, and liaisons for public health nurses or other vaccination teams rather than actually give shots. Because schools require consent forms for students to receive vaccines and because CDC officials expect many students will need two shots a few weeks apart, the documentation for school vaccine clinics will be daunting, school nurses say.
“A lot of folks are going to rely on outside resources,” says James Turner, MD, president of the American College Health Association and executive director for student health at the University of Virginia. The university health center will hire a team of vaccination nurses to set up H1N1 clinics on campus, he says.
Nurses in the Southeast say so far they haven’t been hit with anything they can’t handle, but they are ready for that to change at any minute. “If there were nothing else to worry about, if we had the vaccines and if everybody knew what they needed to know,” Rivera says, the current outbreak would feel pretty much like a regular flu season. But with students and parents calling with questions, uncertainty over when vaccines will be ready, and media attention to the new virus, “it’s a little more exaggerated than just a seasonal flu,” she says. “Nobody knows what to expect.”
“I think it’s going to be an unbelievable flu season,” says Amy Garcia, RN, executive director of the National Association of School Nurses. “Because when the seasonal flu gets here, we’ll be hit with that as well.”
About 97% of flu viruses now circulating in the country are pandemic H1N1, formerly known as swine flu, according to the Centers for Disease Control and Prevention in Atlanta. “During the last two weeks of August, influenza activity increased in the southeastern United States to levels … usually seen during winter seasonal influenza peaks,” the CDC reports in a study of summer influenza activity. “This increase might signal that other areas of the country also will have early influenza activity during the 2009-10 influenza season.”
Though flu is unpredictable, and no one knows why it hits certain areas at certain times, one thought is that children in the Southeast returned to school earlier than in other parts of the country and began spreading the illness. Young people appear to be most likely to become infected with H1N1. The elderly, who are usually susceptible to seasonal flu, do not appear as likely to contract it, according to CDC reports, and may have some immunity from an earlier strain of the virus.
School nurses and nurses at campus heath centers in the Southeast, Alaska, and other areas say they have seen large numbers of students with flu symptoms since the start of school. One of the largest outbreaks happened at Washington State University soon after classes began. Some 2,500 cases have been reported there.
“It’s happening much earlier,” says Ellen Rivera, RN, nursing supervisor at Elson Health Center at the University of Virginia in Charlottesville. “Usually the flu season doesn’t start until January or February.” This year the center had 76 diagnosed cases in the first two-and-a-half weeks of school, she says.
CDC studies of the virus in the southern hemisphere show it has not become more virulent, though some studies show it may spread more rapidly than seasonal flu. School and campus health center nurses say most cases they are seeing are mild and usually involve calling parents or sending students back to bed, but they are especially concerned about young people with underlying conditions, including asthma and diabetes.
Sarah Butler, RN, MSN, CDE, NCSN, an education director at NASN, has firsthand experience with the importance of educating parents about when their children should see a provider for treatment, and following up to be sure the child is seen. Her 17-year-old son, a healthy athlete with controlled asthma, got the flu and within 48 hours was struggling to breathe, she says. He developed a bacterial infection, was treated with antibiotics, and recovered, but she was surprised at how quickly the illness progressed.
“It really takes vigilance,” she says. “The parents really need education so they can pick up those signs that the condition might accelerate.”
Making parents understand the importance of keeping sick children home from school has been one of the biggest challenges for Celia Roberts, RN, ADN, district head nurse for the Lafayette County School District in Oxford, Miss. Roberts had 34 confirmed flu cases in the first week-and-a-half of classes at her three schools. She has sent children with fevers home to have them reappear two days later, taking Tylenol, despite being told to stay home for at least a week.
“We’ve got parents with no phones,” she says. “Communication is very difficult.”
CDC officials say when the H1N1 vaccine does become available — probably in mid- October — schools will be important sites for vaccinations, though plans for these will be up to state and local health departments. School nurses will work with health departments to set up school vaccination clinics, Garcia says, but depending on their student load — nurses in some school districts are responsible for upwards of 2,000 students—they may act as supervisors, education coordinators, and liaisons for public health nurses or other vaccination teams rather than actually give shots. Because schools require consent forms for students to receive vaccines and because CDC officials expect many students will need two shots a few weeks apart, the documentation for school vaccine clinics will be daunting, school nurses say.
“A lot of folks are going to rely on outside resources,” says James Turner, MD, president of the American College Health Association and executive director for student health at the University of Virginia. The university health center will hire a team of vaccination nurses to set up H1N1 clinics on campus, he says.
Nurses in the Southeast say so far they haven’t been hit with anything they can’t handle, but they are ready for that to change at any minute. “If there were nothing else to worry about, if we had the vaccines and if everybody knew what they needed to know,” Rivera says, the current outbreak would feel pretty much like a regular flu season. But with students and parents calling with questions, uncertainty over when vaccines will be ready, and media attention to the new virus, “it’s a little more exaggerated than just a seasonal flu,” she says. “Nobody knows what to expect.”
