Many U.S. daycare centers may lack plans for pandemic flu

Fewer than one in 10 U.S. daycare center directors have taken concrete steps to prepare for a pandemic flu outbreak, a recent study suggests.

Researchers surveyed directors of licensed childcare centers in 2008 and again in 2016, to assess flu prevention measures before and after the 2009 pandemic outbreak of a new strain of H1N1 influenza. Among other things, they looked at flu prevention activities like daily health checks for kids, infection control training for staff, communicating with parents about illness and immunization requirements for children and staff.

Both before and after the 2009 global outbreak, only about 7 percent of directors surveyed said they did any of these flu prevention activities, the study found.

“Pandemic influenza is different than seasonal influenza,” said lead study author Dr. Timothy Shope of the University of Pittsburgh School of Medicine. “It is a novel virus that can be transmitted from person to person and to which most of the world’s population has no immunity.”

For seasonal flu, immunizations are the most effective tool for prevention, Shope said by email. But there’s no vaccine for pandemic influenza, and it takes months once a new virus is discovered to develop a new vaccine for it, he added.

During a pandemic with high rates of disease and death, public health officials may need to close daycare centers and schools to help prevent the spread of the virus.

“So pandemic influenza preparedness involves everything we normally do for seasonal influenza except immunization, but also relies on child care centers creating plans to identify who would be responsible for notifying them of closure, how to communicate with parents in the event of a closure, and encouraging parents to have alternative care plans,” Shope added.

Without vaccines, efforts to prevent the spread of pandemic flu can include things like frequent hand-washing, covering the face when coughing and sneezing and limiting close contact with other people, a practice known as social distancing, researchers note in Pediatrics. All of these things can be tricky with toddlers and preschoolers.

For the study, Shope and colleagues examined survey data collected from 1,500 daycare centers in 2008 and from 518 directors in 2016. They focused on licensed centers, and excluded home-based family childcare programs.

Few directors said they had written plans to for pandemic flu preparation, trained staff or communicated with parents about this possibility, the study found. Less than 5 percent of directors did these things, and this didn’t change significantly in the surveys done before and after the 2009 H1N1 pandemic.

After adjusting for factors that might influence preparedness efforts, the only things that independently influenced whether directors had pandemic flu plans in place were their years of experience, use of heath care consultants to help create plans and perceived barriers to putting plans in place.

Barriers included things like not knowing what to do and lacking resources to put together plans.

One limitation of the study is that it relied on directors to report on practices in place at their centers, and researchers didn’t independently observe or verify infection control practices, the authors note.

Even so, the findings suggest it may make sense for parents choosing a daycare center to ask about the directors’ years of experience and whether the center uses a healthcare consultant, Dr. Laura Faherty, a pediatrician and physician policy researcher at the RAND Corporation in Boston who wasn’t involved in the study, said by email.

And even young children can be taught a little bit about infection control, said Dr. Susan Coffin, associate hospital epidemiologist at the Children’s Hospital of Philadelphia.

“Making sure everyone is immunized against seasonal flu every year is a great first step,” Coffin, who wasn’t involved in the study, said by email. “Additionally it is worth teaching children the behavioral things they can do to lessen their risk of acquiring infections such as washing hands regularly, throwing away used tissues and covering their coughs or sneezes.”

SOURCE: Pediatrics, online May 15, 2017.