August 24, 2009 — As classes begin this week, the University of Virginia is preparing for a possible large-scale outbreak of novel H1N1 flu. The virus – originally called "swine flu" – is proliferating throughout the Southern Hemisphere and likely will appear as dramatically large infection rates this fall and winter in North America.

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So far, most infections worldwide have been relatively mild, with symptoms similar to seasonal flu – headache, chills, body aches, fatigue, dry cough, sore throat and stuffy nose. Most fatalities have been among young children, pregnant women and those with health complications that compromise their ability to fight infection.

The University is working closely with local and state health officials on management and mitigation plans for a major outbreak of flu, said Marjorie Sidebottom, director of U.Va.'s Office of Emergency Preparedness. She also serves on the Commonwealth's pandemic advising committee.

"We have been planning for a number of years for a flu pandemic with a focus on managing large infection rates should they occur," Sidebottom said.

In June, the World Health Organization declared the outbreak a pandemic, the first in 41 years. More than 182,000 cases have been reported worldwide, and more than 1,800 people have died. In the United States, according to the Centers for Disease Control and Prevention, about 7,500 people have been hospitalized with H1N1 flu and nearly 500 have died.

By comparison, on average more than 200,000 Americans are hospitalized from seasonal flu-related causes each year, and about 36,000 die from seasonal-flu-related complications, according to the Centers for Disease Control.

One difference: the H1N1 has persisted in the Northern Hemisphere through the summer months, a rarity for seasonal flu, likely portending an early flu season.

"With 21,000 students returning from everywhere, we are anticipating a significant outbreak beginning this fall and into next spring," said Dr. James Turner, executive director of U.Va.'s Department of Student Health and president of the American College Health Association. "During the next one and a half to two years, we could see as many as 8,000 students becoming infected with H1N1 flu – about 40 percent of the student population."

H1N1 is infecting 19- to 24-year-olds at a disproportionately high rate, making it particularly worrisome to college health officials. As a result of a recommendation by Turner to the CDC, this age group has now been included as priority recipients of H1N1 flu vaccine when it becomes available later this fall.

As it has in the past, the University will hold vaccination clinics for regular "seasonal" flu beginning early this fall for students, faculty and staff.

In addition, several H1N1 flu vaccination clinics are planned once the vaccine becomes available. Health care workers and critical infrastructure workers will receive the vaccine first, followed by the 19- to 24-year-olds. Once the H1N1 vaccine becomes more widely available, the vaccination program will be widened to include the rest of the University community.

"We strongly encourage students and employees to get vaccinated for seasonal flu and for H1N1 flu when that vaccine becomes available," Turner said.

Sidebottom said several sites can be set up at the University and in the city for vaccinations, and for dispensing medication in the event of a large-scale outbreak.

Sidebottom is working with the U.Va. Health System, Turner's office and the academic community on an awareness campaign to educate students and employees on the seriousness of the H1N1 pandemic and ways to mitigate infection rates.

"Each individual can help reduce the spread of disease by staying home when sick, by frequent hand washing, covering up when coughing or sneezing, disposing of used tissues, all the basic personal hygiene practices we can do individually to keep from infecting each other," she said.

Leonard W. Sandridge, the University's executive vice president and chief operating officer, is expected to e-mail flu prevention instructions to the University community early this week, and notices are being prepared for posting on bathroom mirrors throughout Grounds.

The University has a "Continuity of Operations Plan" that plans for the maintenance of University operations during periods of widespread infection.

"It's important that employees and students stay home when sick," Sidebottom said. "Managers should work with their staff members to maintain workflow while ensuring that sick people don't come in and infect their co-workers."

During an outbreak, managers should reduce the number of face-to-face meetings and allow employees to telecommute when needed.

Turner advised sick students to stay away from class and avoid other students. The faculty is looking at ways to hold classes remotely if needed, and will offer opportunities for sick students to complete assignments without coming to class.

"People should prepare to stay home, to self-isolate, if they show symptoms," Turner said. "Residence hall advisers will help students make arrangements to stay isolated and to have food and other needs delivered to them."

Symptoms generally last for two to four days. Infected people can return to normal activities 24 hours after their fever subsides without risk of infecting others.

For people who develop flu symptoms, Turner recommends that they first call their doctor or a health clinic to get instructions. Students should call the Student Health Center at 924-5362 before visiting. Students with mild symptoms will be advised to stay home or in their dorms and to monitor symptoms. Those with more serious symptoms will be advised to be evaluated at Student Health.

"People should not report to hospital emergency rooms unless they truly have a medical emergency," Turner said. "We don't want to overwhelm emergency services with cases that are best treated at home or at a doctor's office."

He said the Student Health Center is preparing for surges of sick students this fall and winter, and likely into the spring.

Sidebottom said people should also make plans for dealing with sick family members. The key to recovery, and reducing the spread of infection, she emphasized, is to consult a doctor, stay at home, and wait for the symptoms and fever to pass.

"Employees should make personal circumstance issues known to their supervisors ahead of time to allow planning for personnel reductions," she said.

"Our plans will continue to be tested as the situation evolves, and we will remain flexible to respond. We are well connected with local and state health departments," Sidebottom said. "We're doing all we can to prepare for what could be a particularly active flu season."

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Tips to prepare for the flu season:

Get vaccinated for both seasonal flu and H1N1 flu (when that vaccine becomes available later this fall). Several student vaccination clinics for both seasonal and H1N1 flu are tentatively scheduled to be held in Newcomb Hall between Nov. 5 to Dec. 15, depending on vaccine availability.

Make plans for handling the needs of a sick family member without disrupting your other activities. Make plans with your supervisor for taking days off or working from home if needed.

Flu symptoms:

Headache, chills, body aches, fatigue, dry cough, sore throat and stuffy nose. Swine flu can also cause nausea, vomiting and diarrhea in 30 percent to 40 percent of cases.

Ways to prevent the spread of germs:

Stay home when you are sick or have flu symptoms, get plenty of rest, and check in with your doctor as needed.

Cough or sneeze into a tissue, throw away the tissue and wash your hands. Wash your hands often with soap and water. Wash for 15 to 20 seconds. Use alcohol-based hand wipes or gel sanitizers when water is not available, and rub hands until dry. Avoid touching your eyes, nose and mouth, because you may have come into contact with germs by touching doorknobs, stair handrails or shaking hands.

Ways to handle flu:

Consult with a doctor. Get a lot of rest and drink plenty of clear fluids. Don't smoke or drink alcohol. Symptoms may be relieved by some over-the-counter medicines, such as acetaminophen (like Tylenol) or aspirin. Decongestants, cough medicines and use of a humidifier may help.

See a doctor if symptoms worsen.

For more information:

Office of Emergency Preparedness
http://www.virginia.edu/emergencypreparedness/

U.Va. Department of Student Health
(under Student Health Bulletin Board H1N1 Swine Flu Information)

Virginia Department of Health
www.vdh.state.va.us/

Centers for Disease Control H1N1 Web site
www.cdc.gov/h1n1flu/