Influenza Prevention in a High School

Capstone Project

Caroline Rast

Public Health Problem

The Flu

• Influenza, more commonly called “the flu” is a contagious virus that attacks the respiratory tract (CDC 2020).
• Although the symptoms-fever, cough, sore throat, head and body aches, etc.- are usually mild to moderate, they can become severe (CDC 2020).
• There are two types of the flu- Type A and Type B- and as they spread across the population, it leads to a seasonal epidemic each year (CDC 2020).

How it Spreads

• There are 2 main ways that the flu can be spread:

Through direct contact of the mouth or nose with the droplets from an infected person through sneezing, coughing, or talking.

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Through indirect contact when an infected person’s droplets land on a commonly touched surface and another person touches that surface and then touches their mouth, nose, or face.

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• People can be contagious starting 1 day before their symptoms begin, which could lead to a person spreading the flu without even knowing they have it (CDC 2020).
• They can stay contagious for 7-5 days after their symptoms begin (CDC 2020).

(CDC 2020)

Statistics

South Carolina is one of the few states that has a high level of influenza-like illness (CDC 2020). The number of cases for type A and B for the 2019-2020 season was 6630. The figure below demonstrates how the numbers of flu infection have increased over the last 4 seasons (SCDEC 2020).

A study done in England for the 2006-2007 season recorded the number of absences in schools for the flu or flu-like symptoms. In the figure above, there is an increase in student absences during the winter months, or “flu season.” This demonstrates that the spread of the flu in schools is prominent in the seasonal epidemic (Mook et.al. 2007)

Priority Population

A school is a hotspot for spreading the flu because there are many commonly touched surfaces that can be touched by hundreds of people on a daily basis. Students, teachers, and administration are constantly in close contact with one another, especially in classrooms with lined up desks and small lunchroom tables.

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Students, Teachers, Administration, and Staff

• Locations where there are multiple surfaces that may come into contact with numerous different people and where people are in close contact with one another, like a school, are hubs for flu germs (CDC 2020)
• School employees and students make up about ⅕ of the US population, creating a large pool of people at risk of coming into contact with the flu on a regular basis (CDC 2020)

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Although the CDC and local governments do not conduct surveillance in schools for the flu, a study in Maryland in 2011 demonstrated the elevated number of flu-related student absences in schools in the figure above to emphasize the benefits of conducting surveillance in schools. (Thorpe et.al. 2011)

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Risk Factors and Determinants

Micro Level

• Personal beliefs- Some people may not want to receive the flu vaccine for religious or other personal reasons.
• Individual medical problems- Someone may not be able to receive the flu vaccine for a medical condition, or they may be at a higher risk of contracting the flu from a compromised immune system.
• Lack of cleaning/disinfecting at home or at school.
• Lack of knowledge on how the flu spreads and prevention strategies.

Macro Level

• Being at a school with high amounts of people on a daily basis puts people at risk of infection socially.
• Students who come to school already infected with the flu can potentially spread it to other students.
• The school at which I volunteered, there is not a policy on students and staff receiving the flu shot each year.
• There was also no policies or regulations on classroom cleanliness and disinfecting the classrooms regularly.
• This private school did not supply any cleaning products to the teachers in order to keep the classrooms as clean as possible, although this is supplied in some public schools.
• Being that this is a very small private school, there isn’t enough funding placed on illness prevention and classroom cleanliness.

Project Setting

Although I only completed a small portion of my hours, I was volunteering at a small private school called Orangeburg Preparatory Schools in Orangeburg, SC.

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I stayed on the Upper Campus, which included grades 6-12.

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I mainly stayed on one particular hallway with about 7 classrooms, and switched classrooms every so often between class changes.

Specific Activities

• My main activity for the time that I was there included applying prevention strategies to the classroom such as using disinfectant wipes to wipe down desks, doorknobs, keyboards, and whiteboard markers and spraying disinfectant spray in the room between every class change. I also administered hand sanitizer to students as they walked in the classroom. All cleaning supplies were supplied by me.
• There were many activities that I did not get the chance to carry out because of the COVID-19 pandemic. Here are some of the things I intended to do:
• Make a survey for the teachers asking specific questions such as what they currently do to prevent the spread of the flu, what they would be willing to start doing, if they got the flu shot or not, if they wish cleaning supplies were given by the school, how knowledgeable they are on flu prevention strategies and how it spreads, and other similar questions.
• Interview the school nurse on ways she prevents the flu in schools or how many students she sees on a regular basis for flu-like symptoms at school and possibly shadow her/help her out with prevention.
• Ask for access to statistics from the assistant principal on the number of absences during the flu season and compare it to other times of year.
• Talk with some of the classes about how they can prevent themselves from catching the flu or spreading it to others.

Lessons Learned

Challenges

• The first challenge I encountered was finding a site. I was sure that I wanted to focus my project on the prevention of the flu in schools, but I had trouble finding a school at which to volunteer. I learned I had to be proactive and reach out to multiple schools in order to find one that would accept me as a volunteer.
• I also found that it was a challenge to find my place in the school. At first, I felt slightly awkward not knowing where I should be, but I quickly learned that I had to take initiative and complete my goals. I jumped into carrying out my prevention strategies all while explaining to the staff and students the reason I was there and spreading awareness.
• The final and most prominent challenge was the COVID-19 pandemic. I was unable to complete my project hours because the schools shut down. From this, I learned how crucial it is for people to be informed on prevention of disease and how diseases can spread swiftly. This made the work I was doing in the school even more important, although I did not get to finish.

Successes

• The first success I encountered was the amount of awareness I raised within the school. As I walked down the hallways and went in the classrooms, students and teachers asked me what my project was about and what I was going to be doing there. I was able to inform them about flu prevention in a 1 on 1 interaction in most cases, which helped people gain knowledge on the subject they might not have had prior knowledge on.
• I successfully kept the classrooms disinfected and cleaned, and sanitized students hands between class changes, as recommended by the CDC. This is a great example of primary prevention which means to prevent the disease before someone has contracted it or before symptoms begin. Killing the germs on commonly touched surfaces and sanitizing as many people’s hands as possible prevents them from infecting another person.

Conclusions

A-HA Moment

A surprising fact that I discovered from both my time at Orangeburg Prep and the COVID-19 pandemic is how little most people know about how diseases are spread and how to protect oneself and others from contracting those diseases. This will impact me personally in that I will make an active effort to not only keep myself clean and safe, but also try to keep myself from spreading diseases to others. In my classroom one day, I will make an extra effort to carry out the same prevention strategies I did at OP and make sure my student know how to protect themselves and others.

Works Cited

CDC Influenza (Flu). (2020, April 17). Retrieved April 23, 2020, from https://www.cdc.gov/flu/weekly/index.htm

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Mook, P., Joseph, C., Gates, P., & Phin, N. (2007). Pilot scheme for monitoring sickness absence in schools during the 2006/07 winter in England: can these data be used as a proxy for influenza activity? Eurosurveillance, 12(12), 11–12. doi: 10.2807/esm.12.12.00755-en

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SCDHEC Flu Watch-Data, Reports, Maps. (2020, April 22). Retrieved April 23, 2020, from https://www.scdhec.gov/health/flu/flu-watch-data-reports-maps

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Thorpe, L., Crawford, G. B., Mckelvey, S., Crooks, J., Siska, K., Russo, K., & Chan, J. (2011). Influenza and School-Based Influenza-Like Illness Surveillance: A Pilot Initiative in Maryland. Public Health Reports, 126(4), 591–596. doi: 10.1177/003335491112600416