Health & Wellness

I. Introduction

Because it is impossible to predict the full effects of the emergence of a new flu virus, instead of a detailed action plan, Wittenberg’s plan provides a general framework and recommended actions to be considered in the event of an outbreak of pandemic flu. Institutional division areas and individual departments are responsible for the development of more detailed plans within their respective areas. The plan is largely informed by the following sources: the World Health Organization web site, the CDC’s Colleges and Universities Pandemic Influenza Planning Checklist, ACHA’s Guidelines for Pandemic Planning, and the U.S. Health and Human Services (HHS) Pandemic Flu Plan. Learn more

The plan is predicated on the assumption that in the event of a pandemic flu entering the United States, the campus may need to suspend academic programs and most operations for weeks or months. In addition to student illness, experts predict that in the event of a pandemic, 20-40% of employees will be unable to come to work. (learn more) Wittenberg’s response plan strategies are intended to limit, as much as possible, the number of people who get sick and to slow the spread, prepare the institution to care for large numbers of people who get sick and minimize disruption to university operation. Wittenberg will utilize a phased response to pandemic disease emergence based upon the pervasiveness of the flu and the severity of the illness it is causing. In case of a pandemic, Wittenberg’s pandemic flu response team and senior administration will coordinate its response with local county, state and federal health authorities. Public health orders will supersede any planned internal responses.

Definitions

• CDC – is the Centers for Disease Control and Prevention (CDC). It is a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting public health activities in the United States.
• H1N1 – is a subtype of influenza virus. According to the CDC, spread of novel H1N1 virus is thought to occur in the same way that seasonal flu spreads. The symptoms of novel H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue—many people also have reported diarrhea and vomiting. Illness with the new H1N1 virus has ranged from mild to severe.
• Pandemic - A pandemic is a new virus strain that is global in scale — it has spread to more than one continent.
• POD – means point of distribution
• PPE – means personal protective equipment
• Social Distancing – refers to measures to decrease the frequency of contact among people in order to decrease the risk of spread from communicable diseases.

II. Chain of Command

A Pandemic Flu Response Team has been established to plan a detailed response for the respective areas of its members and, as necessary, to implement the plan in coordination with the other team members. This is a planning and response team. Institutional decisions including the suspension of classes or any university programs will be made by the president in consultation with his senior staff.

The Pandemic Flu Response Team includes:

1. Dean of Students, Response Coordinator
2. University Physician
3. Provost
4. Director for Human Resources
5. Director of University Communications
6. Director of Physical Plant
7. Director of International Studies
8. Assoc. Dean, Residence Life
9. Chief of Police
10. Athletic Director
11. Nurse Manager

• Dean of Students will convene the Pandemic Flu Response Team as necessary and will serve as the overall response coordinator. The Dean should be kept informed of all response activities.
• The University Physician will be the primary liaison with local, state, and federal health officials and will be engaged in all decisions related to the physical health of the campus community.
• If the pandemic situation reaches a level 3 alert, the President and the senior leadership team will convene.  The decision to close the campus will be made by the President.
• The Chief of Police will be the primary liaison with local, regional, and federal law enforcement agencies.
• The Director for Human Resources will lead the development of the plan including necessary updates.

III. General Responsibilities for Key Departmental Areas

Academic Affairs
The Provost will direct all efforts related to continuation of classes, field trips, study abroad programs, intercollegiate, club and rec competition. The Provost will monitor class absentee rates in the event of a perceived threat (prior to suspension of any classes). If the campus closes for less than two weeks, completion of the semester’s work should still be possible. For closures greater than two weeks, extension of the semester may be required. Alternative learning modalities should be considered for each program or course. Until a Chief Information Officer has been hired, the Provost will also be responsible for the continuation and coordination of technology services.

Business Services
The VP for Business and Finance will coordinate all vendor activity, continuation of financial business, paycheck distribution, and liability insurance matters. The VP will also ensure that Dining Services continues to operate and follows prudent safety precautions in accordance with CDC recommendations; Building Services institutes protocols to prevent the exposure and spread of disease and Physical Plant responds to facility concerns.

University Communications
The Director of University Communications will be responsible for sustaining campus-wide communication by use of email, phones, the web site and campus radio station. In the event of a higher level alert, campus mail will be curtailed to reduce the spread of germs on media. The web site will be used for continuous updates and the cell phone text messaging system will be employed as necessary. A telephone hotline will be established and staffed by the university in order to respond to questions from parents, students, employees and the general public.

Health and Counseling Services
The University Physician will direct and coordinate all health care during a disease outbreak. The physician will have authority over matters of quarantine, isolation, patient care plans, and infection control and will coordinate services with external health officials. The Director will also be responsible for approving portions of campus communications that pertain to infection control, disease management, statistics, and general healthcare. In accordance with CDC recommendations, if confirmed cases of novel influenza A (H1N1) virus infection or a large number of cases of influenza like illness (ILI) (i.e., fever with either cough or sore throat) occur among students, faculty or staff in the community, the Physician will consult with state and local health officials regarding an appropriate response.

Human Resources
The Director for Human Resources will lead the development of the plan including necessary updates. The Director for Human Resources will also direct the development of appropriate response plans in HR including the development of leave policies, management of staffing functions, continuation of payroll services in coordination with the Business Office, and maintenance of a ready list of all employees and their contact information. The Director for Human Resources will also ensure that risk management advice is continuously reviewed and considered, will coordinate legal matters and will provide leadership to the efforts of the police and security department.

International Education
The Director of International Education will develop plans for communication and recommend policies related to study abroad including trip cancelation, restricted travel regions, repatriation, academic credit issues, shelter-in-place guidelines and a review of their health status upon returning home to campus. The Director will also develop plans for communication and recommended policies for international students including providing assistance to students who want to go home and support to students who are not able to return home. The Director will review and plan for the consequences of travel restrictions on students as well as partnering organization including related contractual obligations. The Director is responsible for continually monitoring travel restrictions and advisories from the CDC and WHO.

Police and Security
The Chief of Police will have authority over matters of public safety including facility security, and coordination of services with external law enforcement officials. The Chief of Police will have authority over all vehicles that leave campus and will coordinate with Student Development on evacuation measures.

President’s Office
The President will issue all directives concerning reduction in campus operations, and continuity of business affairs..All releases to media outlets will be approved by the President or his designee. Senior Staff should develop call trees for their respective areas.

Physical Plant Department
In the event classes are suspended, the Director of Physical Plant will assist in the preparation of facilities and equipment as necessary and will close down non-essential facilities and provide a list to the pandemic flu response team and senior staff of those buildings that will remain accessible. In the event the University is declared a community resource site, the Health and Human Services Pandemic Flu Plan criteria will apply for preparation of facilities. The Director of Physical Plant will ensure that Building Services have procured and provided sufficient and accessible infection prevention supplies and have protocols in place to prevent the exposure and spread of disease. he Director is responsible for stepping up sanitation efforts as necessary.

Student Development including Residence Life
The Dean of Students will serve as the university response coordinator and will be responsible for ensuring that the response team acts in accordance with the Pandemic Flu Response Plan. The Dean will also direct the development of appropriate response plans within Student Development. Key responsibilities of the Student Development Division include: monitoring the recommendations of the CDC, communicating with students and parents, determining when co-curricular activities should be suspended, developing a transportation strategy for medical evaluation for students who develop symptoms, monitoring efforts for infection control within the residence halls, developing a strategy to quarantine students if necessary, and ensuring students receive the necessary care and support. In the event of class suspension, Residence Life will provide a list of students/staff requiring temporary housing due to travel restrictions or occurrence of pandemic flu outbreak in areas students may ordinarily have traveled to. The Dean will document the university’s response to a pandemic and maintain records in the event they are needed to show we acted appropriately.

All Faculty and Staff:

1. Social Distancing: Think creatively about ways to increase the space between people, while keeping students in class. For example, in the classroom, consider the following options:
   • holding classes outdoors,
   • distance-learning methods,
   • leaving vacant seats between students,
   • moving desks farther apart, and
   • moving classes to larger spaces to allow more space between students.
2. Keep people at home if they have flu-like symptoms. CDC recommends that people with flu-like illness remain at home and away from other people until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 38 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medications (any medicine that contains ibuprofen or acetaminophen).

   If flu conditions become more severe, the sick person should stay home or in their residence for 7 days. A person who is still sick after 7 days should stay home until 24 hours after the symptoms have gone away.

3. Frequently wipe down (disposable wipes) to clean commonly touched surfaces, including:
   • doorknobs, handrails, elevator buttons,
   • desks, tables, chairs, sofas, and
   • counters and surfaces in cafeterias, meeting rooms, and offices.
   • keyboards,
   • telephone receivers and touchtone pads in common areas.
4. Report absent employees to HR

IV. Levels of Alert and Appropriate Responses

(Public Health Orders will supersede any planned internal responses)

The President of the university makes the final decision to close the University or suspend classes.

Alert Level 1: Alert Period. No current hazard to persons.

Alert Level 2: Elevated Risk. Classes remain in session with stepped up efforts to educate about infection control; Pandemic Flu plan is activated and Pandemic Flu Response Team meets regarding implementation. Travel may be suspended. Operations continue. Infection control efforts are stepped up.

Alert Level 3: Continuation of classes will be managed on a day-to-day basis but suspension is likely and curtailment of all external operations will begin. Once classes are suspended, administrative, academic, and support operations will be reduced with the exception of pre-determined essential functions. All operations will cease with the exception of critical functions. Facilities will be secured to permit access by essential personnel only. Employees who must move about campus between buildings will be instructed in methods of infection control to limit the spread of germs. Ventilation systems, food and supply deliveries, and usage of common bathroom/kitchen areas will be monitored to minimize exposure. Coordination with external agencies is necessary.

Alert Level 4: The campus will close and only critical functions and essential personnel will persist – the list may be altered in the event the University is declared a community-based facility (See excerpts from Health and Human Services Plan).

V. Wittenberg Pandemic Flu Action Plan

APPENDIX

A. CDC Recommended responses to influenza for the ‘09 –‘10 academic year
Recommended strategies under current flu conditions
(similar severity as in Spring/Summer 2009)
Facilitate self-isolation of residential students with flu-like illness

• Those with flu-like illness should stay away from classes and limit interactions with other people (called “self-isolation”), except to seek medical care, for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. Some people with influenza will not have fever; therefore, absence of fever does not mean absence of infection. They should stay away from others during this time period even if they are taking antiviral drugs for treatment of the flu. Learn More
• Review and revise, as needed, policies, such as student absenteeism policies and sick leave policies for faculty and staff, that make it difficult for students, faculty, and staff to stay home when they are ill or to care for an ill family member. Do not require a doctor’s note to confirm illness or recovery. Doctor’s offices may be very busy and may not be able to provide such documentation in a timely way.
• If possible, residential students with flu-like illness who live relatively close to the campus should return to their home to keep from making others sick. These students should be instructed to do so in a way that limits contact with others as much as possible. For example, travel by private car or taxi would be preferable over use of public transportation.
• Students with a private room should remain in their room and receive care and meals from a single person. Students can establish a “flu buddy scheme” in which students pair up to care for each other if one or the other becomes ill. Additionally, staff can make daily contact by e-mail, text messaging, phone calls, or other methods with each student who is in self-isolation.
• If close contact with others cannot be avoided, the ill student should be asked to wear a surgical mask during the period of contact. Examples of close contact include kissing, sharing eating or drinking utensils, or having any other contact between persons likely to result in exposure to respiratory droplets.
• For those who cannot leave campus, and who do not have a private room, IHEs may consider providing temporary, alternate housing for ill students until 24 hours after they are free of fever.
• Instruct students with flu-like illness to promptly seek medical attention if they have a medical condition that puts them at increased risk of severe illness from flu, are concerned about their illness, or develop severe symptoms such as increased fever, shortness of breath, chest pain or pressure, or rapid breathing.

Promote self-isolation at home by non-resident students, faculty, and staff

• Non-residential students, faculty, and staff with flu-like illness should be asked to self-isolate at home or at a friend’s or family member’s home until at least 24 hours after they are free of fever, or signs of a fever, without the use of fever-reducing medicines.
• Review, and revise if needed, sick leave policies to remove barriers to faculty and staff staying home when they are ill or caring for an ill family member. For students, consider altering policies on missed classes and examinations and late assignments so that students’ academic concerns do not prevent them from staying home when ill or prompt them to return to class or take examinations while still symptomatic and potentially infectious.
• Do not require a doctor’s note for students, faculty, or staff to validate their illness or to return to work, as doctor’s offices and medical facilities may be extremely busy and may not be able to provide such documentation in a timely way.  
• Distance learning or web-based learning may help students maintain self-isolation.  
• Click here for more information on staying home while sick.

Considerations for high-risk students and staff

• People at high risk for flu complications who become ill with flu-like illness should speak with their health care provider as soon as possible. Early treatment with antiviral medications often can prevent hospitalizations and deaths. Groups that are at higher risk of complications from flu if they get sick include children younger than age 5; people age 65 or older; children and adolescents (younger than age 18) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye’s syndrome after flu virus infection; pregnant women; adults and children who have asthma, other chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders such as diabetes; and adults and children with immunosuppression (including immunosuppression caused by medications or by HIV). People age 65 and older, however, appear to be at lower risk of 2009 H1N1 infection compared to younger people. But, if older adults do get sick from flu, they are at increased risk of having a severe illness.
• One of the best ways to protect against the flu is to get vaccinated against the flu. People under age 25 are one of the key groups recommended by CDC’s Advisory Committee on Immunization Practices (ACIP) to be among the first to receive the 2009 H1N1 flu vaccine. Learn more
• Communicate with local health officials to determine where vaccine will be administered and to discuss the possibility of a vaccination clinic at the IHE.

Discourage campus visits by ill persons: Use a variety of communication methods such as e-mail, posters, flyers, and media coverage to discourage people with flu-like illness from visiting the campus or attending IHE events such as football games or concerts until they have been free of fever for at least 24 hours.

Encourage hand hygiene and respiratory etiquette of both people who are well and those that have any symptoms of flu: Emphasize the importance of the basic foundations of flu prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).

Routine cleaning

• Establish regular schedules for frequent cleaning of high-touch surfaces (for example, bathrooms, doorknobs, elevator buttons, and tables).
• Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks) can be wiped down by students before each use.
• Encourage students to frequently clean their living quarters, including high-touch surfaces.

Considerations for specific student populations

• Review policies for study abroad programs, including accessing health services abroad and reporting illness to the IHE.
• Communicate plans, policies, and strategies to partner K-12 schools regarding “early/middle college” students, prospective student tours, and other K-12 students regularly on campus.
• Determine if special communication strategies are needed to meet the needs of students with disabilities.
• Remind health-care profession students to follow infection control guidance for health-care workers. Visit http://www.cdc.gov/h1n1flu/clinicians for guidance for health care settings.

Under conditions with increased severity compared to spring/summer 2009
CDC may recommend additional strategies to help protect IHE students, faculty, and staff if global, national, or regional assessments indicate that flu is causing more severe disease. In addition, local health or IHE officials may choose to use additional strategies. Although the following strategies have not been scientifically tested in the IHE setting, they are grounded on basic principles of infection control. Implementing these strategies is likely to be more difficult and to have more disruptive effects than the previously described strategies. These strategies should be considered if influenza severity increases and are meant for use in addition to the strategies outlined above.
Permit high-risk students, faculty, and staff to stay home when flu is spreading in the community

• If flu severity increases, people at high risk of flu complications may consider staying home while a lot of flu is circulating in their community. Such people should make this decision after consulting with their doctor. 
• IHEs should plan now for ways to continue educating students who stay home through distance learning methods. IHEs should also examine policy accommodations that might be necessary such as allowing high-risk students to withdraw for the semester, tailoring sick leave policies to address the needs of faculty and staff, or modifying work responsibilities and locations.

Increase social distances:

• Explore innovative ways to increase the distances between students (for example, moving desks apart or using distance learning methods). Ideally, there should be at least 6 feet between people at most times. 
• Consider whether to suspend or modify public events such as films, sporting events, or commencement ceremonies.

Extend the self-isolation period: If flu severity increases, people with flu-like illness should stay home for at least 7 days after the onset of their symptoms, even if they have no more symptoms. If people are still sick after 7 days, they should stay home until 24 hours after they have no symptoms. See information above for self-isolation in different types of housing.

Consider suspending classes

• IHE and health officials should work closely to balance the risks of flu in their community with the disruption that suspending classes will cause in both education and the wider community.
• Use multiple channels to communicate a clear message about the reasons for suspending classes and the implications for students, faculty, staff, and the community.
• Reactive class suspension might be needed when IHEs cannot maintain normal functioning.
• To decrease the spread of flu, CDC may recommend preemptive class suspension if the flu starts to cause severe disease in a significantly larger proportion of those affected than occurred during the spring/summer 2009 outbreak.
• If classes are suspended preemptively, large gatherings (for example, sporting events, dances, commencement ceremonies) should be cancelled or postponed.
• IHEs with only nonresidential students should consider whether they can allow faculty and staff to continue use of their facilities while classes are not being held. This may allow faculty to develop lessons and materials and engage in other essential activities.
• IHEs with residential students should plan for ways to continue essential services such as meals, custodial services, security, and other basic operations for students who remain on campus. When possible, dismiss students who can get home – or to the home of a relative, friend of the family, or host family – by private car or taxi. International students and others without easy access to alternative housing should stay on campus, but increase the distance between people as much as possible.
• The length of time classes should be suspended will vary depending on the goal of class suspension as well as the severity and extent of illness. IHEs that suspend classes should do so for at least five to seven calendar days. Before the end of this period, the IHE, in collaboration with public health officials, should reassess the epidemiology of the disease and the benefits and consequences of continuing the suspension or resuming classes.  

Deciding on a course of action
CDC recommends a combination of strategies applied early and simultaneously. Strategies should be selected a) based on trends in the severity of disease, virus characteristics, feasibility, and acceptability and b) through collaborative decision-making with public health agencies, IHE faculty and staff, students, students’ families, and the wider community. CDC and its partners will continuously look for changes in the severity of flu-like illness and will share what is learned with state and local agencies. However, states and local communities can expect to see a lot of differences in disease patterns from community to community.
Every IHE has to balance a variety of objectives to determine the best course of action to help decrease the spread of flu. Decision-makers should identify and communicate their objectives, which might be one or more of the following: (a) protecting overall public health by reducing community transmission; (b) reducing transmission in students, faculty, and staff; and (c) protecting people with high-risk conditions. Some strategies can have negative consequences in addition to their potential benefits. The following questions can help begin discussions and lead to decisions.

Decision-Makers and Stakeholders
Are all of the right decision-makers and stakeholders involved?

• Local and state health, education, and homeland security agencies
• Campus health services and mental health services
• Campus emergency managers and security staff
• Student affairs and residential life staff
• Communications staff
• Physical plant staff
• Food services staff
• Students
• Faculty
• Community representatives
• Students’ families

Information Collection and Sharing
Can local or state health officials determine and share information about the following?

• Numbers of and trends in outpatient visits, hospitalizations, and deaths for flu-like illness
• Percent of hospitalized patients requiring admission to intensive care units (ICUs)
• Groups being disproportionately affected
• Ability of local health care providers and emergency departments to meet increased demand
• Availability of antiviral drugs, hospital beds, staff, ICU space, and ventilators for flu patients

What does the IHE know about the following?

• Student, faculty, and staff absenteeism rates
• Number of visits to the campus health service
• Bed availability for student self-isolation
• Severity of illness among affected staff and/or students

Feasibility
Do you have the resources to implement the strategies being considered?

• Funds
• Personnel
• Equipment
• Space
• Time
• Legal authority or policy requirements
• Communication channels

Acceptability
Have you determined how to address the following challenges to implementing the strategies?

• Public concern about flu
• People who do not feel empowered to protect themselves
• Lack of public support for the strategy
• Secondary effects of strategies (for example, job security, financial support, health service access, and educational progress)

B. Flu.gov Take the following steps to help keep students, faculty, and staff from getting sick with flu.

During current flu condition:

• Advise sick students, faculty, and staff to stay at home or in their residence until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 38 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medications (any medicine that  
• Establish a method for maintaining contact with students who are sick. If resources permit, student affairs staff, housing staff or health care providers could be assigned to make daily contact with each student.
• Encourage students and staff at higher risk of complications from flu to check with their health care provider about their options.  People at higher risk of flu complications who get sick will benefit from early treatment with antiviral medicines.
• Encourage students, faculty, and staff to find out if they should get vaccinated against seasonal flu and 2009 H1N1 flu. Institutions should also consider offering opportunities for students, faculty, and staff to get vaccinated on campus for seasonal flu and 2009 H1N1 flu when vaccines are available.
• Discourage sick members of the public and sick visitors from attending institution-sponsored events until they are free of fever for at least 24 hours.
• Encourage students and staff to cover their mouths and noses with a tissue when they cough or sneeze. Also, provide them with easy access to tissues and running water and soap or alcohol-based hand cleaners.  Remind them to cover coughs or sneezes using their elbow or shoulder instead of their hands when a tissue is not available.
• Establish regular schedules for frequent cleaning ofsurfaces and items that are more likely to have frequent hand contact such as desks, door knobs, keyboards, or counters, with cleaning agents that are usually used in these areas. Promote frequent cleaning of bathrooms and ensure adequate supplies of soap and paper towels.
• Provide disposable wipes so that commonly used surfaces such as chairs, remote controls, and keyboards shared by students can be wiped down prior to each use.
• Encourage students to frequently clean their living quarters. Students living together should frequently clean commonly-used surfaces such as doorknobs, refrigerator handles, remote controls, and countertops.

C. Novel H1N1 Vaccination Recommendations

With the new H1N1 virus continuing to cause illness, hospitalizations and deaths in the US during the normally flu-free summer months and some uncertainty about what the upcoming flu season might bring, CDC's Advisory Committee on Immunization Practices has taken an important step in preparations for a voluntary novel H1N1 vaccination effort to counter a possibly severe upcoming flu season. On July 29, ACIP met to consider who should receive novel H1N1 vaccine when it becomes available.

Novel H1N1 Vaccine

Every flu season has the potential to cause a lot of illness, doctor’s visits, hospitalizations and deaths. CDC is concerned that the new H1N1 flu virus could result in a particularly severe flu season this year. Vaccines are the best tool we have to prevent influenza. CDC hopes that people will start to go out and get vaccinated against seasonal influenza as soon as vaccines become available at their doctor’s offices and in their communities (this may be as early as August for some). The seasonal flu vaccine is unlikely to provide protection against novel H1N1 influenza. However a novel H1N1 vaccine is currently in production and may be ready for the public in the fall. The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used along-side seasonal flu vaccine.

CDC’s Advisory Committee on Immunization Practices (ACIP), a panel made up of medical and public health experts, met July 29, 2009, to make recommendations on who should receive the new H1N1 vaccine when it becomes available. While some issues are still unknown, such as how severe the virus will be during the fall and winter months, the ACIP considered several factors, including current disease patterns, populations most at-risk for severe illness based on current trends in illness, hospitalizations and deaths, how much vaccine is expected to be available, and the timing of vaccine availability.

The groups recommended to receive the novel H1N1 influenza vaccine include:

Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;

Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by “cocooning” them from the virus;

Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;

All people from 6 months through 24 years of age

Children from 6 months through 18 years of age because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and

Young adults 19 through 24 years of age because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,

Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.

We do not expect that there will be a shortage of novel H1N1 vaccine, but flu vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be available in limited quantities. So, the ACIP also made recommendations regarding which people within the groups listed above should be prioritized if the vaccine is initially available in extremely limited quantities. For more information see the CDC press release CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1.

Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older. Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.