CHICAGO (ASRN.ORG)- As schoolchildren return to class this fall, they'll find that any trace of a feverish forehead or deep cough could quickly land them in the nurse's office with a call home to pick them up.

Officials worry that a surge of swine flu -- coupled with the annual return of seasonal flu -- just as the school year begins could be an educational and health nightmare. As a precaution, school administrators are quickly changing how they handle sick children.

Students who report for class with a temperature of more than 100 degrees will be sent home without exception and not permitted to return until a day after the fever breaks. School nurses will track absenteeism and report kids' symptoms to county health departments, a practice that began last spring when the virus first emerged. Teachers, aides and cafeteria servers will continue to drill students in common-sense precautions such as washing hands and covering coughs. 

While much about the emergent H1N1 strain remains a mystery, so far it has hit young children especially hard. School officials and health experts are responding with a call for vigilance in the classroom and at home. 

"We're on alert," said Ellen Wolff, health services supervisor with Naperville School District 203. "It's so much of an unknown right now." 

Nearly two dozen 1st graders extended their tiny palms for a squirt of hand sanitizer before heading toward the Elgin school cafeteria, their clean hands pressed to their sides.

Sheridan Elementary School teacher Maribel Andino gave instructions as she put a dollop of the cleansing liquid onto each outstretched palm and demonstrated how to make effective use of it.

"Solo en las manos, si? Only in your hands," Andino said. "Show me how you do it. Not in your hair, not in your eyes. Now rub your hands together." 

In addition to expanding its use of hand sanitizers, the district stepped up surveillance of flulike symptoms. District officials made clear to parents that a fever-ridden child with the telltale flu symptoms will not be permitted to stay in school. 

"Prior to H1N1, if a student came to school with a fever, it may or may not have been noted. There's nothing to say a child would be sent home," said district spokesman Tony Sanders. "With this new strain, if a student comes to school with a fever greater than 100, they will be sent home and parents will be contacted." 

Unlike the seasonal flu, which typically dies off in the summer, the H1N1, or swine flu, strain that emerged last spring continues to spread. To date, 3,443 cases have been confirmed or identified in Illinois, nearly 60 percent of them striking school-age people 5 to 24. Nine of every 10 confirmed infections have been clustered in Chicago and the surrounding counties. 

The spread shows no sign of slowing. Indeed, the U.S. Centers for Disease Control and Prevention anticipates more illness after the school year begins because the flu typically spreads more easily during fall and winter. 

"As far as being a bellwether and a potential hot spot for epidemics, schools are probably No. 1 on the list," said Bill Mays, community health director with the Lake County Health Department. 

How schools handle the virus is shaped by health experts. Last spring, when the first cases were diagnosed in the U.S., the federal government urged schools to shut down for up to 14 days if they had a confirmed case. More than 700 schools in the nation closed, including nearly three dozen in the Chicago area. 

But schools this year likely will be slower to call off classes, based on new information. The CDC now says schools should be conservative about closing entirely. The agency instead urges parents to check their children each morning for flulike symptoms and keep them home from school if they have a fever.

What's more, the CDC has changed its recommendation about when students can return to class after a bout of swine flu. Previously, it said that students with confirmed cases should stay home for up to seven days. Now it's saying that students can return to class 24 hours after the fever ends. 

"We can't stop the tide of flu, but we can reduce the number of people who become very ill by preparing well and acting effectively," said Dr. Thomas Frieden, director of the CDC.

School nurses will be at the forefront of efforts to stop the spread of swine flu. Illinois, however, lags behind most states in the number of school nurses available. Illinois has 2,893 students per school nurse -- a ratio that's 46th in the nation. 

In Barrington, school nurses will continue to work with classroom teachers to reinforce lessons about hand-washing and covering coughs. One teaching tool they employ is an ultraviolet light that allows elementary students to put their hands underneath and see what germs did not get scrubbed away, said district nursing supervisor Eva Dettloff.

"We ask staff to enforce hand-washing and to remind kids when they perhaps need to wash their hands," Dettloff said.

Chicago Public Schools again will look for suspicious attendance dips to identify schools that may be affected by swine flu. 

Any student with a temperature more than 100 degrees will be sent home, but the district is working with the city health department to determine what other symptoms might trigger a dismissal from class, said district spokeswoman Monique Bond.

One factor that's still in play is a possible swine flu vaccine. It is being tested, but it likely won't be available until weeks after students return to class. School-age children are expected to be among those given first access to the vaccine. 

The national health agency also recommends seasonal flu shots for all children older than 6 months. Many schools plan to host health fairs and promote the annual flu shot among employees. 

The common flu vaccine cannot guard against swine flu, but it can avoid confusing a routine illness with the more serious H1N1 infection. 

"You can't tell a difference between seasonal flu and H1N1 by the symptoms," said spokeswoman Melaney Arnold with the Illinois Department of Public Health. "If we build up a better protection to the seasonal influenza, it will cut down on the number of people needing to go the hospitals for H1N1." 

Elise Hauptman typically skips the annual flu shots for her three children. But this year, the Vernon Hills mother insisted on the vaccine for her 6th grader and 4th-grade twins.

"There's no monkeying around," Hauptman said. "We're doing it this time."


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