October 5, 2009

H1N1 flu cases on the rise

As predicted, the flu bug has struck the Johns Hopkins student population this fall, with 214 presumed cases of H1N1 reported on all academic campuses as of Friday, Oct. 2. While the numbers are steadily increasing, university officials have said that the rate of new cases has slowed down of late and that Johns Hopkins has not been hit anywhere near as badly as many of its peer institutions.

In referring to H1N1 cases, the university uses the term “suspected” since onsite testing for the virus is not available, the students diagnosed meet the criteria for influenza-like illness, and there is no strain of flu other than H1N1 in wide circulation in the United States at this time.

The majority of cases have been on the Homewood campus, where 175 students have been infected. Twenty-one student cases have been reported on the East Baltimore campus, 14 at Peabody and four at SAIS. One student on the medical campus required hospitalization.

Due to practical reasons, the university has not been able to track the number of cases among staff and faculty, who receive care from many sources.

The first presumed cases of H1N1 this fall surfaced among students at the Homewood campus in early September.

Nearly 80 percent of the cases, to date, occurred between Sept. 12 and Sept. 25, according to Alain Joffe, director of the Student Health and Wellness Center on the Homewood campus.

Most of the infected students have been undergraduates, and more than 40 percent have been freshmen. Joffe said that these numbers are to be expected as undergraduates, especially underclassmen, tend to live in close quarters and socialize with each other more.

During the second half of September, the Student Health and Wellness Center was seeing up to 120 students per day for a range of illnesses, not just flu. To accommodate the influx, the center opened a second waiting room.

“It’s been very, very busy here. The waiting room is packed all day long,” Joffe said. “Since Saturday [Sept. 26] we have seen a decreased number, but that is not to say it won’t pick up again.”

With young adults—and especially those living in close proximity to each other—as the prime target of the H1N1 virus, Johns Hopkins officials began planning early for the return of students this fall and launched an intensive communications plan that focused on prevention.

The Student Health and Wellness Center staff spent a lot of time this summer preparing for how to handle an influx of sick students, stocking up on antivirals and rapid flu tests, and preparing separate sick and well waiting rooms.

Johns Hopkins is following guidelines issued by the U.S. Centers for Disease Control and Prevention both for treatment of ill students and for preventive treatment for students who have been exposed to the flu virus.

Sick students are being told to isolate themselves, wear masks in the company of others, rest, drink plenty of fluids and take over-the-counter medicines containing ibuprofen or acetaminophen to help reduce fever. Students are told not to return to classes until they are fever-free without the use of medicines for at least 24 hours.

Infected students are given a care packet that includes a flu information sheet, an instruction sheet for roommates, antiseptic wipes, masks, pain- and fever-reducing medications, thermometer if needed, cough drops and some soup, tea and coffee. Sick students living in residential complexes, and on meal plans, can give their JCard to roommates, friends or others to pick up fresh packaged “Flu Food” meals from the dining halls.

At present, CDC guidance is that antiviral medications for treatment or prevention be given only to students at increased risk for complications from infection with H1N1 flu. This includes students with chronic medical conditions requiring ongoing medical treatment, such as asthma or diabetes, or students who have an altered immune system or who take medications that suppress the immune system.

Affected students have reported generally mild or moderate illnesses, which have lasted, on average, three to four days. A number have experienced fever of 103 degrees, or even higher, especially in the first few days they are ill. Other common symptoms include a cough, a sore throat, generalized body aches, significant low back pain and, for some, a headache and stiff neck.

Susan Boswell, dean of student life, said that the sick students who live within three hours of campus have been advised to return home if possible, and many have done so.

Boswell said that she is extremely pleased with how the university community has responded to the health concern.

“Professors have been great, extremely understanding,” said Boswell, who co-chairs the Student Crisis Committee formed last spring in response to the initial H1N1 outbreak. “They were notified early on that if a student is ill to be accommodating, and they have been.”

Contingency plans are in place if H1N1 becomes more virulent or if the number of cases becomes so widespread as to require significant action such as the closing of residence halls and the canceling of classes, Boswell said. However, she said that at the current time such closings are highly unlikely.

Boswell said that as soon as the recently approved H1N1 vaccine becomes available, it will be given out to prioritized at-risk students, meaning those with underlying health risks and certain chronic diseases.

The university is already vaccinating employees and students against seasonal flu.

Johns Hopkins will follow national and state guidelines about giving H1N1 vaccine first to certain priority or at-risk groups, such as patient care staff, pregnant women and people with certain chronic diseases. The university will then offer all other students and employees the H1N1 vaccine, probably late this year.

Until Johns Hopkins receives the vaccine, university officials said that they will continue to focus primarily on efforts to suppress the spread of the H1N1 virus.

“Preventive measures are really critical until a vaccine comes,” Joffe said. “That includes hand washing, covering your cough or sneeze and staying out of contact with others when you’re sick.”

For more information and advice on H1N1, go to http://flu.jhu.edu.