Recommendations for jail response to influenza-like illness

Novel H1N1 influenza appears to be similar to seasonal influenza in severity of illness and transmission. Most people who have had novel H1N1 influenza have recovered without complications. However, like any flu virus, novel H1N1 can be a serious disease. Some people have been hospitalized with novel H1N1 and a number of deaths have occurred.

People at high risk for complications from influenza (seasonal and novel H1N1 influenza) are those with:

- Underlying medical conditions (such as heart, liver or kidney disease, asthma or other chronic lung disease, diabetes, cognitive, neuromuscular or neurological disorders, or a suppressed immune system or chronic blood disorder (such as sickle cell)),
- Pregnant women,
- Children under 5 years (especially those under age 2), and
- People 65 years and older.

Because jails have reduced social distances between individuals in the facility, there is an increased risk of influenza transmission. For this reason, we recommend additional measures be taken. We recognize that these measures may place some burdens on the system. However, these additional measures are prudent at this time due to:

- People living in crowded conditions.
- Higher turnover in jails compared to prisons with less ability to follow up on inmates since they may be housed for only a brief amount of time.
- People suffer from a variety of chronic and acute conditions that may place them at high risk for complications from influenza.

These recommendations refer to the term influenza-like illness (ILI); ILI is defined as a fever (100.0 degrees Fahrenheit or greater) and a cough or sore throat. Other symptoms that may occur with influenza include runny nose, headache, body aches, and with novel H1N1 influenza sometimes vomiting and diarrhea (in addition to fever and cough or sore throat). Generally testing is done only if someone is hospitalized and so it is likely that many people will have influenza without confirmation by laboratory testing.

Influenza primarily spreads when a person with the flu coughs or sneezes. A person is communicable (they are infectious and can transmit flu) from the day before symptoms show up until seven to ten days after the illness began. You can help prevent the spread of influenza in your facility by taking the steps that follow.

We recommend that jails:

- Promote health habits to decrease flu transmission:
o Respiratory etiquette (coughing or sneezing into a sleeve or tissue)
o Regular hand hygiene
o Avoiding touching one’s mouth, nose, or eyes.

- Ensure regular cleaning of commonly used surfaces. Including doorknobs, keys, hand rails, telephones, computer keyboards, elevator buttons, inmate cell bars, desks, tables, eating utensils, exercise equipment, etc. Cleaning of frequently touched surfaces and items should be done with routine cleaning/disinfection products. Frequently dispose of trash contained in plastic liners in waste containers and wash laundry in hot water.

- Seasonal flu vaccination for inmates and employees.

- Novel H1N1 Influenza vaccination. A separate vaccination from seasonal influenza is needed for novel H1N1 influenza which will likely be available beginning in October. Initial target groups for H1N1 vaccination include people who live with or care for children younger than 6 months of age, people age 6 months to 24 years, pregnant women, people 25 through 64 years of age with chronic health disorders or weakened immune systems, and health care providers. One dose of novel H1N1 vaccine will be needed for those over 9 years of age while two doses given several weeks apart will be needed for those 9 years old and younger. Staff should be encouraged to get vaccinated as the novel H1N1 vaccine becomes available and according to risk groups.

- Assess inmates for conditions that place them at high-risk for influenza complications upon arrival. Inmates should be questioned to determine if they have high-risk conditions (see above).

- Antiviral medication for treatment is recommended for individuals who are at high risk of influenza complications, and those not at high risk but with severe symptoms. Inmates with influenza symptoms and who are at high risk should be evaluated by clinical staff. Antiviral prophylaxis may be considered if an individual has a close exposure to someone with influenza and they are at high risk for influenza-related complications. Antiviral therapy is most effective when started within 48 hours of symptoms.

- Coordinate with local health departments to be included in plans for vaccination.

- Perform a daily health check of inmates and staff. Jails should have a process for performing a daily health checks that include screening symptoms and temperature.

- Separate the sick from the well. Employees with ILI should stay home from work until 24 hours after resolution of fever without the use of fever-reducing medications. Individuals can return with lingering symptoms such as a cough. The influenza virus continues to shed (although at lower levels compared to when there was a fever) for 7 to 10 days after symptoms begin and can spread influenza. If employees become sick at work they should be advised to go home. Staff should stay home for the exclusion period even if they are on antiviral drugs or have had a flu test that is negative. Flu tests are not always accurate.

During the exclusion period, staff should stay at home except to get medical care. Inmates with ILI should be promptly identified and separated or put in a cohort of inmates who have influenza symptoms. Screen new inmate arrivals keeping them segregated depending on symptoms indicating illness. If possible, increase spacing between beds so that the ill person’s bed is optimally 6 feet but at least 3 feet from the next bed. Arrange beds to provide the greatest distance between faces (either head-to-toe or toe-to-toe). If a separate room or ability to cohort ill individuals is not available, avoid housing the ill person in a room with individuals who have underlying health conditions that increase the risk of severe illness and complications from influenza. Inmates with ILI should not attend group gatherings. Have meals brought to the ill person. If this is not possible, have inmates with ILI eat at a different time or in an area separated from others by optimally six feet but at least three feet.

- Use personal protective equipment for health service staff with close contact with flu cases which include surgical masks, disposable gloves, gowns, and eye protection. A limited number of staff should be designated to care for ill individuals; these staff should not be at high-risk for complications from influenza.

- Provide infection control messages. Post signs encouraging infection control measures for staff and inmates (e.g. covering coughs and sneezes with an elbow). Post signage in languages of the community asking visitors with flu-like symptoms not to enter the facility. Download materials at:

- Ensure adequate supplies of soap, paper towels, hand sanitizer, cleaning supplies, garbage bags, personal protective equipment, including gloves, surgical masks, and goggles, thermometers and thermometer covers, medications used to bring fevers down, such as acetaminophen, and non-perishable food. Make sure supplies to clean hands are accessible to staff and inmates.

- Refer to hospitals when there is a worsening of pre-existing medical conditions, influenza-related pneumonia, difficulty breathing or chest pain, gray/blue lips or skin, fever above 104º F (any fever in a baby up to 3 months of age) that cannot be reduced, severe or persistent vomiting, signs of dehydration, seizures or uncontrolled movements, inability to move an arm or leg, confusion or not waking up, improvement and then return of symptoms.

Information provided by Jails and Correctional Facilities: MDH Recommendations for Response to Influenza-Like Illness by Minnesota Department of Health (MDH)

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