Day care centers urged to be vigilant against flu

The Centers for Disease Control and Prevention issued guidelines Friday for day care programs that echo the advice for schools: Kids need vaccine - against both regular flu and the new swine flu - and they should stay home when they're sick. Don't return until 24 hours after a fever naturally subsides.

"If your child comes down with the flu, we hope you plan to keep them home and not share this with their playmates," Health and Human Services Secretary Kathleen Sebelius said.

The guidelines urge day care providers to do a quick health check every day, looking for children with flu-like symptoms or other signs that they might be getting ill, such as not playing normally. Centers should separate the sick child from others until he or she can be taken home.

But it can be very hard to tell if a child is sneezing because of flu, the common cold or even allergies.

"There are many, many different kinds of respiratory illnesses that children get, and we don't want to be sending children home unnecessarily," said Dr. Beth Bell, a CDC epidemiologist.

So checking for a fever is what Bell called a "reasonable indicator" of flu, either the regular winter strains or the swine flu that scientists call the 2009 H1N1 flu.

While not everyone with swine flu has a fever, the CDC has said such cases are rare.

Regular winter flu kills 80 to 100 U.S. youngsters every year, so children are supposed to get vaccinated against it each fall. But swine flu is putting new emphasis on flu and kids: At least 40 children have died of it since spring, accounting for about one in 13 U.S. swine flu deaths, the CDC said this week - and it spreads very easily among children.

One puzzle: While regular winter flu is most dangerous to children 4 and under, most children who have died of swine flu so far are age 5 to 17. It's possible that that's because school-age children are the group most infected so far, but scientists aren't sure.

Regardless, children of all ages are supposed to be among the first in line to get swine flu vaccine when it arrives in mid-October.

Vaccine against both types is a good idea for day care workers, too, Sebelius said. It could mean the difference between a center staying open or having to close because of absent staff. Any child care workers that care for infants, or who themselves have high-risk conditions, will be among priority groups for swine flu vaccine.

"It's the best way to keep them safe and the way to keep the children in the center safe," Sebelius said.

Meanwhile, day care centers also should stress commonsense flu-fighters: Wash hands often, and teach children to cough and sneeze into their elbow, not the hand they'll immediately stick onto a toy or a neighbor. A key way that flu spreads is for someone to touch a germy surface and then touch their nose or mouth.

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