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Questions and Answers about CDC’s Guidance for Emergency Shelters for the 2009-2010 Flu Season.

November 24, 2009, 2:00 PM ET

About the Guidance for Emergency Shelters

What is the purpose of CDC’s Guidance for Emergency Shelters for the 2009-2010 Flu Season?

This new guidance considers the potential for people to be placed in close quarters in an emergency shelter, during a natural or man-made disaster, this 2009-2010 flu season. Prevention and response measures for shelter managers, workers, volunteers, and clients are provided specifically for this flu season.

Rationale for Planning

Why should emergency shelters plan for flu?

We expect that 2009 H1N1 flu will be circulating in the United States along with seasonal flu this season. At any time, a natural or human-made disaster could happen and cause people to be displaced from their homes and be placed in emergency shelters. By helping their clients, shelters actually bring people closer together, which could increase the spread of flu. At such close quarters, special measures should be taken to prevent and monitor the spread of flu. 

Why should we be concerned about the spread of flu in emergency shelters?

Emergency shelters may increase the speed with which flu moves from person to person because people are sharing living spaces and bathrooms and may be exposed to crowded conditions where the flu can easily be spread to others. And, people in need of emergency shelters and shelter staff will include some people who are at increased risk of severe illness from the flu. More information on people at high risk for complications from flu is available. The guidance provides action steps that emergency shelter managers and staff can take to slow the spread of flu in the shelter.

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How to Plan and Prepare

What should emergency shelters do to prepare?

Actions to consider:

  • Review the Guidance for Emergency Shelters and develop a plan for your shelter. Review and, if necessary, revise existing policies that might make it more difficult to implement the guidance.
  • Educate staff, volunteers, and partners about your flu plan, strategies for infection control, and use of personal protective equipment.
  • Engage your state and local health department to confirm channels of communication and methods for delivering local outbreak information.
  • Consider staffing needs. Review sick-leave policies and look for ways to reduce barriers to staying home when ill or to care for an ill household member. Make sure employees are well-aware of these policies.  Identify staff members with high-risk health conditions who should avoid, if possible, caring for people with flu-like illness.  Assign them roles that do not put their health at risk.  Cross-train staff to perform essential functions so that the shelter can continue operating. Provide additional staff to conduct flu screening and help decrease intake time. Consider pre-deployment of additional healthcare workers and mental health personnel to shelters during flu season.
  • Purchase supplies such as tissues, soap, and alcohol-based hand rubs to encourage healthy habits of hand hygiene and respiratory etiquette to help prevent the spread of flu at the shelter.
  • Plan for the possible need for additional or different spaces from those typically used as emergency shelters. Be ready to provide isolation areas for people with flu-like symptoms.

What should emergency shelter managers consider when selecting a facility?

  • Space for social distancing.
  • Adequate air exchange and air volume per person (tall ceilings, adequate HVAC system with filter changes)
  • Separate intake or waiting areas for people who self-identify as sick before medical screening.
  • Space for conducting medical assessment and screening of staff and clients.
  • Space for isolating sick people.
  • Space for placing groups or families in individual rooms or in separate areas of the facility.

Should emergency shelters have flexible leave policies or alternate work schedules?

An important way to reduce the spread of flu is to keep sick people away from those who are not sick. Therefore, any shelter worker who has flu-like symptoms should stay home and not come to work. Employees and volunteers may need to take care of sick household members or care for children if schools are dismissed or child care programs are closed. Flexible leave policies and alternate work schedules will help prevent the spread of flu at your shelter. Flexible leave policies allow employees and volunteers to continue to work or function while limiting contact with others, help maintain continuity of operations, and help people manage their health and their family’s needs.

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Steps for Emergency Shelters during the 2009-2010 Flu Season

What steps can shelters take to keep volunteers, workers and clients from getting sick?

Shelters should take the following steps to keep their workers and clients from getting sick with flu. These steps should be followed ALL the time, not only during the flu season.

  • Encourage people who are likely to work or volunteer in emergency shelters to get vaccinated against seasonal flu now, and 2009 H1N1 flu as soon as the vaccine is available to them.
  • Encourage hand hygiene and respiratory etiquette by providing education about washing hands and covering coughs and sneezes with tissues.
  • Advise all workers to stay home if they are sick. Under current flu conditions, volunteers and staff with flu-like symptoms should stay home for at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius or more) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined after fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen) are no longer needed.
  • Routinely clean with common cleaning agents any surfaces and items that are more likely to have frequent hand contact.
  • Encourage staff and clients at higher risk of complications from flu to contact their health care provider as soon as possible if they have flu-like symptoms.
  • Isolate and group sick clients and caregivers from others in individual rooms or in separate areas of the facility.
  • Ensure staff are aware of the warning signs of severe illness.
  • Plan ways to ensure infection prevention and control during meal service.

What is the best way to practice good hand hygiene?

Wash your hands with soap and water for at least 20 seconds (the time it takes to sing the “Happy Birthday” song twice). Be sure to wash both sides of the hands, between fingers and under the nails. This method is the best way to keep your hands from spreading the virus. If soap and water are not available, and hands are not visibly dirty, alcohol-based hand rubs can be used. After applying the hand cleaner, rub hands until dry.

How long should a shelter employee or volunteer who is sick stay home?

Under current flu conditions, people with flu-like symptoms should stay home for at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius or more) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined after fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen) are no longer needed.
Sick people should stay at home, except to seek medical care or other necessities, and they should avoid contact with others. Keeping people with a fever at home may reduce the number of people who get infected with the flu virus.

What are fever-reducing drugs?

Fever-reducing drugs are medicines that contain acetaminophen (such as Tylenol®) or ibuprofen (such as Motrin®). These medicines can be given to people who are sick with flu to help lower their fever and relieve their pain. Aspirin (acetylsalicylic acid) should not be given to children or teenagers (anyone aged 18 years and younger) who have flu. Aspirin can cause a rare but serious illness called Reye’s syndrome in persons infected with influenza or other viral illnesses.

Can the flu virus live on surfaces, such as doorknobs and computer keyboards?

Yes, the virus can live on hard objects up to 8 hours. Flu viruses may be spread when a person touches a hard surface (such as a desk or doorknob) or an object (such as a keyboard or pen) where the virus has landed and then touches his or her eyes, nose, or mouth. Routine cleaning of surfaces may help stop the virus from spreading in this way.
Routinely and frequently clean common areas, with a particular focus on areas and items used by children (for example, toys and play areas.) Additional disinfection beyond routine cleaning is not recommended.

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Symptoms

How do I know if someone has 2009 H1N1 flu or seasonal flu?

It is very hard to tell whether someone is sick with 2009 H1N1 flu, seasonal flu, or another cause of respiratory illness. Public health officials and medical authorities do not recommend laboratory tests for most persons with mild symptoms. The symptoms of seasonal and 2009 H1N1 flu virus include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and tiredness.  Some people may also have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1, and have respiratory symptoms without a fever.

Anyone with flu-like symptoms should stay home for at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius or more) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined after fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen) are no longer needed. The sick person may decide to stop taking fever-reducing medicines as he or she begins to feel better and should continue to monitor his or her temperature until it has been normal for 24 hours. 

How do I recognize a fever or signs of a fever?

A fever is a temperature taken orally with a thermometer that is equal to or greater than 100 degrees Fahrenheit (37.8 degrees Celsius). If a temperature cannot be taken, look for these possible signs of fever: if the person feels very warm, has a flushed appearance, or is sweating or shivering.

What are the warning signs of serious illness? When should people seek emergency medical care?

Consult a medical care provider if you are worried about your illness or illness in someone that you are caring for. Call for emergency care if you or someone that you are caring for becomes ill and experiences any of the following warning signs:

In children emergency warning signs that need urgent medical attention include:

  • Fast breathing or trouble breathing
  • Bluish or gray skin color
  • Not drinking enough fluids (e.g., not going to the bathroom or making as much urine as they normally do)
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
  • Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms that improve but then return with fever and worse cough

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People at Higher Risk for Complications

Who is at higher risk for severe illness (that is, complications) from flu?

Anyone – even healthy people – can get either the seasonal flu or 2009 H1N1 flu, and anyone can have serious problems from the flu. However, some groups are at higher risk for complications from the flu than others. These include children younger than 5 years old, but especially children younger than 2 years old; people aged 65 years or older; pregnant women; adults and children who have asthma, neurological and neurodevelopmental conditions; chronic lung disease; heart disease; blood disorders; endocrine disorders, such as diabetes; kidney, liver, and metabolic disorders; weakened immune system due to disease or medication; and people younger than 19 years of age who are receiving long-term aspirin therapy. People at higher risk for complications from the flu who develop flu-like illness should speak with a health care provider as soon as possible about whether or not antiviral treatment is appropriate for them. Antivirals are most effective when started within the first 48 hours of feeling sick.

What should a pregnant worker or client do to prevent getting sick with 2009 H1N1 flu?

Pregnant workers and clients are at higher risk of complications from flu. Pregnant workers should not care for people with flu-like illness. Pregnant women should speak with their health care provider as soon as possible if they develop flu-like symptoms. Early treatment with antiviral flu medicines is recommended for pregnant women and others at high risk for complications who have the flu. Antivirals are most effective when started within the first 48 hours of feeling sick. Pregnant women are among the first target groups to receive the 2009 H1N1 flu vaccine. Seasonal flu vaccine is also recommended for pregnant women and can be given at any time during pregnancy. In addition, pregnant women should follow the same guidance as the general public about staying home when sick, keeping hands clean, covering coughs, and routine cleaning.

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