Planning for School Health Emergencies: This District's Experience in Handling a Meningitis Outbreak Offers Lessons in How to Effectively Handle Similar Emergencies
Gomes, Patricia, Smith, Mary C., Ashlock, Laurel, Leadership
Dear Parent/Guardian: Your child may have been exposed to bacterial meningitis. Monitor your child for symptoms of illness (high fever, severe headache or very stiff neck) for the next three weeks. If you see these symptoms, visit the doctor immediately.
School emergencies take many forms, but one emergency often missed in crisis planning is a health emergency. Children spend most of the school day in close proximity to other kids, and that proximity is a key factor in the transmission of disease and illness.
School districts need to include health emergency preparedness in their crisis plans, and to have links with the community health department in order to prepare for a health crisis. Maintaining open, efficient and effective lines of communication is key.
Central USD in Fresno was put to the test when we received word that two students at a large middle school had been diagnosed with bacterial meningitis, a potentially life threatening illness that can cause infection of the fluid surrounding brain and spinal cord. According to the Centers for Disease Control and Prevention, 2,600 people get meningococcal disease each year. Of those, 10 to 15 percent die in spite of antibiotic treatment.
Anyone can get meningococcal disease, but it is most common where people are in high density situations or in close physical contact, such as school. Although a student is occasionally diagnosed with bacterial meningitis, it is rare to have more than one diagnosed at a time.
At the time of our outbreak, it was not known if the students had been in close contact, of how they were exposed to the disease. Both students were hospitalized. Key district administrators and the district Emergency Management System team were alerted. Parent information and notification letters were prepared to be sent home with students.
The following day, the local health department arrived to conduct a contact investigation. Family and friends of the ill students were interviewed to determine how and where the disease was contracted, and to determine whether any other students or staff were exposed so they could be given preventative antibiotics to reduce their risk of developing the disease. Student contact information was given to Health Department personnel and parents were called to come to school so they could be present during the interview process.
The school nurse helped the health department personnel identify and locate students. Parents were greeted by school staff and escorted to a designated confidential space to complete the interview process and sign consent if prophylactic medication was recommended by the Health Department. The school nurse also called parents of absent students to see if they had meningitis-type symptoms.
The investigation ended without finding a definite link between students and no new contacts. As a result, by the end of the day the Health Department considered the situation resolved and the investigation was completed.
Third student identified
As school administration was completing documentation of the event that evening, the school nurse received a call from the Health Department stating that a third student from the school had been hospitalized with bacterial meningitis.
Now that there were three students with bacterial meningitis and no known link between the students, the California Department of Health Services determined that this situation qualified as a health emergency, and preventative medication would need to be offered to the entire student body and staff the next day.
Students and parents would need to be notified immediately and students would need signed consent forms to participate. The clinic would begin at 11 a.m. We had 15 hours to prepare for the event and notify our students.
The district Emergency Management System plan was activated and the crisis team was mobilized. The team included district administration, food service, transportation, maintenance/operations, support services, the district cabinet and school board members. …