HomeMy WebLinkAboutCOM 0525.010 2008-2010
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CDC Guidance for Businesses and
Employers To Plan and Respond to the 2009-
2010 Influenza Season
August 19,2009 11 :00 AM ET
CDC is releasing new guidance that recommends actions that non-healthcare employers should
take now to decrease the spread of seasonal flu and 2009 HI Nl flu in the workplace and to help
maintain business continuity during the 2009-2010 flu season.1The guidance includes additional
strategies to use if flu conditions become more severe and some new recommendations regarding
when a worker who is ill with influenza may return to work. The guidance in this document may
change as additional i1iformation about the severity of the 2009-2010 influenza season and the
impact of2009 HINl influenza become known. Please checkwww.flu.govr!J periodically for
updated guidance.
Introduction
The U.S. Department of Health and Human Services' (HHS) Centers for Disease Control and
Prevention (CDC), with input from the U.s. Department of Homeland Security (DHS), has
developed updated guidance for employers of all sizes to use as they develop or review and
update plans to respond to 2009 HINl influenza now and during the upcoming fall and winter
influenza season. Businesses and employers, in general, playa key role in protecting employees'
health and safety, as well as in limiting the negative impact of influenza outbreaks on the
individual, the community, and the nation's economy. Employers who have developed pandemic
plans should review and revise their plans in light of the current 2009 HINl influenza outbreak
to take into account the extent and severity of disease in their community as outlined in this
guidance.1
Planning for Fall and Winter Influenza Season
Businesses may have already been impacted by the spring and summer outbreaks of 2009 HINI
influenza affecting their employees. CDC anticipates that more communities may be affected
than were in the spring/summer 2009, and/or more severely affected reflecting wider
transmission and possibly greater impact. In addition, seasonal influenza viruses may cause
illness at the same time as 2009 HINI this fall and winter. In response to the anticipated spread
of2009 HINI influenza, the CDC has revised its recommendations to assist businesses and other
employers of all sizes.
The severity of illness that 2009 HINI influenza flu will cause (including hospitalizations and
deaths) or the amount of illness that may occur as a result of seasonal influenza during the 2009-
2010 influenza season cannot be predicted with a high degree of certainty. Therefore, employers
should plan to be able to respond in a flexible way to varying levels of severity and be prepared
to refme their pandemic influenza response plans if a potentially more serious outbreak of
r No S~~.IO
Submitted by Council MEmber Brenda Ford (on 10/21/09) ,~omm. '. ~/r~.__.6![
Ref. To: f" _~
Ref. Date OCT 2 1 2.UG9
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influenza evolves during the fall and winter. More people and communities are likely to be
affected as influenza is more widely transmitted. The CDC and its partners will continuously
monitor national and international data on the severity of illness caused by influenza, will
disseminate the results of these ongoing surveillance assessments and will make additional
recommendations as needed.
Considerations of Appropriate Response Strategies
~mplo~ers must balance a vari~ty of obj~ctives wh~ determini~fi?w besno-decreas~cth~
~S~Jiefll:l:]~t-i,nfluenza-and-lowerthe-illlPact-oflllfluenza-lll-the-workIJlace.3lrey-should-conslder. .
an~unicate-their-objectives;-which-may-i.nelude-ene-or-moreonlie following:~etll:1;ci:n;g
~.~~!~S~0n,among sta~:{~rprotecti~g ~eople who are at.inc:e~sed ris~ ofinflue~a relatea------!J
complIcatIOns ITom gettlllg lllfected WIth influenza, (c)ma:1htaImng-busmess-operatIO~~ and (d)
minimizing .adverse effects on other entities in their supPly chains. .j
Employers should expect to see a wide range of disease patterns across the country. Employers
should base their strategies and response to influenza outbreaks on local information from local
and state public health authorities. Some of th~ey indicators \hat should be used when making
decisions on appropriate responses are:
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. Disease severity (i.e., hospitalization and death rates) in the community where business is
located;
Extent of disease (number of people who are sick) in the community;
Amount of worker absenteeism in your business or organization;
Impact of disease on workforce populations that are vulnerable and at higher risk (e.g.,
pregnant women, employees with certain chronic medical conditions that put them at
increased risk for complications of influenza); and
Other factors that may affect employees' ability to get to work, such as school dismissals
or closures due to high levels of illness in children or school dismissals.
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Employers need to plan now to be able to obtain updated information on these indicators from
state and local health departments in each community where they have a business presence and
to respond quickly to the changing reality on the ground. Employers with more than one business
loca~ion ~e en~oura~ed to p~vitl~-tocal-managers-with-the:~uth~rity-to-take-~pprapriate-acti~
outlIned m theIr busmess panaemlc-plan-based-orrthe-condttlon-m-each-localIty.
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Preparedness and Response Recommendations
Planning/or 2009 H1N1 and the 2009-2010 irifluenzaseason
This. gui~ce is designed to help emplo~ers pl.an for and respond t<[two pos~iOIe conOi~lon11) a
contmuatIOn of the current level of seventy of mfluenza as was observea aurmg tfie spnng and
summer of 2009 and 2) a more severe outbreak. The first situation is what is being experienced
in some communities now-an outbreak of similar severity of2009 HINI to the spring.
However, even if the severity of the virus does not change, planners should~ecttha1}tlirJJe:wtll
~re-peoplewl1Olifeilrintliefall and winter as 2009 HI NI outbreaks coi;;cide~-\V1ih tlier
~alifi11uenza season, apa tlQs level of aosenteelsm-may-impact-business-operations\ A
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second situation involves an outbreak: of greater severity including more people with severe
illness and thus, more people hospitalized for influenza complications; more deaths from
influenza; and a probable escalation of absenteeism.
Businesses should have an understanding of their normal seasonal absenteeism rates and~o~
how-tomonitor-th-eir-personne1-for any unusuarincreases in aBsenteeism through the fall ana
L...,. ,', .... .. ----'
winter. Business continuity planners slioula assess tlieir essentiafousiness functions now to
determine at what threshold of absenteeism those functions would be threatened if absenteeism
escalates. Planners can then pre:Rar~-tq-take,.mo.:re aggressive measures to protectcofttiIuiitY'as
. ;j,'-llh"~',i":I~-i4' Jf,,'.:":::{<':'!,~l'jt~~:~,~F;:,:,::''''~;t:-
ansenteeism escalates towards'thoseJ1lresholds.
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Even employers in communities that have not yet felt effects from 2009 BINI influenza should
plan for an influenza outbreak: this fall and winter, and be ready to implement strategies to
, ct their workforce while ensuring continuity of operations. Ourin- -' "-IJanuemrc,
-..-1,"'-""')
~()~1~Jsh~uld:stay-homeand aw~~o~~_,:~~~e, ~ _ ., coY~r~
,.s~~.ezes~should:be.encouragea, .~d,--r~utme~leanmg of commonly-touched su:rface~
~~~;t '.' ,:~tif~~e@'l1~gulaFly,\lf-t~e-sev~ty ~f lll~s-mcreas~s, employers-s~ould-De~ready to
1ll1plement-additlOnal-measures while continwng to ngorously 1ll1plement the mterventions
recommended for an outbreak: similar to the spring/summer 2009 HINI outbreak:. If severity
increases, public health officials may recommend a variety of methods for\.increii'$j.iig~
',"idlstance"hetween-peopte'( called social distancing) to reduce the spread of disease, such
" ,..", . ...... ..' ~chHdcare progcamclosure.L5aJ1c~li~g-~arge-community~gat~eFiFlgs,1~1tl~~ri!rg
',.,...... ,..relat~j fueetings,-spacing workers fannei"tlparrirrthe'workplace}canc~ling;;l1on,:
(tt;~~7,~!~;t~I,_ana_recommeniling~worK::fiam"liome-strategies-fot=-workers~that can 'conduct~ YB
tnelf.::}jusmess_remately..
Please remember: employers should develop capabilities to respond to both scenarios and these
two conditions serve only as a planning framework. Businesses and other employers should
develop flexible capabilities to respond to either situation given the difficulties in accurately
predicting the extent and severity of 2009 HINl as it unfolds during the 2009-2010 influenza
season. Individual businesses may implement additional actions if they experience high
absenteeism or business continuity is compromised. In addition, employers should be aware that
otli(;:~"emergencies-s\il~n as nurricanes or atlier natUral-disasters-mayhappen-duringtn:efanana~
&nrer, creating additional challengii1gprolJrems~for~busines'ses-=-an1l-COmmunitiesj
Work with State and Local Public Health Partners
Coordination with state and local health officials is strongly encouraged for all businesses so that
timely and accurate information can guide appropriate responses in each location where their
operations reside. Since the intensity of an outbreak: may differ according to geographic location,
local public health officials will be issuing guidance specific to their communities. Also,
businesses could work with public health and community leaders to explore ways of improving
accessibility of vaccination for the workforce and in the community.
~icKworkers Home J
One ofllie oest way to reduce the spread of influenza is to keep sick people away from well
people. However, in the fall and winter, it will not be possible to quickly determine if workers
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who are ill have 2009 HINI, seasonal influenza, or any number of other different conditions
based on symptoms alone. Local and state health department surveillance information can be
helpful to know when influenza is circulating in the community, although the availability,
timeliness, and amount of local information on when influenza is circulating may vary
substantially from community to community.
~~Jg~~fwhohave symptomsoniill~~nza-like i!lnesslare r~~mmended to stay ~mearicFn6t~
\~. 9~OfK:unti1 ~-leasr2~ ~ours after theirfe~e~as:::.~~l~~~egardless of the ~i~e ~~~~,:__
~u ". s-or ~e fiiiictlOn or servIces that.you provIoe, ~ll:emplo~e~s should plan nO\\rto>a.l'l~~~an\
~~ll:Mt~~t1"s~FKworKers to stay nome wItnout fear oflosmg theIr J06s. VDC recommends this
strategy for iilrIevels of severity. Employers snouIaplan now for now they will operate if there is
si~i~~aIlt abse~teeis~ from si~k w~!~rs. However, employers should know that .~.~tlp~~SQ~J
~~~lft:ltli';re~a;'lllcluomg diose III WIth 2009 HINI, do not have fever.'jTherefore It WIll not be
possi6le to excluoe everyone wno isill with influenza from the worKplace.
~~~f?;r(?Jrared-ij'-Schools-Bismiss-Students-orehila-eare Programs C1iii0
Iii some communities;-schools-may-dismiss-students ana.cliiIacare programs may close,
particularly if the severity increases.~ Officials will make these decisions to protect-:~ublic~ealth,
but they will affect your business's functioning, especially affecting absenteeism. ~a .. '. .~t\
tt~!.-: ~.~~;~~\V-you-~ll-ope~ate-ifabsenteeism-spikes-from~~creaseKin-sick-wor}(erJ2!~1!~~;''Z'eo
ts, _~~to:q~e=f0I=1l1 famIly_members>=and:those=-who:::n1ust-stay~n01ne~to watch. ili.elr8liila.re~
t:/,.,.c..q.i~:-~om=~~~~usinesses_and_other-employers-shouId-prepare'to"'institute-flexiOl~' .' .
w6rI<:place-aridJeave_p..ohcI~s for these workers.
Actions Employers Should Take Now
. Review or establish a flexible influenza pandemic plan and involve your employees in
developing and reviewing your plan;
. Conduct a focused discussion or exercise using your plan, to find out ahead of time
whether the plan has gaps or problems that need to be corrected before flu season;
o Have an understanding of your organization's normal seasonal absenteeism rates and
know how to monitor your personnel for any unusual increases in absenteeism through
the fall and winter.
e Engage state and local health department to confirm channels of communication and
methods for dissemination of local outb.r.eakjnformation;
. ~lrf6W;sick workers to stay home withou.tfear_ofJosing~j.2Q0
o Develop other flexible leave policies to allow workers to stay home to care for sick
family members or for children if schools dismiss students or child care programs close;
. Share your influenza pandemic plan with employees and explain what human resources
policies, workplace and leave flexibilities, and pay and benefits will be available to them;
. Share best practices with other businesses in your communities (especially those in your
supply chain), chambers of commerce, and associations to improve community response
efforts; and
. Af(i(liYa"wiogIT'or"6Utton:':"to_your_company Web Rage_or em12loyee \\)eb sites so
employees can access the latest information on influenza: www.cdc.gov/widgets/ and
www.cdc.gov/SociaIMedia/Camoaigns/HINI/buttons.html
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Important Components of an Influenza Pandemic Plan
. Be prepared to implement multiple measures to protect workers and ensure business
continuity. A layered approach will likely work better than using just one measure.
. Identify possible work-related exposure and health risks to your employees. The
Occupational Safety and Health Administration (OSHA) has developed tools to
determine if your employees are at risk of work -related exposures and, if so, how to
respond (see www.osha.gov / dsg/topics/pandemicflu/index.htmll~).
. R~ie~-hutp~-resourees-policies-to-make sure tliatpoliciesana practices are consistent]
~.~::~ealth=r:e~~~~?~~~~~~~~~..ar~-;~,~~~,~~~~~~~~i~~:~,~~~t~~~~~~~e-a-rnl-fooeral~
~race laws"~f(,)f.im(!)F€ll:d@J1lililat-r(m:'0n emp-io:)::cf"'f.€Sp-Onsl'15rIItres; employers. should~
visit theDepartmentofLaoor's ana the Equal Employment OppOrtunity Commission's
websites at www.dol.goWt' and www.eeoc.goWt').
. Allow emp-Ioy~es to ~ay liome iftn~Y..(ll'e i1l~liave to care for ill-family memoers, or musr1
(watc~theifcliTIdrenifSCliOols or chlldcare facilities~Close. j-
. Explore whether you can establish policies and practices, such as flexible worksites (e.g.,
~leoommutingJ ~d f1e~ible work hours (e.g., ~r~u sliifts)~when possible. to .
mcrease<hne phYSIcal dIstance among employees ana Between-employees and others if
local public health authorities recommend the use of social distancing strategies. Ensure
that you have the information technology and infrastructure needed to support multiple
workers who may be able to work from home.
. IqeirtHy essentii~rBusiness-function~;-essentia~-jobs-on"Oles, anacnti~al elements-withi~
your supply chams (e.g., raw]natenals-;supphers;-subcontractor servlceSi'proaucts;-a:nd
logistics) required to maintain business operations. Rlan Torhow your fiUSiness will '3
o~erate-ifthe~_e.-is-i~:reasingabsenteei~-these~sup~ly-chains-ar~-in~eITUpted\
. Set up auiliontles, triggers, ana proceuures foracttvatmg-and-tcrmmatmg-the-company's
response plan, altering business operations (e.g., possibly changing or closing operations
in affected areas), and transferring business knowledge to key employees. Work closely
with your local health officials to identify these triggers.
. Plan to minimize exposure to fellow employees or the public if public health officials call
for social distancing.
o Establish a process to communicate information to workers and business partners on your
2009 HINl influenza response plans and latest 2009 HINl influenza information.
Anticipate employee fear, anxiety, rumors, and misinformation, and plan
communications accordingly.
Over the past several years, HHS, CDC, DHS, OSHA, EEOC, and other federal partners have
developed guidelines, including checklists, to assist businesses, industries, and other employers
in planning for a pandemic outbreak. Review these resources to assist in your planning efforts:
www.flu.gov/plan/workplaceplanning/index.html@.
The recommendations that follow provide guidance on how employers can develop strategies
and respond to two levels of severity. Local conditions will influence the decisions that public
health officials make regarding community-level strategies; employers should take the time now
to learn about plans in place in each community where they have a presence.
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Recommended Employer Responses for the 2009-2010 Flu
Season
Recommended Action Steps under Current Flu Conditions
(similar severity as in Spring/Summer 2009)
If the severity of illness in the fall and winter is similar to that observed in the spring and
summer of 2009, the effects of 2009 HINI influenza may not have substantial impacts on
absenteeism, though some increase in absenteeism over the spring season is anticipated. When
larger numbers of people become ill, correspondingly larger numbers of people will become
seriously ill and may require hospitalization.
fSi~'k~$onS'--sh(jjjljJ-staY-ho'f'e
. Advise workers to be alert to any signs of fever and any other signs of influenza-like
illnes~before reporting to work each day, and notify their supervisor and stay home if
they are ill. Employees who are ill should not travel while they are ill.
. CDC recommends that employees with influenza-like illness remain at home until at least
24 hours after they are free of fever (1000 F [37.80 Cl or greater), or signs ofa fever,
without the use of fever-reducing medications.
. Expect sick employees to be out for about 3 to 5 days in most cases, even if antiviral
medications are used.
. Ensure that your sick leave policies are flexible and consistent with public health
guidance and that employees are well aware of these policies.
. Talk with companies that provide your company with contract or temporary workers
about the importance of sick workers staying home and encourage them to develop non-
punitive leave policies.
. Do not require a doctor's note for workers who are ill with influenza-like illness to
validate their illness or to return to work, as doctor's offices and medical facilities may be
extremely busy and may not be able to provide such documentation in a timely way.
. Employees who are well but who have an ill family member at home with influenza can
go to work as usual. However, these employees should monitor their health every day,
and notify their supervisor and stay home if they become ill. Employers should maintain
flexible policies that permit employees to stay home to care for an ill family member.
Employers should be aware that more workers may need to stay at home to care for ill
children or other ill family members than is usual.
~pJg)!!}~j!Lw.ark.shauJd be askiillii7fOliame J
. CDC recommends that workers who appear to have an influenza-like illness upon
arrival or become ill during the day be promptly separated from other workers and
be advised to go home until at least 24 hours after they are free of fever (1000 F [37.80
C] or greater), or signs of a fever, without the use of fever-reducing medications.
. Those who become ill with symptoms of an influenza-like illness during the work day
should be:
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o Separated from other workers and asked to go home promptly. (For
recommendations on personal protective equipment for a person assisting
the ill employee, see Interim Recommendations for Facemask and
Respirator Use to Reduce Novel Influenza A (HINI) Virus Transmission;
http://www.cdc.gov/hlnlflulmasks.htm. )
o When possible and if they can tolerate it, workers with influenza-like
illness should be given a surgical mask to wear before they go home if
they cannot be placed in an area away from others.
. If an employee becomes ill at work, inform fellow employees of their possible exposure
in the workplace to influenza-like illness but maintain confidentiality as required by the
Americans with Disabilities Act (ADA). For more information on privacy issues, please
refer to:
http://www.flu. gov /faq/workplace questions/equal employment/index.html#PrivacyIssu
eS@. Employees exposed to a sick co-worker should monitor themselves for symptoms of
influenza-like illness and stay home if they are sick.
Cover coughs and sneezes
. Influenza viruses are thought to spread mainly from person to person in respiratory
droplets of coughs and sneezes. Provide employee messages on the importance of
covering coughs and sneezes with a tissue or, in the absence of a tissue, one's sleeve.
Place posters in the worksite that encourages cough and sneeze etiquette.
. Provide tissues and no-touch disposal receptacles for use by employees.
Improve hand hygiene
. Influenza may be spread via contaminated hands. Instruct employees to wash their hands
often with soap and water or use an alcohol-based hand cleaner. especially after coughing
or sneezing. Place posters in the worksite that encourage hand hygiene.
. Provide soap and water and alcohol-based hand sanitizers in the workplace. Ensure that
adequate supplies are maintained. If feasible, place hand sanitizers in multiple locations
or in conference rooms to encourage hand hygiene.
Clean surfaces and items that are more likely to have frequent hand contact
. Frequently clean all commonly touched surfaces in the workplace, such as workstations,
countertops, and doorknobs. Use the cleaning agents that are usually used in these areas
and follow the directions on the label.
. No additional disinfection beyond routine cleaning is recommended.
Encourage employees to get vaccinated
. Encourage your employees to get vaccinated for seasonal influenza. For information on
groups prioritized for seasonal influenza vaccines, please see
http://www.cdc.gov/flulprotect/keyfacts.htm.
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. Encourage your employees also to get vaccinated for 2009 HINI influenza when
vaccines are available to them. Different groups are prioritized for 2009 HINI influenza
than for seasonal influenza. For information on groups prioritized for HINI influenza
vaccine please see http://www.cdc.gov/hInIflu/vaccination/acip.htm.
. Offer opportunities at your worksite for influenza vaccination. Consider granting
employees time off from work to get vaccinated if not offered at the worksite.
. Review the health benefits you offer employees and work with insurers to explore if they
can cover the costs of influenza vaccination.
Take measures to protect employees who are at higher riskfor complications of influenza
. People at higher risk for complications from influenza include pregnant women; children
under 5 years of age; adults and children who have chronic lung disease (such as~t1iiTfa'\),
heart disease, diabetes, diseases that suppress the immune system and other chronl~
medical conditions; and those who are~-y~ars-or~older~ " .
. Inform employees that some people are arhiglrernsk-ofcomphcatlOns from Influenza
and that if they are at higher risk for complications, they should check with their health
care provider if they become ill. Early treatment with antiviral medications is very
important for people at high risk because it can prevent hospitalizations and deaths.
. Encourage employees recommended for seasonal influenza vaccine and 2009 HINI
vaccines to get vaccinated as soon as these vaccines are available. For information on
groups prioritized for seasonal and HINI vaccines, please see
http://www .cdc.gov /flu/protect/keyfacts.htm and
http://www.cdc.gov/hInIflu/vaccination/acip.htm.
. Employees who become ill and are at increased risk of complications from influenza and
ill employees who are concerned about their illness should call their health care provider
for advice. Their health care provider might want them to take antiviral medications to
reduce the likelihood of severe complications from the influenza.
. See http://www.cdc.gov/hInIflu/qa.htm for more information.
Prepare for increased numbers of employee absences due to illness in employees and their
family members, and plan ways for essential business functions to continue.
e Employers should plan to monitor and respond to absenteeism at the workplace.
Implement plans to continue your essential functions in case you experience higher than
usual absenteeism. Elevated absentee rates can be due to sick workers, those who need to
stay home and care for others, or from workers with conditions that make them at higher
risk for complications from influenza and who may be worried about coming to work.
. Cross-train personnel to perform essential functions so that the workplace is able to
operate even if key staff are absent.
. Assess your essential functions and the reliance that others and the community have on
your services or products. Be prepared to change your business practices if needed to
maintain critical operations (e.g. identify alternative suppliers, prioritize customers, or
temporarily suspend some of your operations if needed).
Advise employees before traveling to take certain steps
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. Advise workers to check themselves forlfever and any other siggs of influenza",likJU
In1riess~efore starting travel and notify their supervisor and stay home if they are ill.
. Advise employees who will be traveling or on temporary assignment about precautions
they may need to take to protect their health and who to call if they become ill.
. Employees who become ill while traveling and are at increased risk of complications
. from influenza and others concerned about their illness should promptly call a health care
provider for advice.
. Ensure employees who become ill while traveling or on temporary assignment
understand that they should notify their supervisor.
. If outside the United States, ill employees should follow your company's policy for
obtaining medical care or contact a health care provider or overseas medical assistance
company to assist them with finding an appropriate health care provider in that country, if
needed. A U.S. consular officer can help locate health care services. However, U.S.
embassies, consulates, and military facilities do not have the legal authority, capability,
and resources to evacuate or give medications, vaccines, or medical care to private U.S.
citizens overseas.
. See CDC's Travel Website (http://wwwn.cdc.gov/travel/contentlnovel-hlnl-flu.aspx) for
more information for travelers.
thep'liie!lo1!fJJ1U!p$sifiili!J!. o~iSiiiisSiilOi'temporary EJ!!E!:!fLof-child-car.e-pr.ogratn.~]j
. Although school dismissals or closures of child care programs are not likely to be
generally recommended at this level of severity, they are possible in some jurisdictions.
. Be prepared to allow workers to stay home to care for children if schools are dismissed or
child care programs are closed.
. Strongly recommend that parents not bring their children with them to work while
schools are dismissed.
. Ensure that your leave policies are flexible and non-punitive.
. Cross-train employees to cover essential functions.
. Read CDC's Guidance for State and Local Public Health Officials and School
Administrators for School (K-12) Responses, which can be found at
http://www.cdc.gov/hlnlflu/schools/schoolguidance.htm. to better understand the
conditions under which schools may be dismissed.
Under Conditions with Increased Severity Compared to Spring/Summer 2009
If 2009 HINI becomes more severe than during spring/summer 2009, absenteeism will likely be
far greater, and additional protective measures to slow the spread of influenza may be
considered. Check with your local health department for the extent and severity of disease
activity in your community and for recommendations for necessary measures. Decisions about
what tools should be used during a severe 2009 BINI outbreak should be hased on the observed
severity of the event; its impact on specific subpopulations; the need to protect workers; the
expected benefit of the interventions; the feasibility of success of implementing these measures;
the direct and indirect costs of different interventions; and the effects on critical infrastructure,
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health care delivery, and society. The following are measures that should be considered if
influenza severity increases, and are meant for use in addition to the measures outlined above.
Consider active screening of employees who report to work
.
If influenza severity increases, at the b~ginnin~ oft~e. workday or with.each ~e\V shift, ~
~RiW ,~S';S4~llld:;~~~~k~dFatroutsymptomsC()nsistent with a:niffiItlenZai~l11es~~ such as
feve -chi1l1r7\Nr>~cough-orsore throat. If the severity or the impact of"influenza
increases, CDC recommends that persons with an influenza-like illness not come to work
or ~a:el and ~Fl~~-h?~~;f?r~~-least-7-day,s;-~en i~ symptoms res?lve sooner.
IndIvIduals wlio are stIll-srck-7-days~after-they-become III should contmue to stay home
until at least 24 hours after symptoms have resolved. If influenza severity increases, CDC
recommends that people stay home at least 7 days whether or not antiviral medications
are used.
Make sure your sick leave policies are flexible and consistent with public health
~!~~~e,an~your emp!O~ees_ar~aware of these Qolicie.s.
ID~ifeadoctor's.i.no.te_for_workers who are ill with influenza.J
Co~se workers to check for any signs of illness before reporting to work
each day.
Make contingency plans for increased absenteeism caused by illness in workers or illness
in workers' family members that would require them to stay home. Planning for
absenteeism could include cross-training current employees or hiring temporary workers.
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Consider alternative work environments for employees at higher risk for complications of
influenza during periods of increased influenza activity in the community
. Employees with an underlying chronic medical condition or who are pregnant should
consider calling their health care provider for advice about how to reduce their risk of
exposure to influenza and, if they get sick, how best to get early treatment for influenza.
. If influenza severity increases and if influenza transmission is high in the community,
employers may want to evaluate their work environment to see how they can reduce the
number of people that high-risk employees come in contact with, such as exploring
options for telecommuting from home (if feasible). Employers can also think about how
workers at higher risk for influenza complications could be reassigned to duties that have
minimal contact with other employees, clients, or customers. If these workers cannot be
reassigned duties to reduce contact with others, are concerned about their ability to avoid
influenza at the workplace, or will be in crowded conditions at work or while commuting
to work, then consider allowing employees at higher risk for influenza complications to
stay home from work.
. CDC recommends that ill workers at higher risk of complications from influenza seek
early treatment if they become ill.
. See http://www.cdc.gov/hlnlflu/qa.htm for more information.
Consider increasing social distancing in the workplace
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o
. If influenza severity increases, local public health officials may recommend that
employers implement measures to increase the physical distance between people in the
workplace to reduce the spread of influenza. The goal sho_uld be for there to be -
1(~tQf\~i~tance-betwee.n people at most times. This is nota_simple or easy strategy and
Would-tYPically require consiaerable flexibility. These measures may include avoiding
crowded work settings, canceling business-related face-to-face meetings, spacing workers
farther apart, canceling non-essential travel, increasing use of teleworking, and using
staggered shifts to allow fewer workers to be in the workplace at the same time.2
. If appropriate for your type of business and feasible, review or develop policies for
teleworking including an assessment of the capabilities and gaps of your current
computer systems and availability of technical support. Take remedial steps if needed,
and test your system in advance to assure it can handle an increase in remote users.
. Recommendations to increase social distancing may affect community functioning.
Because supply chain issues may be affected, make sure you have plans for back-up
suppliers.
Consider canceling non-essential business travel and advising employees about possible
disruptions while traveling overseas
. If the severity of the outbreak worldwide increases in the fall or winter, public health
officials may recommend social distancing strategies which include canceling non-
essel1tial travel and travel restrictions may be enacted by some countries which may limit
the ability of employees to return home if they become ill while on travel status.
. If influenza severity increases, travelers should also be prepared for travel delays, health
screenings, and other activities targeted towards travelers. Provide information to
travelers about contingency plans and how their travel can be rebooked for these possible
delays.
Prepare for school dismissal or closure of child care programs
.
School dismissals and closure of child care programs are more likely at higher levels of
sev~rity: Et ,,~a~to~118w ~prRers to sta~, nome to care for theirchildre~i~sc~ools
;t~~~!~f~!< '\",;;...""T!~~eJrr~gf~~'!r~~I~-~..~dn,aismissal is neede~,c~GinQ'Q'1!Mrre'15($hlg~
~fs~~sfucrents''f6r'atleast 5 to 7 cafendar.daysor longerlT\neCe$s.aryi'1
ge employees who perform essential functions and wlio liave cliilaren to plan for
contingencies should local child care programs close or schools dismiss students.
Be prepared for prolonged absenteeism if schools dismiss students for an extended time.
Make sure your leave policies are flexible and non-punitive.
~loye~s should strong~y r,:commend that p\are1l1S not-lmngtheirchildfl~Il;",viJ~:!~~lIt!Q
W;grk;-,~l1ile-schools-are-dlsmlssed~ ' .' ,..' ,',., ~~
fuij)l'eilient-flexible-workplace-policies like teleworking and staggered shifts.
Cross-train employees to cover essential functions.
.
.
.
.
.
.
Read CDC's school guidance, which can be found at
http://www.cdc.gov/hlnlflu/schools/school~uidance.htm. to better understand the
conditions under which schools may be dismissed.
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Other considerations
. As part of their comprehensive pandemic planning, some public and private sector
employers have stockpiled or otherwise arranged for influenza antiviral drugs to be
available for their employees during a pandemic. To guide these efforts, HHS released
guidance to businesses in 2008 entitled Considerations for Antiviral Drug Stockpiling by
Employers in Preparationfor an Influenza Pandemic
(http://www.flu.gov/vaccine/antiviral emplovers.html@). See updated interim guidance
on the use of antiviral agents for treatment and prophylaxis of2009 HINI influenza
infection at http://www.cdc.gov/hInIflu!recommendations.htm.
. Employers should be aware that the severity of 2009 HINI influenza could change
rapidly; therefore, local public health recommendations to communities and businesses
could be revised quickly. Planners should identify sources of timely and accurate
information so they are aware of changes to recommendations and can promptly
implement revised or additional measures recommended by local public health officials.
Resources
Additional tools and guidance documents have been developed by the federal government to
assist employers in their planning. These resources are available online at:
www.flu.gov/plan/workplaceplanning/index.html@.
One-Stop
www.flu.goV@
2009 HtNt Influenza Information
http://www.cdc.gov/h I n I flu!
2009 HtNt Influenza Resources for Businesses and Employers
http://www.cdc. gov /h I n I flu/business/
Worker Safety and Health Guidance for a Pandemic
www.osha.gov/dsg/topics/pandemicflu!index.html@
OSHA's Guidance on Preparing Workplaces for an Influenza Pandemic
http://www.osha.gov /Publications/influenza pandemic.html@
CDC/NIOSH Occupational Health Issues Associated with 2009 HtNt Influenza Virus
http://www.cdc.gov /niosh/topics/h 1 n I flu!
I This guidance was developed for use by employers that do not provide health care services or
have "high and very high exposure risk tasks and operations." Please see:
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o
https://www.osha.gov/Publications/influenza pandemic.html#classifying exposure&' for more
information about levels of occupational risk and exposure. Special considerations need to be
included for these employers. Resources for health care entities can be found at:
http://www.cdc.gov/hI nI flu/clinicians/
2 In 2006, to help businesses and employers with pandemic planning, the United States
government (USG) created response stages to guide actions for state and local government and
the private sector. Until the 2009 HINl influenza outbreak, the planning was based on the
assumption that the next pandemic would start overseas and would be high in severity and
therefore the stages served as a guide for planning and response. However, because of the unique
characteristics of the 2009 HINI influenza outbreak, the stages will no longer be used as a
planning and response framework.
3 SYmptoms of influenza-like illness include fever or chills and cough or sore throat. In addition,
sYmptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting.
4 Fever is usually described as lOooF [37.80C] or greater.
5For more information about CDC's recommendations for schools, see
http://www.cdc.gov/hInlflu/schools/schoolguidance.htm.
6 SYmptoms of influenza-like illness include fever or chills and cough or sore throat. In addition,
sYmptoms of flu can include runny nose, body aches. headache. tiredness, diarrhea, or vomiting.
7 People older than 65 years of age and older are at lower risk of getting infected with 2009
HINI than younger persons. However, similar to seasonal influenZa, when people 65 and older
do get infected with 2009 H 1 N l, they are at increased risk of severe illness.
8 SYmptoms of influenza-like illness include fever or chills and cough or sore throat. In addition,
symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting.
9 See this OSHA website for examples of protective social distancing methods for the workplace:
https://www.osha.gov/Publications/influenza pandemic.html#medium exposure riskIftJ