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Special Issue: H1N1: Swine Flu
Updated: August 28, 2009
Swine Flu: Issues to Consider for Study Abroad Programs
by Gary Rhodes, Ph.D., Director, SAFETI Clearinghouse
Most institutions have positive experiences with their study abroad programs. College presidents and government leaders continue to emphasize the importance of study abroad. H1N1 (Swine Flu) is not the first health and safety issue to come to the attention of the study abroad field. The field has recently responded to other potential "worst-case scenarios", which have (so far) been localized problems, including:
- The possibility of a similar situation with the spread of SARS or Avian Flu.
- The possibility of all technology around the world failing, resulting in a worldwide crisis at the end of the millennium (Y2K).
Health and safety issues have continued to grow in importance for institutions, students, and parents. One of the health issues that is gaining in attention and could affect our programs and students in Mexico, the U.S. and other countries abroad in a significant way is the possibility of an H1N1 (Swine Flu) pandemic.
The Current Situation:
Concerns about Swine Flu have impacted decisions about study abroad programs during spring, summer, and fall 2009. Students participating in programs during Fall and Winter 2009, during the height of the Flu season, have the potential of being impacted by H1N1 (Swine Flu). At this time, it is important to bring your campus crisis management team (including health center and risk management/insurance representatives) together to make sure there is collaboration to monitor the situation and develop a plan for students that will be studying in any part of the world. I would suggest contacting your emergency assistance and insurance providers to confirm support for students, faculty, and staff who may come down with the flu to find out how they will be supported if they or other members of their group become ill with H1N1 or if their travel is delayed because of Swine Flu. It may not be possible for them to leave the country where they are studying if they have H1N1 or any other strain of the flu. So, it is important to plan for both local care and treatment and the possibility to bring them home after they are infected and decide how that would be supported. Find out what other colleges and universities in your area are doing to provide local guidance. I would also suggest communicating with your international partners to confirm the situation in the city where your program takes place.
Plans and information continue to change on a regular basis. The World Health Organization (WHO) raised the alert from level five (5) to level six (6) on June 11th after raising it from level four (4) to level five (5) on April 29th (http://www.who.int/csr/disease/swineflu/frequently_asked_questions/
levels_pandemic_alert/en/index.html). As of August 23rd, they noted that 177 countries have officially reported over 209,438 cases of influenza A(H1N1) infection, including at least 2,185 deaths (http://www.who.int/csr/don/2009_08_28/en/index.html).
Travel Health Precaution
The CDC currently has no Travel Health Warnings or Travel Health Precautions against U.S. citizens traveling abroad on the basis of swine flu concerns. (http://wwwn.cdc.gov/travel/notices.aspx.)
WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus as “limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.” (http://www.who.int/csr/disease/swineflu/frequently_asked_questions/travel/en/index.html)
WHO is advising "countries in the northern hemisphere to prepare for a second wave of pandemic spread. Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases…Countries in temperate parts of the southern hemisphere should remain vigilant. As experience has shown, localized “hot spots” of increasing transmission can continue to occur even when the pandemic has peaked at the national level.”
New Challenges: International Travel for U.S. Study Abroad Students to Countries Around the World: As many of the cases of Swine Flu have impacted U.S. citizens, countries around the world are on a heightened alert with concerns that U.S. citizens traveling abroad may be infected by Swine Flu. The CDC has suggested that U.S. citizens with symptoms of influenza-like illness should not travel. There is concern that if a student or anyone on a flight is found to have symptoms of H1N1, that all the passengers could be delayed. (Announcement: Possible International Travel Delays Due to Novel H1N1 Flu Screening Procedures )
Background Information: Swine Flu
(from the U.S. Centers for Disease Control and Prevention: http://www.cdc.gov/swineflu/key_facts.htm)
What is Swine Influenza? Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.
How many swine flu viruses are there? Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by swine influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or swine influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.
Swine Flu in Humans
Can humans catch swine flu? Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.
How common is swine flu infection in humans? In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.
What are the symptoms of swine flu in humans? The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.
Can people catch swine flu from eating pork? No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products are safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.
How does swine flu spread? Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.
It is critical that faculty, staff, students, and parents put appropriate perspective on the possibility of the spread of Swine Flu. While there have been no reported cases of study abroad participants being ill or dying because of Swine Flu, it is critical for institutions to analyze the issues and risks for their faculty, staff, and students. We have developed a document on our Study Abroad Student Handbook, offering perspective and resources for students and parents: Special Issue: Swine Flu. In the article, we direct students to communicate with the study abroad office staff, a physician, and to check on their emergency assistance plan and coverage:
Putting Swine Flu Into Perspective
One suggestion is that institutions should consider reviewing their emergency planning methods using a potential Swine Flu pandemic as a "worst-case scenario". Study abroad administration is complex and involves administering the responsibilities of a full university in another part of the world. As a result, responding to any serious health and safety issue is best done if it is a part of an effectively run program that receives institutional support and has colleagues to assist in the various issues that come up during a crisis. The possibility of a Swine Flu pandemic falls into this category.
Preparing for the worst-case scenario requires a broad-ranging review on issues from medical care abroad, emergency evacuation policies and options, refund policies, separation of faculty, staff, and students if on-site administrators are the ones who become sick, having 24-hour support in the U.S. and abroad, maintaining updated information about Swine flu’s impact in any place where a program takes place, where excursions go, and where students go during independent travel.
If an institution integrates this into their crisis management planning, this can become and opportunity to be prepared for other crises not foreseen by faculty and staff. This is also an opportunity for study abroad administrators to take on a an active role in on-campus crisis management planning as this is a problem that could just as easily affect the city where your campus is in the U.S. This is an opportunity to prepare on campus and prepare abroad in an integrated fashion.
Key personnel to involve in planning, for a comprehensive university, could include:
- Ten Steps for Effective Crisis Response Planning
- Centralized Support and Planning: Include Cross-Campus Planning for All International Programs (Study Abroad, Research, Internships, Service-Learning, Athletic Teams, etc.) and Decision-Making
- Develop a Balanced Campus-wide Response – Don't Over – or Under – react – Leadership Needs to Be Organized, Consistent, On Message, Calm, and Appropriate to the Incident
- Keep Campus Response Team Current With Relevant Data
- Monitor Broad Ranging Data/Situation Regularly Using Resources Including:
- US Govt (CDC, State dept.);
- International Institutions (WHO);
- Country(ies) Impacted (Mexican govt, US Embassy, Mexico);
- Field-based (NAFSA, URMIA, ACHA); and
- Regional – other study abroad programs based near your US or International Campus
- Provide Information for Faculty, Staff, Students, and Parents with Perspectives, Links, and Advice on Response
- Have Emergency Communication Plans in Place
- Maintain Quality Insurance and 24 Hour Emergency Assistance Coverage
- Have a Contingency Fund for Special Support and Extra Costs Associated With Emergencies, Including Program Cancellation
- Have Emergency Cards and Other Emergency Information Readily Available in Multiple Locations for Faculty, US and International Staff, and Students
- Develop Emergency Action Plan, Practice Your Plan (with All Partners – Faculty, Staff, Students, etc.), Update Your Plan, Practice Again
Following are links to several resources that may help your institution develop its Crisis Management Team, Crisis Management Plan, and policies and procedures.
- SAFETI Audit Checklist:
- SAFETI Adaptation of Peace Corps Resources:
- SAFETI Resources for Crisis Management :
- Student Study Abroad Safety Handbook
Impact on Students
The Center strongly suggests that institutions provide information to parents and students, including travel and country-specific warnings provided by the U.S. Department of State, the U.S. Centers for Disease Control and Prevention and the World Health Organization (WHO). The Center also suggests you seek alternative information from international sources in the European Union, United Kingdom, Canada, Australia, and from the World Health Organization. (Please see below for links to these resources).
As program support varies from institution to institution, develop a method monitoring the situation daily, reviewing the possible impact of Swine Flu on students and programs, and updating emergency plans accordingly. Develop a process for deciding whether or not to cancel programs in affected areas, reviewing transportation plans, or postponing pending study abroad programs in certain areas due to a potential health risk. For students returning from affected regions, inquire to see if your institution encourages you to get a check-up at your campus health center and remember to report any Swine Flu-like symptoms.
Other Information Resources
The U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have both provided resources and information to help you understand Swine Flu.
CDC Swine Flu Info
WHO Swine Flu Info
U.S. Government Resources:
- U.S. Department of State
- U.S. Centers for Disease Control and Prevention (CDC)
- World Health Organization (WHO)
- Updates on Swine Flu
Lists most current information on outbreaks, including regional information.
- Updates on Swine Flu
- CONAHEC (Consortium for North American Higher Education Collaboration) H1N1 Flu and International Education Information and Resources Website
Advice for international educators to help in developing an appropriate response.
- European Centre for Disease Prevention and Control
Advice for travelers regarding Swine Flu
- Canadian Government-Current Health Issues
Provides updated information on Swine Flu, including Public Health Agency of Canada recommendations
- United Kingdom Foreign and Commonwealth Office
Provides travel advice and fact sheet on Swine Flu
- Australian Government Department of Foreign Affairs and Trade
Travel bulletin for health, with specific information and links about Swine Flu
- The Center for Global Education's Resources: