Beautiful Camp Inna Fluenza, on Lake Tamiflu

Thanks to Kathy in the comments section for pointing me to this interesting article in Slate, describing an H1N1 outbreak at a Maine summer camp. I understand the desire to hold oseltamivir in reserve for those at highest risk, but I’m still surprised that the Maine Department of Public Health was initially reluctant to use prophylaxis during a clear H1N1 outbreak at a large summer camp. Protecting several hundred youngsters who will soon be boarding buses and planes back to their home communities seems like a smart public health move, regardless of the likelihood that any individual camper will suffer an adverse outcome from H1N1. This issue is picking up speed, with outbreaks at other camps hitting the news as well. I’m also copying, below, a query from a pediatric ID physician in New Jersey, from this morning’s Emerging Infections Network listserve:

"I have received several calls from camp directors or physicians because of influenza in sleepaway summer camps. They are already working in accordance with ACA and state guidelines but as a result, many children are being isolated for 7 days or are being sent home regardless of duration and severity of symptoms without any testing as the current recommendations recommend this regardless of flu test result. In one camp, the sicker children were tested and tested positive for fluA. Now, any child who presents with a single isolated temp above 100 and any other symptom is being removed for 7 days. However, no one is particularly ill and many are well within a day.

For the children who test positive for fluA, the answer is fairly straightforward. However, summer colds and strep do happen at camps and many children may be isolated who either do not need it or who have something else that does not necessitate this (eg, strep after abx). I think it is reasonable for kids with sore throat and fever to be tested for strep--if positive, treat, etc. It may also be reasonable to test those with fever and cough for flu (they are picking it up on their rapid kit with some success)--if positive, follow the guidelines as they currently exist. The quandary is what to do with a child who is negative and is well within two days and whether or not they may return to their bunk and activities.

Obviously the camps will comply with local health authorities. Any other thoughts?"

So what do you think? If you were a summer camp director, or camp nurse, or local public health official, how would you manage H1N1 risk at camp?