Recommendations and Reports BOX 1. (Continued) Lessons learned from the 2009 H1N1 pandemic response cruise ship (25). Moreover, an observational cohort care center or school closed temporarily in response to study of 259 households in the United Kingdom found the 2009 H1N1 pandemic, 90% of parents agreed with that administration of antiviral medications to 285 the dismissal decision, and 85% believed the dismissal confirmed patients and their 761 close contacts was reduced influenza transmission (27,28). very effective (92%) in preventing household – A total of 75% of parents who responded stated that transmission (26). the dismissal was not a problem, and 3% stated it • Although limited, the H1N1pdm09 experience suggests was a major problem. Approximately 20% of parents that antiviral chemoprophylaxis might be recommended reported that an adult in the household missed work in the future in some settings as an adjunct to self- because of the dismissal, and 19% had a child who quarantine, assuming that additional antiviral missed a free or reduced-cost lunch. Of these, 2% medications are on the market, providing more treatment and <1%, respectively, said missing work and choices and making the emergence of drug resistance missing lunch were major problems. less of a concern. However, this recommendation would – Most of the 523 parents polled believed that at least require much greater quantities of antiviral medications, one of the following factors was a major reason the even if no new products are developed, to ensure institution had closed: 1) to keep children apart and sufficient supplies. reduce the chance they would infect each other Mobilizing the public (81%), 2) because the school decided cleaning the Most members of the public complied with public building and surfaces that children touch was health recommendations regarding hand hygiene and important for reducing the spread of the illness social distancing. (73%), and 3) because the school or child care center • The Harvard Opinion Research Program conducted could not operate effectively when numerous 13 polls on the response of the U.S. public during the students were absent (58%). 2009–2010 pandemic, including the response of the • A study conducted through an online survey of school general public, pregnant women, new mothers, parents, principals showed that implementing NPIs in public and businesses. These randomized telephone polls schools in New York City, New York, was feasible during found the following: the 2009 H1N1 pandemic (29). Schools successfully – A total of 59% of 1,067 Americans reported washing implemented respiratory etiquette education, hand- their hands or using hand sanitizer more frequently hygiene measures, and environmental measures and during the 2009 H1N1 pandemic (27). A total of isolated ill students. Another online survey found that 25% avoided places where numerous people tend the majority of public schools in Georgia also were able to gather, such as sporting events, malls, or to successfully implement both personal and community public transportation. NPIs recommended by CDC (23). – Most (85%) of 514 pregnant women washed or Public health practitioners should be prepared to explain sanitized their hands more frequently to reduce the that the initial pandemic guidance might change if a chance of infection with H1N1pdm09 virus (27). pandemic is more or less severe than initially assessed. A total of 68% reported taking steps to avoid • Within 12 days of recognizing the emerging pandemic proximity to someone who had influenza-like on April 23, 2009, CDC updated its initial guidance symptoms, and 31% avoided mass gathering places. on NPIs (issued on May 1, 2009) on May 5, 2009, on Most (91%) of 526 new mothers also washed or the basis of more complete and robust data that sanitized their hands more frequently, and 81% took suggested that the majority of U.S. cases were less severe steps to avoid being near someone who had than those reported from Mexico. influenza-like symptoms. • Certain public health departments reported difficulties School-related NPIs, including school closures and in communicating the updated guidance on school dismissals, were acceptable and feasible. closures to their communities, especially communities • According to a Harvard Opinion Research Program that were planning to implement school closures or had poll of 523 parents from 39 U.S. states whose child already done so (30,31). 6 MMWR / April 21, 2017 / Vol. 66 / No. 1 US Department of Health and Human Services/Centers for Disease Control and Prevention