Targeted prevention stopped spread of H1N1 at Alabama boys camp

David Kimberlin, M.D., a preeminent influenza physician and researcher, volunteered as the camp's doctor in 2009 when three campers were confirmed to have H1N1. Kimberlin serves on the American Academy of Pediatrics Committee on Infectious Diseases, and he advises the federal panel that recently updated the guidelines for childhood and teen immunizations to include H1N1 vaccine.

He is the lead author on a case study of the camp outbreak published online Feb. 1 in the Archives of Pediatrics & Adolescent Medicine. It describes the targeted preventive measures undertaken by Kimberlin and the medical team, dozens of counselors and camp staff to contain the virus among campers ages 8-14 during a two-week period.

The camp session occurred in July before the H1N1 vaccine was widely available and flu infections in communal settings like camps and elder-care homes were a major concern. Kimberlin said the preventive measures undertaken at the Alabama camp were successful once the three flu-sickened campers were isolated, treated and sent home to recover. The remaining 171 campers, including Kimberlin's 10-year-old son, did not acquire flu at the camp.

The preventive measures included prescribing and giving a 10-day Tamiflu course to all campers staying in the cabins adjoining the sick campers, including all counselors and camp staff, and closely monitoring their symptoms. Also, alcohol-based hand sanitizer was provided at each of the daily activities, in the boys' cabins and in the dinning hall, and counselors were educated by the camp medical staff on the spread of flu and proper hand hygiene.

"The bottom line is prevention worked," Kimberlin said. "This was not a highly scientific study, and we never envisioned this camp to be a test-case scenario, but a targeted, antiviral prophylaxis plan activated along with strict hand sanitization and surface decontamination helped contain this disease.

"Here we have a real-world example of how planning, prevention, coordination and public-health common sense prevailed, and these kids have a great experience to look back on."

Since spring 2009, millions of Americans have been infected with H1N1 and thousands have died, including children. In most cases Tamiflu and other antivirals help control the spread of the virus, along with frequent use of hand sanitizer and disinfectant. Other actions people should take to avoid catching and spreading flu include covering the nose and mouth with a tissue during a cough or sneeze and throwing the tissue in the trash after use or coving coughs with the bend of an elbow.

Kimberlin said in the case of the Alabama boys' camp, a targeted approach to antiviral use in those at highest risk achieved the benefits of prevention while minimizing side-effects and reducing the chance the virus would become resistant to the drug. A majority of the 65 staff and counselors and a smaller percentage of campers experienced some antiviral-related discomfort including nausea, vomiting and headaches. None of those symptoms led anyone at the camp to stop taking antiviral treatments.