Several recent stories have reminded us that perhaps the most looming health crisis is not the political debate about health reform but the pandemic swine flu H1N1. The dreaded phone call has not come from a pollster or the local political party urging you to call your representative, but from a summer camp or overseas program telling you that your child is sick or their program has been shut down. Thousands of American children this summer have either had the flu, been exposed to flu, or had their summers disrupted as day camps, sleep-away camps, special-needs camps, and overseas and domestic programs for middle and high school age children either never opened, shut down in the middle of a session, or sent children home and some into quarantine. 

While the New York Times featured a story about flu, quarantine, and American students overseas, programs in the U.S. that attract students from overseas including China, such as one at  Johns Hopkins, also had to figure out how to send children back to their home countries, where they might face quarantine and also deal with myriad airline rules about flu exposure, quarantine, and unaccompanied minors on airplanes.

Two generations ago, our parents and grandparents remember the summer disease watch and dreaded phone call season as one connected to polio. Polio in the U.S. in the twentieth century was largely a summer phenomenon attacking children. In the 21st century, polio is rare, eradication efforts are tied more to culture and diplomacy than to vaccination and quarantine, but outbreaks have still occurred even in the U.S. The July-August issue of Health Affairs has two articles examining the fight against polio.

Mass polio vaccinations in the United States started in 1954 and at the time constituted the largest public health experiment ever in the U.S.  The goal was to deliver three doses of the vaccine to the children enrolled in the vaccine trials that year. This year’s influenza planning sounds eerily similar as plans are being developed to vaccinate both for H1N1 and seasonal flu also in three doses.

Earlier this month Health Affairs published a report on how well prepared state and local health departments are to communicate about swine flu. As summer turns to fall, it will be interesting to watch how education departments and school boards coordinate with public health departments to implement comprehensive guidelines for dealing with outbreaks. The summer camp experience should give us pause, however, as some camps, particularly those for high-risk children, never opened, some shut down, some with enough space to house ill campers continued with their activities since the illness itself was mild, and some distributed Tamiflu to end the outbreak. It seems each camp developed its own guidance, and so there have been multiple and uncoordinated responses. We probably also have several thousand school-age children who do not need to be vaccinated as they have developed immunity from the illness, even though most camps did not do extensive testing to determine if their ill campers actually had swine flu or some other virus.

Health Affairs plans to continue covering the H1N1 story this fall.