Flu vaccines, keeping kids home when sick are key back-to-school strategies in 2022

Thousands of students across Oregon are settling into their first few weeks of school and many classes are back in person, but the COVID-19 pandemic is still ongoing and flu season is just around the corner. Monkeypox also continues to spread across the state. Dr. Jennifer Vines, Multnomah County’s public health officer, spoke with OPB’s All Things Considered host, Crystal Ligori, on Monday about what students and parents need to know as we head back into the classroom.

This conversation has been edited for length and clarity.

Crystal Ligori: The newest virus of concern in the state is monkeypox, also known as hMPXV. The Oregon Health Authority has already confirmed more than 100 cases in the state. But how worried should parents and schools be about the spread of this outbreak among children and teens?

Jennifer Vines: Certainly, children can get infected with monkeypox like anyone else. It takes skin to skin contact with the rash. But we’re hopeful so far that we haven’t seen many [pediatric] cases. [There’s been] just one in Oregon in a child [younger than 18].

And this is where public health case investigation and contact tracing is very effective. As we find out about cases, we can do prevention within the household, hopefully identify anyone at risk, get them the vaccine, and keep it out of schools. And even if it is in a school, [we can] do that same kind of case investigation and contact tracing to keep it from spreading in a school. So while it certainly could be introduced into a school, we’re optimistic that it would be unlikely to spread broadly in schools this fall.

Ligori: Let’s turn to COVID-19. Masks are no longer required in schools anymore and the Oregon Health Authority is posting COVID data less frequently. But school officials are asking families to screen their kids for COVID symptoms. So what should parents and students be thinking about when deciding whether or not to mask up at school?

Vines: Families should be thinking in terms of going back to sort of a pre-COVID approach to illness. If your child is unwell for any reason, they should be home from school until they’re feeling better or totally themselves for at least 24 hours. If they have COVID, then it’s still a 5-day isolation period. If they’re feeling well [after that], they can return to school with a mask. If they’ve had an exposure to COVID, it’s 10 days of masking at school as the recommendation.

If you simply don’t know, just making sure they’re well before they go back would be key. I think parents have vaccines as options now for children of all ages, including boosters for 5 and over and the new reformulated booster for 12 and over. I think those are steps in addition to staying home when you’re sick.

Having your household vaccinated is going to help slow spread within your household and maybe within the community. These are all tools that can stabilize schools, keep kids in schools, keep them learning. Masking will be in play, but I think it will be on individual voluntary basis unless we see a lot of cases in a school and then public health would be there to support the school district and making any decisions about broad mask [requirements].

Ligori: The CDC did sign off on those updated versions of Pfizer and Moderna boosters that specifically target the BA.4 and BA.5 omicron subvariant. Pfizer’s booster was authorized for people 12 and older and Moderna’s for people over 18. How quickly do you think that students and families need to be prioritizing their next shot of the vaccine?

Vines: The omicron-specific boosters are going to be most important for older adults and most important for those with underlying health conditions. I think they’re available to young healthy people as a way to promote short term risk reduction as far as getting infected. They’re an important option and people should be getting good information and talking to their health care provider about whether they think that’s a good choice for them.

By far the most important vaccines are the first two doses, what we call the primary series of generally Moderna and Pfizer. That’s where we see the biggest risk reduction in terms of severe illness and in some of the worst outcomes of COVID. So those additional boosters come into play more for at-risk adults, but for those who want to lower their short-term risk of infection and want to get the omicron booster heading into the fall, [getting it] some time within the next month along with the rollout of the flu vaccine would be wise as far as case numbers of COVID.

Ligori: What do you think we can expect as we head into fall and winter?

Vines: We’re in a lull right now with COVID. We’re in one of the troughs between these waves of illness that we’ve experienced over the last several years. I think broadly the expectation is that as people head indoors and as immunity from spring and summer infections wears off, we’re going to be seeing more COVID-19 infections heading into this winter. And this will be one of the first [winters] without broad public health protections in place.

It will also be our population’s first run-around with influenza which has similar symptoms and is also preventable through vaccines. So this is an uncertain time.

It’s expected to be a rough winter, but hopefully vaccine uptake, people staying home when they’re sick and voluntary use of masking will help to dampen the effects on our day-to-day lives and hopefully on our hospitals. We know that fall is typically flu season.

Ligori: What can parents and students expect with flu and RSV and other viruses?

Vines: One important thing for parents to remember about influenza is that unlike COVID, influenza can be serious among children under age 5 and especially those under age 2.

Certainly, COVID can be serious in those age groups, but they’re not generally considered risk groups for COVID. They are for influenza. And so vaccinating the youngest among us and making sure households are vaccinated against influenza is an important strategy. It’s not a new strategy, but not one to forget as we start to live with both influenza and COVID during our falls and winters.

Ligori: Just recently, the polio virus was found in wastewater in New York. And last week the city declared a state emergency to increase vaccination efforts. Are we seeing anything similar here in Oregon as far as vaccination rates go?

Vines: The situation in New York is somewhat unique, but it is certainly setting off alarm bells for public health departments across the country to be on the lookout. I don’t know that our statewide wastewater program looks for polio at this point, but polio is entirely preventable through routine childhood vaccination. And so to the extent that our public health efforts are focused on catching kids up on those routine school required vaccines were going to be better off from a polio prevention standpoint.