The threat of an Avian (Bird) Flu human pandemic has caused many camp professionals moments of concern. Both West Nile Virus and SARS conditioned us to taking note of threats posed by communicable diseases. Now, as we move toward Summer 2006, we again find ourselves considering preparedness, and trying to determine a level of camp preparedness appropriate to threats of diseases such as pertussis (whooping cough) and mumps, let alone a pandemic.

What action should a camp take to remain proactive about communicable disease threats?

The first step is access to reliable information. One of the best is the Centers for Disease Control and Prevention, commonly known as the CDC. Access this resource online at www.CDC.gov; bookmark this searchable site. It includes information about specific diseases, international travel, and access to publications as well as enough data and statistics to keep even the most number-crunching staff member delighted. Both pertussis (whooping cough) and mumps should be a concern to camps this summer. CDC's Web site coaches what to look for, how to minimize the potential for an outbreak, and tips for controlling an outbreak should one occur.

CDC's homepage has a direct link to another Web site, www.pandemicflu.gov. Clicking into this site's "Community Planning" link brings one face-to-face with a preparedness checklist, a guide for planning that includes topics such as internal and external communication, assessment of the threat in relation to your program's mission and the people you serve, policies to follow during a pandemic, allocation of resources with an emphasis on protection, and coordination with the camp's external community. Following the "Individual Planning" link on the Web site provides access to an information-filled PDF called "Pandemic Influenza Planning: A Guide for Individuals and Families."

Another reliable resource, one appreciated by those who need to stay up-to-date with emerging information, is the Center for Infectious Disease Research & Policy (CIDRAP) at www.cidrap.umn.edu. This site provides information beyond influenza; it includes food safety, bioterrorism, and biosecurity. Sign up for CIDRAP updates on self-selected topics by following the "E-mail Alerts" link.

A fourth resource is your state's Department of Health. Whereas previously mentioned resources target national and international information, your camp's State Department of Health is specific to your geographic locale, including county-by-county information. Know your local Department of Health staff by name and how to access them should need arise. Because these folks typically don't understand camp, invite them for dinner some evening and spend time talking about your camp's preparedness plans. Department of Health staff — such as your local epidemiologist — can provide critical information, including how camp plans should/could be linked to community resources.

In addition to reliable information, the second step in preparedness is implementing reasonable and prudent communicable disease control strategies at camp — now. After an outbreak occurs is not the time to do this. Strategies currently used by camps include the following:

• Adequate and effective hand washing. At minimum, after using the bathroom and before each meal. A growing number of camps have placed a pump-dispenser of hand sanitizer around camp, on each table in particular. Staff monitor that campers use the sanitizer before touching any food.
• Sneezing and coughing into one's forearm or shoulder — not the hands. We do a lot with our hands and often do not wash adequately after coughs and sneezes. Coughing into one's shoulder or forearm minimizes the potential to pass droplet contamination from person-to-person much more effectively than covering those sneezes with one's hand.
• Keeping people at least an arm's length away from one another while sleeping, and placing them head-to-foot in bunk beds — and tents.
• Screening people upon arrival at camp. Physical assessment may not be necessary but, at minimum, everyone should be asked (a) how they're feeling upon arrival; (b)if they've been exposed to any communicable diseases in the past two, three weeks; and (c) have they been given a visual appraisal for signs of communicable diseases (e.g., scratching the head, sniffling, feverish appearance).
• Maintaining personal resilience by making sure everyone — staff and campers alike — has adequate food, water, and sleep/rest. Consider sleeping-in for thirty minutes on rainy days, sending tired youth to bed early, extending rest hour on rainy days, and having down-time to use effectively (especially important for staff). Since many kids can't eat enough at one meal to last to the next, consider having a nutritious snack available in your dining area. Assess access to drinking water for campers and staff; is it adequate? Is it used?!?
• Know the immunization status of campers and staff; advocate for appropriate immunizations. Granted, most camp professionals agree that tetanus status has the most immediate impact upon camp life, but having information about other immunizations — especially mumps and pertussis — can make a difference in today's world.
• Consider the risk profile of international campers and staff as well as your camp population's travel history. Some countries are endemic for certain diseases such as tuberculosis. Talk with your medical director about the feasibility of targeted screening, such as a Mantoux test, for at-risk people. (See the article, "American Camp Association Immunization Recommendations for International Staff")
• Monitor Health Center activity for signs of emerging communicable disease. Health care staff see people for common things: sore throats, upset stomachs, coughs, various rashes, red eyes. Often benign, these signs and symptoms could also signal an emerging threat instead of one more minor complaint. Don't minimize an emerging threat.

The world of today and tomorrow will continue to pose disease threats as we travel more, continue to live close to one another, and stretch personal coping reserves to the limit. Our camp programs are excellent opportunities to shape human behavior conducive to good health while also maintaining surveillance for emerging problems. But this is only possible with access to reliable information coupled with appropriate risk-reduction strategies. People don't come to camp to get ill; they come to enjoy the magic of your program. It's worth the effort to make your campers and staff as resilient as possible!

Flu Terms Defined

Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available.

Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available.

Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu.

Linda Ebner Erceg, R.N., M.S., P.H.N., is assistant director of health & risk management for the Concordia Language Villages as well as executive director of the Association of Camp Nurses. Passionate about "Healthier Camping for All," Linda is interested in hearing from you about additional resources, ideas for improving camp health, and your stories of risk reduction efforts. Contact her via erceg@campnurse.org.

This article is reprinted from the May 2006 issue of Inside ACA, ACA's online member newsletter.