Module 1a: Human-to-Human Transmission and First U.S. Cases

From July 1 to August 13, 2014, China has witnessed more than 100 cases of a new strain of H7N9 influenza during its summer flu season. Fewer than half of these cases have involved direct contact with poultry. Based on a hospital-associated cluster of cases, the World Health Organization declares a Phase 4 Pandemic Alert, which indicates evidence of increased human-to-human transmission.

On August 14, the U.S. Department of State and Centers for Disease Control and Prevention issue advisories against non-essential travel to China. Incoming travelers to the United States are subject to “passive lookout” for symptoms of illness by U.S. Customs and Border Protection officers.

Our university and five others had a total of 40 students participate in a summer study abroad program at a Chinese university from late June through mid-August. Our institution also participates in fall and spring semester programs at this Chinese university. Ten students and two faculty members are slated to attend in the fall and expect to travel to China soon.

As of August 19, additional localized outbreaks of the novel H7N9 strain have occurred in other countries in China's region, including North Korea, South Korea and Taiwan. The World Health Organization declares a Phase 5 Pandemic Alert, which indicates that a pandemic is imminent. Meanwhile, international students continue returning to our region in anticipation of classes, having been cleared to enter the United States by Customs and Border Protection. The American College Health Association begins providing news updates to its membership regarding disease developments and holds preliminary discussions on establishing surveillance and developing guidelines for potential outbreaks on U.S. campuses.

On August 19, parents of one of our students (Student A) notify the registrar’s office that she has been hospitalized in her hometown of [suburb] for two days with a fever of 103F, muscle aches, and severe coughing. They note that the student participated in the China summer program. They have been advised by the [insert county name] Health Department and the [insert state name] Department of Public Health that this is the first U.S. case with the novel H7N9 strain. They are uncertain that she will be able to attend the first week of classes.

1. Uncertainty over pandemic in our region.
2. Our university has large population of international travelers (student, faculty, staff)

1. What information do you release, and to whom, how, and with what goals do you release it?
2. What do we communicate to students and other stakeholders?
   1. Specifically, consider the following questions:
      1. Does the university notify other students who participated in the study abroad program about the sick student?
         1. What information do you provide? How do you provide this information?
      2. The media are identifying the first U.S. case of the novel H7N9 strain as a student at our university.
         1. What risks does this pose for your university's reputation?  How would you mitigate them?
      3. How does your messaging about the situation and your delivery mechanisms differ for:
         1. Students?
         2. Faculty and Staff?
         3. Parents (including parents of international students)?
         4. The surrounding commnity and the general public?