The vast majority of U.S. child care centers are not fully prepared to handle the risks posed by a possible influenza pandemic, a new investigation warns.

The finding is based on the results of two flu-preparedness telephone surveys conducted in 2008 and 2016, both before and after the 2009 H1N1 “swine flu” pandemic.

During both surveys, only 7 percent of child care center directors said that they had taken sufficient steps to prepare, even though about two-thirds said they were concerned about the threat.

The main issues were “a lack of knowledge of what to do to prepare, where to find information, not having the time, and lacking resources,” said study author Dr. Timothy Shope.

Shope is an associate professor of pediatrics at Children’s Hospital of Pittsburgh.

According to the U.S. Centers for Disease Control and Prevention, the H1N1 pandemic originated in Mexico and first hit the United States in April 2009.

Over the course of the following year, the CDC estimates there were nearly 61 million H1N1 flu cases, resulting in more than 274,000 hospitalizations and nearly 12,500 deaths.

The study authors pointed out that about one-quarter of American children under the age of 5 regularly gather in an organized group setting, such as a child care center or preschool.

Such settings are considered high risk for person-to-person influenza transmission, because the flu is mainly spread via airborne droplets. That means that the most effective protection involves the kind of good hygiene habits that children often lack — such as repeated hand washing or covering one’s nose and mouth when sneezing or coughing.

With that in mind, the CDC issued child care center preparation resource guidelines back in 2006. So, the researchers set out to see to what degree such centers had taken that advice.

About 1,500 directors were polled in 2008, followed by roughly 500 in 2016.

All were asked what they had done to ensure good communication with parents regarding illness and infection in the event of a pandemic; ensure general infection control and seasonal flu risk control; enlist advice from expert health consultants to increase center safety and pediatric health; and meet national accreditation standards for child care quality of care.

More than nine in 10 directors indicated they had failed to take any concrete steps to prepare, such as developing a written pandemic plan, drafting a preparedness checklist, engaging in pandemic planning workshops, or holding flu-related meetings with staff or parents.

“This is a difficult problem to prepare for because pandemic influenza occurs rarely — every 10 to 20 years,” Shope acknowledged.

Still, his team was “somewhat surprised and disappointed at the lack of preparedness for pandemic influenza.”

But, Shope added, “this is helpful information to policymakers and public health officials. It suggests that there may be a problem with the message itself, [that it is] too complex or not understandable, or that it is not reaching its target audience.”

Meanwhile, he said that “parents should keep informed, but not panic,” given the rarity of a pandemic. Shope did, however, suggest that “parents should have a plan for alternative care arrangements, just like they have a plan to communicate and take shelter in the event of a tornado.”

The study, funded by the U.S. Centers for Disease Control and Prevention, was published online May 15 in the journal Pediatrics.

Cameron Wolfe, medical director of biopreparedness in the division of infectious disease at Duke University Medical Center, said the study highlights the fact “that we’ve not really learned the lessons of H1N1.”

The problem is that for child centers, “it’s difficult to know quite how to prepare for a major flu epidemic,” he noted.

“That said,” added Wolfe, “I would challenge [child] care center directors by saying that this represents a call to action, noting that when it comes to a flu pandemic, very young children are often our ‘canary in the coal mine.'”

More information

There’s more on influenza pandemics at the U.S. Centers for Disease Control and Prevention.

Source: HealthDay