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How to cough is not what you typically learn in school, but the nurse at tiny Upton Elementary/Middle School in northeast Wyoming stepped up to the public address microphone just before Christmas break and taught the student body -- all 156 of them.
You cough into the crook of your arm, of course.
It was this advice, along with a vigorous regimen of hand-washing, desk-scrubbing and doorknob-disinfecting, that helped the school avoid an epidemic of influenza, principal Janice Peterson says. ''We had everybody involved'' -- nurse, teachers, aides, even janitors. ''Everybody had input and did something.''
As in Upton, educators across the nation are combating an unusually tenacious cold and flu season by stressing often-neglected basics of personal hygiene. They're being aided by a new government campaign that encourages hand-washing and -- yes -- proper coughing techniques.
Peterson says her janitorial staff took extra care scouring the school over winter break; custodians now wipe down desks and doorknobs every day. When students returned to school in January after winter break, they found a new contraption hanging on the cafeteria wall: a dispenser of hand-sanitizing lotion. Now everyone takes a dollop and disinfects his or her hands before lunch.
But even extra precautions weren't enough to stop a mild, mid-December flu epidemic, in which 22% of the students were out sick. Many other schools, especially in hard-hit areas, had higher absentee rates in December.
''During the biggest outbreak, we just called parents and sent kids home,'' Peterson says.
Though no reliable figures exist on how many children are going home sick this winter, government figures show that 22 million school days are lost each year to the common cold alone. Since autumn, an alarming number of children have died from flu-related illness.
The Centers for Disease Control and Prevention (CDC) last week tallied 93 flu-related deaths in children from Oct. 11 to Jan. 6. Of those, 41 of the children had no known medical problems, the CDC said.
Officials said flu is still widespread from coast to coast in 20 states: California, Connecticut, Delaware, Georgia, Hawaii, Indiana, Iowa, Maryland, Minnesota, Mississippi, Montana, New York, North Carolina, Pennsylvania, South Carolina, Texas, Vermont, Virginia, West Virginia and Wisconsin.
CDC director Julie Gerberding said this month that cases were dropping, but cautioned that the flu is unpredictable. In past years, Gerberding said, ''we have seen flu come back and we've also seen new strains emerge late in the season.''
This month, the CDC unveiled an online campaign called ''Be a Germ Stopper.'' A colorful animé-style illustrated poster exhorts kids to cover their coughs and sneezes and keep their hands clean. The site received more than 31,000 hits in the first week, a CDC spokeswoman says.
''Because of the seriousness of the flu epidemic and the number of deaths, they've taken much more initiative than in the past to alert school nurses and teachers,'' says Marcia Rubin of the American School Health Association.
Schools are taking the precautions more seriously too, Rubin says.
''They have children too.''
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