Abstract
The threat posed by the highly pathogenic H5N1 influenza virus requires public health authorities to prepare for a human pandemic. Although pre-pandemic vaccines and antiviral drugs might significantly reduce illness rates1,2, their stockpiling is too expensive to be practical for many countries. Consequently, alternative control strategies, based on non-pharmaceutical interventions, are a potentially attractive policy option. School closure is the measure most often considered. The high social and economic costs of closing schools for months make it an expensive and therefore controversial policy, and the current absence of quantitative data on the role of schools during influenza epidemics means there is little consensus on the probable effectiveness of school closure in reducing the impact of a pandemic. Here, from the joint analysis of surveillance data and holiday timing in France, we quantify the role of schools in influenza epidemics and predict the effect of school closure during a pandemic. We show that holidays lead to a 20–29% reduction in the rate at which influenza is transmitted to children, but that they have no detectable effect on the contact patterns of adults. Holidays prevent 16–18% of seasonal influenza cases (18–21% in children). By extrapolation, we find that prolonged school closure during a pandemic might reduce the cumulative number of cases by 13–17% (18–23% in children) and peak attack rates by up to 39–45% (47–52% in children). The impact of school closure would be reduced if it proved difficult to maintain low contact rates among children for a prolonged period.
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Acknowledgements
We thank the MRC, European Union FP6 SARSTRANS and INFTRANS projects, RCUK, and the NIGMS MIDAS initiative for research funding. We thank F. Carrat for comments.
Author Contributions S.C. developed the transmission model and conceived and implemented the inference framework used, did the analysis and drafted and revised the text. All other authors edited or commented on the text. A.-J.V., P.-Y.B. and A.F. identified, collated and processed the surveillance and holiday data. P.-Y.B. also provided input on the statistical framework. N.M.F. conceived the study (building on earlier work by A.-J.V. and A.F. examining the correlation between holidays and seasonal influenza incidence), provided input on the statistical framework, model design and assumptions and gave other technical advice.
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Cauchemez, S., Valleron, AJ., Boëlle, PY. et al. Estimating the impact of school closure on influenza transmission from Sentinel data. Nature 452, 750–754 (2008). https://doi.org/10.1038/nature06732
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DOI: https://doi.org/10.1038/nature06732
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