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  • H1N1 study shows closing schools, other measures effective

    H1N1 study shows closing schools, other measures effective
    Mexico social distancing reduced flu transmission

    TEMPE (May 24, 2011) - Schools were closed, restaurants shuttered and large public gatherings cancelled.

    The H1N1 virus was new, and most of the cases occurred among young people. Health professionals and scientists weren't sure at the onset what the world would encounter with the virus.

    Social distancing measures were enacted in Mexico where the pandemic affected different geographical areas of the country during three distinct waves. During the spring of 2009 when the virus affected the Mexico City area, officials choose to take measures to limit the virus' spread including cancelling large gatherings like soccer games.

    New evidence suggests that these measures were effective, according to a new study led by ASU assistant professor Gerardo Chowell-Puente, an investigator for the Fogarty International Center at the National Institutes of Health and an assistant professor in the Arizona State University School of Human Evolution and Social Change in the College of Liberal Arts and Sciences.

    The study provides the first comprehensive epidemiological description of the age, geographical and severity pattern of the 2009 pandemic in Mexico. Results of the study will be published in PloS Medicine.

    "The interesting finding is that school closures and other social distancing measures during the first wave were associated with a reduction in the transmission rate by approximately 29 to 37 percent," Chowell said. "That is a significant change for a rapidly disseminating pandemic virus." Approximately 1,500 deaths were directly attributed to H1N1 flu in Mexico during 2009, he added.

    In addition, hospitalization rates declined from about 70 percent to 10 percent during the period when schools closed and other social distancing measures enacted. Results of the study were calculated by applying mathematical modeling to influenza surveillance data compiled by the Mexican Institute for Social Security, a private health system representing 40 percent of the population.

    "We found a significant effect from the social distancing interventions that could help mitigate the impact of future pandemics by relieving the burden on hospitals," Chowell said. "The peak of the pandemic could be pushed farther away so that health officials can prepare with pharmaceuticals and anti-virals. A vaccine could potentially be developed during that time."

    More young people were affected by the H1N1 virus since older people had some immunity after a similar strain circulated years ago.

    "There were a significant number of young people with severe respiratory disease particularly during the early pandemic phase," Chowell said.

    Researchers also examined how the virus spread spatially, identifying three H1N1 waves with the first cases primarily around the Mexico City metropolis in spring of 2009 and the second summer wave in southeastern Mexico. The third wave was more widespread throughout the country and coincided with the start of school during the fall.

    Findings from the study have implications for improving preparedness plans in future pandemics, said Chowell, who noted that in a previous pandemic in the 19th century, the majority of deaths occurred two years after the initial wave.

    "We must remain vigilant and continue to monitor the circulation and health burden of this flu virus in the coming years," he added.

    ###

    The study is a collaborative effort by Fogarty International Center (the international component of the National Institutes of Health), Arizona State University and colleagues at the Mexican Institute for Social Security.

    Contact:
    Julie Newberg
    Media Relations Officer
    Arizona State University
    (480) 727-3116
    julie.newberg@asu.edu

    Social distancing measures proved effective according to a new study that examined the H1N1 pandemic in Mexico. The study shows three distinct pandemic waves. Results will aid health officials plan for future pandemics.

  • #2
    Re: H1N1 study shows closing schools, other measures effective

    Plos Medicine

    Characterizing the Epidemiology of the 2009 Influenza A/H1N1 Pandemic in Mexico

    Gerardo Chowell1,2*, Santiago Echevarría-Zuno3, Cécile Viboud2, Lone Simonsen2,4, James Tamerius2,5, Mark A. Miller2, Víctor H. Borja-Aburto6

    1 Mathematical, Computational & Modeling Sciences Center, School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, United States of America, 2 Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America, 3 Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, 4 Department of Global Health, School of Public Health and Health Services, George Washington University, Washington (D.C.), United States of America, 5 School of Geography and Development, University of Arizona, Tucson, Arizona, United States of America, 6 Coordinación de Vigilancia Epidemiológica y Apoyo en Contingencias Instituto Mexicano del Seguro Social, Mier y Pesado 120, México, México
    Abstract Top
    Background

    Mexico's local and national authorities initiated an intense public health response during the early stages of the 2009 A/H1N1 pandemic. In this study we analyzed the epidemiological patterns of the pandemic during April–December 2009 in Mexico and evaluated the impact of nonmedical interventions, school cycles, and demographic factors on influenza transmission.
    Methods and Findings

    We used influenza surveillance data compiled by the Mexican Institute for Social Security, representing 40&#37; of the population, to study patterns in influenza-like illness (ILIs) hospitalizations, deaths, and case-fatality rate by pandemic wave and geographical region. We also estimated the reproduction number (R) on the basis of the growth rate of daily cases, and used a transmission model to evaluate the effectiveness of mitigation strategies initiated during the spring pandemic wave. A total of 117,626 ILI cases were identified during April–December 2009, of which 30.6% were tested for influenza, and 23.3% were positive for the influenza A/H1N1 pandemic virus. A three-wave pandemic profile was identified, with an initial wave in April–May (Mexico City area), a second wave in June–July (southeastern states), and a geographically widespread third wave in August–December. The median age of laboratory confirmed ILI cases was ~18 years overall and increased to ~31 years during autumn (p<0.0001). The case-fatality ratio among ILI cases was 1.2% overall, and highest (5.5%) among people over 60 years. The regional R estimates were 1.8–2.1, 1.6–1.9, and 1.2–1.3 for the spring, summer, and fall waves, respectively. We estimate that the 18-day period of mandatory school closures and other social distancing measures implemented in the greater Mexico City area was associated with a 29%–37% reduction in influenza transmission in spring 2009. In addition, an increase in R was observed in late May and early June in the southeast states, after mandatory school suspension resumed and before summer vacation started. State-specific fall pandemic waves began 2–5 weeks after school reopened for the fall term, coinciding with an age shift in influenza cases.
    Conclusions

    We documented three spatially heterogeneous waves of the 2009 A/H1N1 pandemic virus in Mexico, which were characterized by a relatively young age distribution of cases. Our study highlights the importance of school cycles on the transmission dynamics of this pandemic influenza strain and suggests that school closure and other mitigation measures could be useful to mitigate future influenza pandemics.


    Comment


    • #3
      An Effective Quarantine Measure Reduced the Total Incidence of Influenza A H1N1 in the Workplace: Another Way to Control the H1N1 Flu Pandemic

      J Occup Health. 2011 May 18. [Epub ahead of print]
      An Effective Quarantine Measure Reduced the Total Incidence of Influenza A H1N1 in the Workplace: Another Way to Control the H1N1 Flu Pandemic.
      Miyaki K, Sakurazawa H, Mikurube H, Nishizaka M, Ando H, Song Y, Shimbo T.
      Source

      Department of Clinical Research and Informatics, National Center for Global Health and Medicine.
      Abstract

      Objectives: To evaluate the effectiveness of a non-vaccine quarantine measure against pandemic influenza A H1N1 in workplaces. Methods: Design was quasi-cluster randomized controlled trial in two sibling companies (Cohort 1 n=6,634, Cohort 2 n=8,500). The follow-up period was from July 1st, 2009 to February 19th, 2010 (233 days). Intervention was voluntary waiting at home on full pay if the family became Influenza like Illness (ILI). The incidences of influenza A H1N1 and those of the subgroups whose families got ILI in both cohorts were compared by a Cox regression model and log-rank test. Results: There were 189 and 270 workers who got H1N1 infection during the follow-up period in each cohort. In this period 317, workers in Cohort 1 were asked to wait at home for several days (100% obeyed). The intervention group (Cohort 1) showed a statistically significant lower risk (p for log-rank test=0.033) compared with the control (Cohort 2), and the hazard ratio of the intervention was 0.799 [0.658-0.970] after adjusting for age, sex, BMI and smoking status. The workers who were asked to wait at home showed H1N1 infection more frequently (49 out of 317) compared with the workers whose family got ILI but were not asked to wait and work regularly (77 out of 990, RR=2.17 [1.48-3.18]). Conclusions: The waiting on full pay policy in the workplace reduced the overall risk of influenza A H1N1 by about 20% in one flu season in Japan. This kind of non-vaccine measure will be a promising option in workplaces to control the next flu pandemic.

      PMID:
      21597235
      [PubMed - as supplied by publisher]

      Free Article

      The waiting on full pay policy in the workplace reduced the overall risk of influenza A H1N1 by about 20% in one flu season in Japan. This kind of non-vaccine measure will be a promising option in workplaces to control the next flu pandemic.

      Comment


      • #4
        MEXICAN FLU PANDEMIC STUDY SUPPORTS SOCIAL DISTANCING (HHS, NIH, May 25 2011)

        [Source: US Department of Health and Human Services, full text: (LINK). Edited.]
        U.S. Department of Health and Human Services
        NATIONAL INSTITUTES OF HEALTH NIH News

        John E. Fogarty International Center for Advanced Study in the Health Sciences (FIC) <http://www.fic.nih.gov/>

        Embargoed for Release: Tuesday, May 24, 2011, 5 p.m. EDT

        CONTACT: Ann Puderbaugh, 301-496-2075, <e-mail:puderba@mail.nih.gov>


        MEXICAN FLU PANDEMIC STUDY SUPPORTS SOCIAL DISTANCING



        Fogarty research published in PLoS Medicine

        Eighteen-day periods of mandatory school closures and other social distancing measures were associated with a 29 to 37 percent reduction in influenza transmission rates in Mexico during the 2009 pandemic. The research was carried out by scientists at the Fogarty International Center at the National Institutes of Health and published in PLoS Medicine.

        The social distancing measures implemented by the Mexican health authorities in spring 2009 were effective in reducing disease transmission by more than one-third, the study found. Social distancing interventions can be implemented during unusual infectious diseases outbreaks and include school closing, closure of movie theaters and restaurants, and the cancellation of large public gatherings. Mexico implemented a nationwide mandatory school closure policy during an 18-day period in late April and early May 2011. The United States implemented school closure interventions on a local basis during the 2009 pandemic, but the impact of these interventions has yet to be evaluated.

        The study was led by Gerardo Chowell, Ph.D., a Fogarty investigator and faculty member at Arizona State University, Tempe. His team provides the first comprehensive epidemiological description of the age, geographical and severity patterns of the 2009 pandemic in Mexico.

        The authors applied mathematical modeling to influenza surveillance data compiled by a large private health system, the Mexican Institute for Social Security, which covers 40 percent of the population.

        A three-wave pandemic profile was identified throughout Mexico. The initial wave occurred in spring 2009 in the Mexico City area. A second wave was noted in summer 2009 in the southeastern region. Finally, a third wave occurred in fall 2009. The onset of the third pandemic wave in fall 2009 occurred within two to five weeks of the beginning of the fall school term, coinciding with increased disease incidence among school-age children.

        The hardest hit were the very young, not the elderly who are typically at high risk with influenza. There were a few cases reported among seniors during the pandemic period, but the most severe influenza-related infections were seen in those 5 to 14 years old, as well as in infants.

        Overall, the researchers' findings highlight variation in pandemic influenza incidence and severity among age groups, and reveal the importance of school cycles on the transmission dynamics of this disease. The importance of school -- children for pandemic influenza transmission is based on the findings that school closure effectively reduced influenza transmission in spring 2009 in Mexico, together with a large increase in influenza cases among school children coinciding with schools reopening.
        The study suggests that school closure and other measures could be useful to mitigate future influenza pandemics.

        "We believe this study has implications for improving preparedness plans in future pandemics," said Chowell. Noting that, in a previous influenza pandemic in the 19th century, the majority of deaths occurred two years after the initial wave, he emphasized that "we must remain vigilant and continue to monitor the circulation and health burden of the pandemic A/H1N1 and co-circulating influenza viruses in the coming years."


        Fogarty International Center

        Fogarty, the international component of the NIH, addresses global health challenges through innovative and collaborative research and training programs and supports and advances the NIH mission through international partnerships. For more information, visit: <www.fic.nih.gov>.

        About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit <www.nih.gov>.


        This NIH News Release is available online at: <http://www.nih.gov/news/health/may2011/fic-24.htm>.

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