Estimating the impact of school closure on influenza transmission from Sentinel data

[Sally Furniss]

Estimating the impact of school closure on influenza transmission from Sentinel data

Simon Cauchemez¹, Alain-Jacques Valleron^2,^3,⁴, Pierre-Yves Bo?lle^2,^3,⁴, Antoine Flahault^2,^3,⁵ & Neil M. Ferguson¹

1. MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Diseases Epidemiology, Imperial College London, Norfolk Place, London W2 1PG, UK
2. Universit? Pierre et Marie Curie?Paris 6, UMR S 707, 27 rue Chaligny, Paris 75012, France
3. INSERM, UMR S 707, 27 rue Chaligny, Paris 75012, France
4. AP-HP, H?pital St Antoine, 27 rue Chaligny, Paris 75012, France
5. French School of Public Health (EHESP), 1 place du Parvis Notre-Dame, Paris F-75004, France

Correspondence to: Simon Cauchemez¹ Correspondence and requests for materials should be addressed to S.C. (Email: s.cauchemez@imperial.ac.uk).

Top of pageAbstract

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 rates^1,², 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.

http://www.nature.com/nature/journal/v452/n7188/full/nature06732.html

 

[Oracle]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

Why is it considered 'expensive' to close public schools in the event of a pandemic?

1. Kiddies have been shown by many studies to be key distribution points for infectious disease in the community setting for several reasons: immature risk recognition and avoidance skills; particulars of immune system molecular mechanics; and social and physical habits conducive to direct and indirect pathogen contamination of their environment.

2. Kids have MONTHS off every summer. You shift the school year so that this yearly vacation period is utilized effectively to avoid heavy community penalties for this very risky subpopulation.

That's coverage for two waves of six-week period closings. No extra expense.

 

[janetney]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

not sure where those teachers you speak of live but the teachers i know don't make anywhere near that much...my mother taught 5th grade for over 20 years and we were considered poor (my father was a minister)...

closing the schools is IMHO the only option for their own safety as well as for others...

saw that you edited out that info about teacher's salaries...so, my post is kindof worthless...sorry...

 

[gsgs]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

my summary:
school closure during outbreaks of seasonal flu prevents
15% of flu-cases.


normal flu : 1 flu-case spared for 13 pupils staying home during season
and 1 flu-death spared for 10000 pupils staying home during season

1918 : 1 flu-case spared for 5.5 pupils staying home during waves
and 1 flu-death spared for 222 pupils staying home during waves



I found US-school-statistics here

 

[Sally Furniss]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

Thanks gs! nice summary

 

[sharon sanders]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

Impact of closing schools during pandemic less than projected: study

16 hours ago
TORONTO ? Closing schools during a flu pandemic might slow spread of the disease but probably won't have as big an impact on overall cases as some pandemic planners hope, a new study suggests.
British and French researchers reported that one in seven cases of pandemic flu might be averted if schools are closed and parents ensure that dismissed children don't simply congregate elsewhere, such as in formal or informal daycares or at the mall.
Their projections, generated by mathematical models, were published Thursday in the journal Nature.
Earlier modelling studies have predicted closing schools could dramatically lower the number of cases in a pandemic. This new work suggests those studies may have been overly optimistic.
"I think our predicted impact is quite limited, but not so limited that school closures should not be considered as an option," said senior author Neil Ferguson of the department of infectious diseases epidemiology of London's Imperial College.
"I mean, we're in the regime of 'It may be worthwhile, but the costs need to be borne in mind."'
Those costs are not trivial.
Children who are not in school need to be cared for. If parents need to stay home, that knocks healthy people out of an already weakened workforce. And not all parents can afford to stay home from work. Likewise, in some places children who don't have access to a school meal program will go hungry if other arrangements are not made.
Still, closing schools is one of the so-called non-pharmaceutical interventions or social distancing measures that pandemic planners have firmly in mind as they search for ways to blunt the blow of the next pandemic.
A key goal of this type of planning is to find ways to slow spread of disease so that health-care systems don't get swamped by a tidal wave of sick patients. Planners talk of "flattening the peak" - essentially spreading out cases so that hospitals can continue to function and more people remain healthy until vaccine becomes available several months into the pandemic.
Ferguson said his group's work suggests school closings could help achieve this goal.
"The one thing it might do by slowing down the epidemic somewhat - smearing it out - is reduce peak demand on health-care systems quite substantially."
The notion is based on the fact that children play a key role in the spread of seasonal flu. Whether that will be true in a flu pandemic remains to be seen.
In trying to estimate what kind of impact closing schools might have, Ferguson and his co-authors drew on data from France, where for more than 20 years a group of nearly 1,200 doctors have submitted daily reports on new cases of a variety of diseases, including influenza-like illnesses.
Using those data, the group was able to study what happened to rates of new infections when French schools break up for holidays and to use that as a basis on which to estimate what might happen in a pandemic.
The calculations suggest infection rates in children would drop by between 20 and 25 per cent, Ferguson said. But the modelling suggests the patterns of interactions of adults wouldn't change that much and the overall reduction in cases might be more in the order of 15 per cent.
That would mean that instead of an estimated 34 per cent of the population falling ill during a pandemic, only 28 per cent would be expected to get sick.
But all these figures are estimates, calculated using assumptions set by the modellers themselves. And not everyone is convinced academic projections will have much bearing on reality when a pandemic hits.
"I find these models to be of little help because I don't believe they're practical in the real world," said Dr. Michael Osterholm, an infectious diseases expert at the University of Minnesota who worked for years as that state's chief epidemiologist.
"For example, I am convinced we will not even have a chance to shut down schools before they are shut down on their own. Parents will not send their kids to school ... long before the actual transmission begins."
Osterholm pointed to school closings in the U.S. last fall, sparked by anxiety over the death of a Virginia high-school student. The 17-year-old died from an infection with antibiotic-resistant Staph, or MRSA.
A spokesperson for the World Health Organization said the Geneva-based agency is looking at these questions as its scientists draft the next version of its pandemic preparedness guidelines for member countries.
But Dr. Nima Asgari-Jirhandeh, a medical officer with the WHO's Global Influenza Program, said conditions vary so much from country to country that it will be difficult to come up with a single piece of advice on something like whether to close schools.
"If you've got a country where you've got 90 per cent of children going to school and when they come home they're going to come and play in front of the computer, that's a very different epidemiology of the disease than in a country where you've got 20 per cent of children going to school and when they leave they go and either play together or go and work," Asgari-Jirhandeh said.
"So you have to balance that. If I'm going close the school, is it actually going to work? It's not going to be so black and white."




http://canadianpress.google.com/article/ALeqM5i34Q-uCCB9kUhtVtySD4MqXxX9sg

 

[tropical]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

"closing the schools is IMHO the only option for their own safety as well as for others..."

I agreed, and I agree with Oracle also:
"Why is it considered 'expensive' to close public schools in the event of a pandemic?"

The first thing to do in a very begining of the pandemic must be to release home all the workforce but the very necessary ones - on prolonged hollidays, 1-2 month, and all childs/teens taken at home.

If summing the free days, and the holiday break during the working year, that will give us that necessary period to SIP at home the first vawe, later will be what will be.

 

[Amish Country]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

"closing the schools is IMHO the only option for their own safety as well as for others..."

I agreed, and I agree with Oracle also:
"Why is it considered 'expensive' to close public schools in the event of a pandemic?"

[/U]

Public schools also function as unpaid baby sitters hopefully providing a safe environment for children, allowing parents to work outside the home. Closing schools could present parents with another expense that they could have trouble affording. Some parents may be forced to chose between going to work to provide food and necessities for their families and leaving children unattended or providing some other form of child care and deciding what to cut out of an already tight budget. Add to this the problems inherent in a pandemic and the dangers and issues continue to multiply.

I also believe IMHO, that it is a nessity to close the schools to help limit the spread of contagion and protect children. What can we replace it with? Online schooling is one possiblity if the internet remains online and has the capasity to meet the demand. Granted not everyone has an in home computer or internet access. After a pandemic many students may have to make up missed class time.

 

[tropical]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

Hi A.C., thanks for the post, but I think that in a such event, if it would be serious, it must be forget the usual kind of daily thinking.

In my opinion we must forget this mambo...o of must teaching the childrens in an pandemic.

There is no reason to force children study in such an event. The children will must do it well at home, or in special designed places.
The necessary money during the SIP must be previously achieved.
Do you think it would be better leave the childrens with other few hundreds in the same place? How many between them will have the virus?

The main goal is to preserve the "nude" life!

What was doing the childrens 150 years ago when no mass teaching exists?

The home budget MUST resist an 1-2 months SIp in house!
The same time period are somebody's hollidays.
That is the real goal - to remain in home isolation with all your family with enaugh stored water and food, without going to work - if you are not between the "necessary ones".

Childrens will (if they have the power) read books, instead of Internet.

Sorry now, I must switch off. Bye!

 

[Oracle]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

"Closing schools could present parents with another expense that they could have trouble affording. Some parents may be forced to chose between going to work to provide food and necessities for their families and leaving children unattended or providing some other form of child care and deciding what to cut out of an already tight budget."

The POINT of closing schools is to reduce social contact among the age cohort shown repeatedly to be central to community dissemination of infectious disease during epidemic events.

You do NOT shuttle them off to daycare/recreation/other place than home.

National law, enacted earlier this decade, provides relief to parents who are faced with a home care need for sick dependents.

Employers must make leave time available for employees who have sick dependents. NOW is the time for discussion with employers for provision of Flex time arrangements (several days work at home per week, alternating with spouse, relatives for child care) during extended periods during infectious epidemic events.

 

[Sally Furniss]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

12 Suggestions Should A School Close Due To Influenza

http://www.flutrackers.com/forum/showthread.php?t=11038

 

[Amish Country]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

"In my opinion we must forget this mambo...o of must teaching the childrens in an pandemic."

While educating children is important keeping them alive in the first place occupies a significantly higher priority. The problem is what if parents can't feed them because they are not working because they have to be home to take care of the kids? What if their employer is shut down due to the pandemic?

It would be great if every family had:
a 3 months store of shelf stable food,
A guaranteed supply of potable water for the duration of a pandemic or other prolonged emergency,
were completely out of debt and could afford a 3 month SIP.

How can we encourage families in the current economy to achieve this? Many will not have the determination, discipline, ambition and ability needed to achieve these goals. Especially since many do not understand the threat or even believe there is one. How can we encourage back up child and dependent care plans for those that have to work?

"Employers must make leave time available for employees who have sick dependents. NOW is the time for discussion with employers for provision of Flex time arrangements (several days work at home per week, alternating with spouse, relatives for child care) during extended periods during infectious epidemic events."

This is all well and good but IMHO putting the responsibility on employers will not work. It is not their job, priority or responsibility to take care of their employee's children. If the employer is forced to close due to the pandemic (theaters, restaurants etc.) they will probably not have the money or ability to pay non working employees. Not every employee has the ability to "work from home". Imagine telling a plumber, police officer, fireman, nurse, EMT, electrician, construction worker, cab driver, garbage collector, gas station operator, train engineer, food processor, factory worker, cook, waitress, mail carrier, lineman or trucker that for the next week you'er working from home? Somehow I have trouble imagining getting a tractor trailer or locomotive into the living room.

Taking care of children is a parental responsibility. What can we here at Flutrackers do to encourage families to prepare for an unexpected (at least by some) emergency that we are not already doing? What have we missed?

 

[tropical]

Re: Estimating the impact of school closure on influenza transmission from Sentinel data

"In my opinion we must forget this mambo...o of must teaching the childrens in an pandemic."

While educating children is important keeping them alive in the first place occupies a significantly higher priority. The problem is what if parents can't feed them because they are not working because they have to be home to take care of the kids? What if their employer is shut down due to the pandemic?

This would be the best possibility - you don't need to work until the employer start again, your family will stay at home SIPing during the first pandemic vawe with the goods you stored previously - if you haven't enaugh storidge -> that would be a real problem.

It would be great if every family had:
a 3 months store of shelf stable food,
A guaranteed supply of potable water for the duration of a pandemic or other prolonged emergency,
were completely out of debt and could afford a 3 month SIP.

How can we encourage families in the current economy to achieve this? Many will not have the determination, discipline, ambition and ability needed to achieve these goals. Especially since many do not understand the threat or even believe there is one. How can we encourage back up child and dependent care plans for those that have to work?

"Employers must make leave time available for employees who have sick dependents. NOW is the time for discussion with employers for provision of Flex time arrangements (several days work at home per week, alternating with spouse, relatives for child care) during extended periods during infectious epidemic events."

This is all well and good but IMHO putting the responsibility on employers will not work. It is not their job, priority or responsibility to take care of their employee's children. If the employer is forced to close due to the pandemic (theaters, restaurants etc.) they will probably not have the money or ability to pay non working employees.

If the pandemic is declared by gov. with special public health laws, than the employer must give a leave (holiday break). The non-payed break doesn't matter because the family have stocked goods - if not, that would be a problem.

Not every employee has the ability to "work from home". Imagine telling a plumber, police officer, fireman, nurse, EMT, electrician, construction worker, cab driver, garbage collector, gas station operator, train engineer, food processor, factory worker, cook, waitress, mail carrier, lineman or trucker that for the next week you'er working from home? Somehow I have trouble imagining getting a tractor trailer or locomotive into the living room.

Taking care of children is a parental responsibility. What can we here at Flutrackers do to encourage families to prepare for an unexpected (at least by some) emergency that we are not already doing? What have we missed?[/quote]

Nothing. We missed nothing.
The problem is that the country government must put on such kind of special laws that authorize the employers to holiday non-payed, or payed, leaves during an serious pandemic event, because of public health concerns. I agreed with Oracle.