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1 in 7 cases of bird flu could be prevented by closing schools in event of pandemic
April 10, 2008Closing schools in the event of a flu pandemic could slow the spread of the virus and prevent up to one in seven cases, according to a new study published today in the journal Nature.
School closure is the non-pharmaceutical policy option that health organisations and governments most often consider to control the spread of a future flu pandemic, but there had previously been little evidence about its potential effectiveness.
Researchers from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, working with colleagues in France, used computer modelling to explore how school closure would affect the spread of a theoretical pandemic H5N1 avian flu virus which had mutated to pass between humans. They extrapolated from data collected by French GPs, showing how school holidays alter the patterns of influenza transmission in France.
The new study shows that shutting down schools for a prolonged period in the event of a pandemic could prevent up to one in seven cases.
School closures would also slow and flatten the pandemic, reducing the numbers becoming ill in the worst week of the outbreak by up to 40%. The researchers suggest that this could be important in reducing pressures on healthcare services during this time so that hospitals and GP surgeries would be better able to cope.
However, the researchers caution that closing schools for a prolonged period would be a very costly measure, particularly because of its impact on working parents. Taking away the childcare that schools provide could also affect the spread of the virus, in ways that are difficult to model using existing information.
For example, parents might share childcare with each other or place their children with child minders, so that children would still mix and spread the virus between them, much as they would in a school setting. In addition, the number of healthcare professionals available to care for those with the virus might fall if some needed to stay home to look after their children.
Dr Simon Cauchemez, one of the authors of the study from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, said: "Our research shows that school closures could be a useful measure in terms of slowing the spread of a flu pandemic. However, its effectiveness would very much depend on what other measures, like vaccination or antiviral drugs, were put in place as well."
Professor Neil Ferguson, another author of the study from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, added: "Closing schools for a long time is not an option you can take lightly, because it has a big economic and social impact, and the extent to which there would be a knock-on effect on transmission is hard to predict.
"Even though the children would not be in school, they would still mix with other children and adults in the community and spread the virus through this contact. We also think it's likely that parents would need to devise new childcare arrangements so that they could continue working, meaning that they would be setting up the equivalent of small schools where the virus could easily be transmitted," added Professor Ferguson.
The researchers reached their conclusions after analysing surveillance data collected since 1984 by 1,200 GPs in France, to see how the rate of influenza transmission is reduced during the country's school holidays. This data showed 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. The French data also revealed that children were responsible for around 46% of all infections.
The researchers then extrapolated from this to explore how prolonged school closure might affect transmission in the event of a pandemic of mutated H5N1 in a country like France.
At present, the H5N1 strain of influenza is transmitted to people by birds and person-to-person transmission is very rare. However, the virus is so lethal that if it were to mutate and become more transmissible, as in the researchers' new model, the consequences of a global pandemic could be disastrous.
Imperial College London
The new study shows that shutting down schools for a prolonged period in the event of a pandemic could prevent up to one in seven cases.
School closures would also slow and flatten the pandemic, reducing the numbers becoming ill in the worst week of the outbreak by up to 40%. The researchers suggest that this could be important in reducing pressures on healthcare services during this time so that hospitals and GP surgeries would be better able to cope.
However, the researchers caution that closing schools for a prolonged period would be a very costly measure, particularly because of its impact on working parents. Taking away the childcare that schools provide could also affect the spread of the virus, in ways that are difficult to model using existing information.
For example, parents might share childcare with each other or place their children with child minders, so that children would still mix and spread the virus between them, much as they would in a school setting. In addition, the number of healthcare professionals available to care for those with the virus might fall if some needed to stay home to look after their children.
Dr Simon Cauchemez, one of the authors of the study from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, said: "Our research shows that school closures could be a useful measure in terms of slowing the spread of a flu pandemic. However, its effectiveness would very much depend on what other measures, like vaccination or antiviral drugs, were put in place as well."
Professor Neil Ferguson, another author of the study from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, added: "Closing schools for a long time is not an option you can take lightly, because it has a big economic and social impact, and the extent to which there would be a knock-on effect on transmission is hard to predict.
"Even though the children would not be in school, they would still mix with other children and adults in the community and spread the virus through this contact. We also think it's likely that parents would need to devise new childcare arrangements so that they could continue working, meaning that they would be setting up the equivalent of small schools where the virus could easily be transmitted," added Professor Ferguson.
The researchers reached their conclusions after analysing surveillance data collected since 1984 by 1,200 GPs in France, to see how the rate of influenza transmission is reduced during the country's school holidays. This data showed 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. The French data also revealed that children were responsible for around 46% of all infections.
The researchers then extrapolated from this to explore how prolonged school closure might affect transmission in the event of a pandemic of mutated H5N1 in a country like France.
At present, the H5N1 strain of influenza is transmitted to people by birds and person-to-person transmission is very rare. However, the virus is so lethal that if it were to mutate and become more transmissible, as in the researchers' new model, the consequences of a global pandemic could be disastrous.
Imperial College London
Pandemic Current Events and Pandemic News RSSAsthma a significant risk factor for complications in children with H1N1
A new study on pediatric H1N1 influenza admissions has found that asthma is a significant risk factor for severe disease in children with pandemic H1N1 compared with the seasonal flu.
Preventing H1N1 spread to health care workers: Dilemma, debate and confusion
A commentary in the December issue of The Lancet Infectious Diseases brings to light the gaps in knowledge on the transmission of a common pathogen - the influenza virus - and its impact on decisions about how best to protect health care workers.
New culprit for viral infections among elderly -- an overactive immune response
Researchers at Yale School of Medicine have found that exaggerated responses of the immune system explain why the elderly succumb to viral infections more readily than younger people.
New research helps explain why bird flu has not caused a pandemic
Bird flu viruses would have to make at least two simultaneous genetic mutations before they could be transmitted readily from human to human, according to research published today in PLoS ONE.
Mechanical ventilation for patients with lung damage don't always work as planned
As more Canadians are diagnosed with H1N1 influenza infection, some will be admitted to hospital. The most severely affected may be treated in the intensive care unit (ICU) and placed on a mechanical ventilator to help them breathe while they recover from the infection.
90 percent of Africans are not protected by smoke-free laws
As African nations are poised to undergo the highest increase in the rate of tobacco use among developing countries, nearly 90 percent of people on the continent remain without meaningful protection from secondhand smoke, according to a new report released at a regional cancer conference today.
Researchers mobilizing global resources to test new treatments for severe H1N1 infection
An important, ground-breaking initiative is unfolding in the global critical care community in response to the H1N1 pandemic.
New Synthetic Molecules Trigger Immune Response to HIV and Prostate Cancer
Researchers at Yale University have developed synthetic molecules capable of enhancing the body's immune response to HIV and HIV-infected cells, as well as to prostate cancer cells. Their findings, published online in the Journal of the American Chemical Society, could lead to novel therapeutic approaches for these diseases.
When should flu trigger a school shutdown?
As flu season approaches, parents around the country are starting to face school closures. But how bad should an influenza outbreak be for a school to shut down?
Sneezing in times of a flu pandemic
The swine flu (H1N1) pandemic has received extensive media coverage this year. The World Health Organization, in addition to providing frequent updates about cases of infection and death tolls, recommends hyper vigilance in daily hygiene such as frequent hand washing or sneezing into the crook of our arms.
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