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D. J. D. Earn, D. He, M. B. Loeb, K. Fonseca, B. E. Lee, and J. Dushoff (2012)

Effects of school closure on incidence of pandemic influenza in Alberta, Canada

Annals of Internal Medicine, 156(3):173-181.

BACKGROUND: Control of pandemic influenza by social-distancing measures, such as school closures, is a controversial aspect of pandemic planning. However, investigations of the extent to which these measures actually affect the progression of a pandemic have been limited. OBJECTIVE: To examine correlations between the incidence of pandemic H1N1 (pH1N1) influenza in Alberta, Canada, in 2009 and school closures or weather changes, and to estimate the effects of school closures and weather changes on pH1N1 transmission. Design: Mathematical transmission models were fit to data that compared the pattern of confirmed pH1N1 cases with the school calendar and weather patterns. SETTING: Alberta, Canada, from 19 April 2009 to 2 January 2010. DATA SOURCES: 2009 virologic test results, 2006 census data, 2009 daily temperature and humidity data, and 2009 school calendars. MEASUREMENTS: Age-specific daily counts of positive results for pH1N1 from the complete database of 35 510 specimens submitted to the Alberta Provincial Laboratory for Public Health for virologic testing from 19 April 2009 to 2 January 2010. Results: The ending and restarting of school terms had a major effect in attenuating the first wave and starting the second wave of Social-distancing measures feature prominently in analyses of pandemic preparedness and management strategies (1), and school closure is one of the most frequently considered measures (2). Influenza incidence and mortality data do not typically show obvious effects of school closures, but several studies (2–4) have used mathematical models to infer that closing schools reduced transmission in various situations, including the first phase of the 2009 influenza pandemic in Hong Kong (5). Here, we present the effects of closing schools in Alberta, Canada, during the 2009 pandemic. The effects are visually apparent in the data and confirmed by transmission modeling. The 2009 pandemic emerged first in Mexico in April 2009 (6). The subtype of the new virus (A/H1N1) was the same as the 1918 pandemic strain, descendants of which have circulated continuously since 1977 (7). However, the new pandemic H1N1 (pH1N1) virus was sufficiently antigenically novel in humans that preexisting immunity seemed to be weak or absent in most persons (8). The World Health Organization declared the outbreak to be a pandemic on 11 June 2009 (8). By the end of December 2009, more than 12 000 deaths and more than 600 000 laboratory-confirmed cases of pH1N1 had been reported worldwide (9, 10). The World Health Organization declared the pandemic to be over on 10 August 2010. pandemic influenza cases. Mathematical models suggested that school closure reduced transmission among school-age children by more than 50\% and that this was a key factor in interrupting transmission. The models also indicated that seasonal changes in weather had a significant effect on the temporal pattern of the epidemic. LIMITATIONS: Data probably represent a small sample of all viral infections. The mathematical models make simplifying assumptions in order to make simulations and analysis feasible. CONCLUSION: Analysis of data from unrestricted virologic testing during an influenza pandemic provides compelling evidence that closing schools can have dramatic effects on transmission of pandemic influenza. School closure seems to be an effective strategy for slowing the spread of pandemic influenza in countries with social contact networks similar to those in Canada.