Effect of school closure on the incidence of influenza among school-age children in Arizona

Prolonged School Closure and Pediatric Respiratory Hospitalization: The Silver Lining of the COVID-19 Pandemic

Objective. This is a single-center retrospective cohort study that aimed to quantitatively assess the association between prolonged school closure (>2 weeks) and pediatric respiratory hospitalization during the COVID-19 pandemic. Methods. Subjects included 1243 patients presenting to Children's Hospital of Michigan during the winters of 2019, 2020, and 2021. The primary outcome measures were total respiratory hospitalizations and respiratory diagnoses. Results. Data was analyzed using a 2-sample z-test for proportions. We found that pediatric patients in the setting of prolonged school closure had significantly fewer hospitalizations in 2020 compared to 2019 (9% vs 47%; P < .001) and 2021 (9% vs 45%; P < .001). There were decreases in bronchiolitis, asthma/reactive airway disease (RAD), and pneumonia hospitalizations compared to 2019 and 2021. Conclusions. Our study showed that during prolonged school closure, there was a significant decrease in pediatric respiratory hospitalization. As such, it should be considered when creating a pandemic response strategy.

Effect of planned school breaks on student absenteeism due to influenza-like illness in school aged children-Oregon School District, Wisconsin September 2014-June 2019

Background

School-aged children and school reopening dates have important roles in community influenza transmission. Although many studies evaluated the impact of reactive closures during seasonal and pandemic influenza outbreaks on medically attended influenza in surrounding communities, few assess the impact of planned breaks (i.e., school holidays) that coincide with influenza seasons, while accounting for differences in seasonal peak timing. Here, we analyze the effects of winter and spring breaks on influenza risk in school-aged children, measured by student absenteeism due to influenza-like illness (a-ILI).

Methods

We compared a-ILI counts in the 2-week periods before and after each winter and spring break over five consecutive years in a single school district. We introduced a "pseudo-break" of 9 days' duration between winter and spring break each year when school was still in session to serve as a control. The same analysis was applied to each pseudo-break to support any findings of true impact.

Results

We found strong associations between winter and spring breaks and a reduction in influenza risk, with a nearly 50% reduction in a-ILI counts post-break compared with the period before break, and the greatest impact when break coincided with increased local influenza activity while accounting for possible temporal and community risk confounders.

Conclusions

These findings suggest that brief breaks of in-person schooling, such as planned breaks lasting 9-16 calendar days, can effectively reduce influenza in schools and community spread. Additional analyses investigating the impact of well-timed shorter breaks on a-ILI may determine an optimal duration for brief school closures to effectively suppress community transmission of influenza.

Trends in Pediatric Head and Facial Trauma During the COVID-19 Pandemic

INTRODUCTION

The effect of physical-distancing policies and school closures on pediatric health has been a topic of major concern in the United States during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to assess the immediate impact of these public policies on patterns of head and facial trauma in the pediatric population.

MATERIALS AND METHOD

The Pediatric Health Information System (PHIS) was queried to identify patient encounters at 46 children's hospitals across the United States in 2016-2020. Encounters were included if resultant in ICD-10 diagnosis for head or facial trauma in a child under 18 between April 1 and June 30 in 2020 (first COVID-19 school closures) and during the same period in the previous 4 years (for comparison).

RESULTS

A total of 170,832 patient encounters for pediatric head and facial trauma were recorded during the study period, including 28,030 (16.4%) in 2020 and 142,802 (83.6%) in 2016-2019. Patient encounters declined significantly in 2020 among children of all age groups relative to previous years. Relative reductions were greatest in children aged 11 to 17 (middle/high school) and 6 to 10 (elementary school), at -34.6% (95% confidence interval: -23.6%, -44%; P <0.001) and -27.7% (95% confidence interval: -18.4%, -36%; P <0.001). Variation in relative reductions by race/ethnicity, sex, and rural/urban status were not statistically significant.

CONCLUSIONS

Physical-distancing policies and school closures at the start of the COVID-19 pandemic correlated with significant reductions in pediatric head and facial trauma patient encounters. As in-person activities resume, reductions in head and facial trauma during the pandemic may indicate a range of possible preventable injuries in the future.

Impact of COVID-19 on psychological and academic performance of medical students in Saudi Arabia

Background and Objectives:

The COVID-19 pandemic affected the mental health and psychosocial conditions of everyone worldwide according to the WHO. Public health emergencies affect college students and are expressed as anxiety, worry, and fear. The aim of this study was to assess the impact of COVID-19 on the psychological health and performance of medical students.

Design and Settings:

A cross-sectional study using an online survey was done.

Participants and Methods:

Participants were 1591 Saudi medical students. A predesigned questionnaire included questions on demographic characters, GPA, having a relative got COVID-19, how to face sad news and stressors, and satisfaction with online lectures. The Generalized Anxiety Disorder (GAD-7) scale was used that included seven items asking about the degree the participant was bothered by feeling anxious in the last 2 weeks.

Results:

A total of 59.4% of students had various degrees of anxiety. Participant age, unsteady family income, high grade point average (GPA,) satisfaction with the online lectures, and being female were associated with higher GAD-7 scores.

Conclusion:

Mental health of medical students was significantly affected by the COVID-19 pandemic. Psychological support programs for medical students during the pandemic and provision of high-quality distance learning is essential for psychological well-being during the pandemic.

Teaching and Researching in the Context of COVID-19: An Empirical Study in Higher Education

There is increasing recognition worldwide of the importance of academic activities, specifically in situations of pandemics. Therefore, this study aimed to understand the effects of COVID-19 on lecturers/researchers and Ph.D. and master students who have faced unexpected and continuous disruption in their teaching and research activities. To fulfil the aims, the study focused on a mixed method approach quantitative study based on a questionnaire administered on social networks and open questions. The unit of analysis was lecturers/researchers and Ph.D. and master students. The results obtained show that this lengthy interruption had severe impacts on their activities, requiring new competencies and capacities to deal with changes in a short period of time, including less positive feelings affecting them and their families. The main contribution of this study lies in identifying the barriers and opportunities created by this virus in the academic world and in presenting a theoretical framework to improve the situation, given that the confinement exponentiated negative and psychological feelings in academics, although telework is seen as a positive factor with continuity in the future, as a way to foster the social, environmental sustainability of Higher Education Institutions (HEIs) and the wellbeing of their human capital. As implications for practice, the evidence points to the need for academics to be provided with training in E-learning, about technological tools for use in distance-learning and to reconsider how they carry out their research on the ground.

School closures were over-weighted against the mitigation of COVID-19 transmission: A literature review on the impact of school closures in the United States

BACKGROUND

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread wildly across the world. In March of 2020, almost all kindergarten through 12th grade (K-12) schools were closed in the United States in an urgent attempt to curb the pandemic in the absence of effective therapeutics or vaccination. Thirteen months since then, schools remain partially closed. Accumulated evidence suggests that children and adolescents are not the primary facilitators of transmission, limiting the restrictive effects of school closures on disease transmission. The negative effects of school closures on K-12 students need to be systematically reviewed.

METHODS

Following the guideline of Preferred Reporting Items for Systematic Reviews and Meta-analyzes, a comprehensive literature search from PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science regarding school closures and its impact on K-12 students was conducted. The primary outcomes included the impact of school closures on the mitigation of the pandemic and the resulting public health concerns of K-12 students.

RESULTS

Prolonged school closures possessed negative effects on K-12 students' physical, mental, and social well-being and reduced the number of health and social workers, hindering the reopening of the country.

CONCLUSIONS

School closures were over-weighted against the mitigation of coronavirus disease 2019 (COVID-19) transmission. A safe reopening of all K-12 schools in the United States should be of top priority.

Impact of COVID-19 on Educational Sustainability. Initial Perceptions of the University Community of the University of Cádiz

This research analyses the impact of COVID-19 on the Spanish university system during the period of home lockdown put in place by the government of Spain between 15 March and 21 June 2020. This period did not involve a change to online teaching. Instead, it involved emergency remote teaching, wherein the content of face-to-face teaching was taught through non-classroom training using media, devices and tools available at that time. The main objective of the paper is related to the perceptions of students and teachers on emergency remote teaching regarding the face-to-face model. We applied statistical techniques of descriptive and inferential analysis over a sample of 2778 students and 221 teaching staff from the University of Cádiz. We also analysed the methodologies used, as well as the acquisition of skills, competencies and knowledge by the students in this situation, in order to detect whether this type of action can achieve sustainable education. This term refers to education that is capable of maintaining the continuous quality of the training of each student, who should acquire the required knowledge and competences regardless of unforeseen events. However, according to the results of this research, the sudden transition to e-learning, based on available technological and computer-based methods, did not guarantee sustainable education or its quality. This study establishes different possibilities for improving non-face-to-face teaching in this kind of situation. The results show greatly concerning levels of training and evaluation, as well as worse acquisition of skills. Both teachers and students declared a preference for face-to-face teaching. This perception should prompt the educational authorities to solve the existing problems in e-learning education, improving the transition and guaranteeing the sustainability of non-face-to-face education. This research highlights the areas for improvement in e-learning education in the ongoing situation, the general uncertainty in the transition, the lack of communication and the completion of a fair evaluation system. The results show that the methods used in this period must be improved to achieve sustainable teaching and learning during a pandemic. The results also emphasize the uncertainty in the educational community about the entire process. This study will help the educational authorities to improve the change of paradigm in higher education in the future.

Examining university students' behavioural intention to use e-learning during the COVID-19 pandemic: An extended TAM model

This present study aims to investigate factors that impact behavioural intention of university students on e-learning use during the COVID-19 pandemic. An online questionnaire was utilised to gather data from 109 students enrolled in one of the universities in Indonesia. The Technology Acceptance Model (TAM) was the primary framework employed for analysis, in which system quality and e-learning experience were included as external constructs to seek out a much better model to improve the understanding of students' intention to adopt e-learning. An extended TAM model was developed and tested in this study. The model consists of six constructs: system quality, e-learning experience, perceived ease of use, perceived usefulness, attitude toward use, and behavioural intention. Structural Equation Modelling (SEM) and SMART PLS 3.0 software were applied for data analysis. The findings informed that the proposed model has been succefully explained factors university students use of e-learning during the pandemic in Indonesia. It suggested that attitude toward e-learning use was the most prominent construct to predict university students' behavioural intention to use e-learning during the pandemic. Finally, this study offers recommendations for future research and practices.

Implementing social distancing policy measures in the battle against the coronavirus: protocol of a comparative study of Denmark and Sweden

BACKGROUND

Social distancing policies to ensure physical distance between people have become a crucial strategy in the battle against the spread of the coronavirus. The aim of this project is to analyze and compare social distancing policies implemented in Denmark and Sweden in 2020. Despite many similarities between the two countries, their response to the coronavirus pandemic differed markedly. Whereas authorities in Denmark initiated mandatory regulations and many severe restrictions, Swedish authorities predominantly promoted voluntary recommendations.

METHODS

The project is an interdisciplinary collaboration between researchers in Denmark and Sweden with different disciplinary backgrounds. The project is based on a comparative analysis, an approach that attempts to reach conclusions beyond single cases and to explain differences and similarities between objects of analysis and relations between objects against the backdrop of their contextual conditions. Data will be gathered by means of document analysis, qualitative interviews, and a questionnaire survey to address three research questions: (1) What social distancing policies regarding the coronavirus have been formulated and implemented, who are the policymakers behind the policy measures, which implementers are expected to implement the measures, and who are the targets that the measures ultimately seek to influence? (2) How have the social distancing policies and policy measures been justified, and what types of knowledge form the basis for the measures? and (3) What are the differences and similarities in citizens' perceptions of acceptability and compliance with social distancing policy measures in relation to the coronavirus?

DISCUSSION

To create a structure for addressing the three research questions, the project applies a theoretical framework informed by the policy and implementation science literatures. The framework consists of five interdependent domains that have an impact on policy implementation: (1) policymakers, (2) policy characteristics, (3) implementers, (4) targets, and (5) policy environment. Details of the framework are provided in the article.

COVID-19 and Disruption in Management and Education Academics: Bibliometric Mapping and Analysis

COVID-19, What to do now? This issue has had devastating effects in all domains of society worldwide. Lockdowns, the lack of freedom and social distancing meant the closure of a country’s entire activity. Having effects at all levels, beside incalculable ones in health, it is argued that scientific activity in education, business, economics and management suffered some of the most drastic impacts of this pandemic. This study aims to map the scientific literature in these areas in the context of COVID-19 and analyze its content through bibliometrics, which made it possible to highlight the scarcity of studies on the topic, namely empirical studies on the effects of this pandemic on scientific research and teaching/education. The results show there is a lack of peer-reviewed publications on this topic, with the studies covered (93) via the threads used revealing only 28 articles coming within the proposed objective. The bibliometrics corroborates that shortage. Finally, the contributions and implications for theory and practice are presented, followed by the limitations and suggestions for future research.

School closure, COVID-19 and lunch programme: Unprecedented undernutrition crisis in low-middle income countries

The coronavirus disease 2019 pandemic has affected nearly 70% of children and teenagers around the world due to school closure policies. School closure is implemented widely in order to prevent viral transmission and its impact on the broader community, based on preliminary recommendations and evidence from influenza. However, there is debate with regard to the effectiveness of school closures. Growing evidence suggests that a child's SARS-CoV-2 infection is often mild or asymptomatic and that children may not be major SARS-CoV-2 transmitters; thus, it is questionable if school closures prevent transmission significantly. This question is important as a majority of children in low- and middle-income countries depend on free school meals; unexpected long-term school closure may adversely impact nutrition and educational outcomes. Food insecurity is expected to be higher during the pandemic. In this viewpoint, we argue for a more thorough exploration of potential adverse impacts of school closures in low- and middle-income countries and recommend actions to ensure that the health and learning needs of vulnerable populations are met in this time of crisis.

Weathering the pandemic: How the Caribbean Basin can use viral and environmental patterns to predict, prepare, and respond to COVID-19

The 2020 coronavirus pandemic is developing at different paces throughout the world. Some areas, like the Caribbean Basin, have yet to see the virus strike at full force. When it does, there is reasonable evidence to suggest the consequent COVID‐19 outbreaks will overwhelm healthcare systems and economies. This is particularly concerning in the Caribbean as pandemics can have disproportionately higher mortality impacts on lower and middle‐income countries. Preliminary observations from our team and others suggest that temperature and climatological factors could influence the spread of this novel coronavirus, making spatiotemporal predictions of its infectiousness possible. This review studies geographic and time‐based distribution of known respiratory viruses in the Caribbean Basin in an attempt to foresee how the pandemic will develop in this region. This review is meant to aid in planning short‐ and long‐term interventions to manage outbreaks at the international, national, and subnational levels in the region.

Inter‐tropical regions have seen a slower spread of SARS‐CoV‐2 compared to temperate ones, suggesting viral spreading could likely be influenced by environmental factors.

Other coronaviruses also seem to respond to environmental factors, with peaks closely following the geotemporal patterns of influenza.

In the Caribbean, timing interventions to fight COVID‐19 around the projected peaks of influenza is a reasonable public health approach.

Closure of Universities Due to Coronavirus Disease 2019 (COVID-19): Impact on Education and Mental Health of Students and Academic Staff

The novel coronavirus disease 2019 (COVID-19), originated in Wuhan city of China, has spread rapidly around the world, sending billions of people into lockdown. The World Health Organization (WHO) declared the coronavirus epidemic a pandemic. In light of rising concern about the current COVID-19 pandemic, a growing number of universities across the world have either postponed or canceled all campus events such as workshops, conferences, sports, and other activities. Universities are taking intensive measures to prevent and protect all students and staff members from the highly infectious disease. Faculty members are already in the process of transitioning to online teaching platforms. In this review, the author will highlight the potential impact of the terrible COVID-19 outbreak on the education and mental health of students and academic staff.

The impact of unplanned school closure on children's social contact: rapid evidence review

BackgroundEmergency school closures are often used as public health interventions during infectious disease outbreaks to minimise the spread of infection. However, if children continue mixing with others outside the home during closures, the effect of these measures may be limited.AimThis review aimed to summarise existing literature on children's activities and contacts made outside the home during unplanned school closures.MethodsIn February 2020, we searched four databases, MEDLINE, PsycInfo, Embase and Web of Science, from inception to 5 February 2020 for papers published in English or Italian in peer-reviewed journals reporting on primary research exploring children's social activities during unplanned school closures. Main findings were extracted.ResultsA total of 3,343 citations were screened and 19 included in the review. Activities and social contacts appeared to decrease during closures, but contact remained common. All studies reported children leaving the home or being cared for by non-household members. There was some evidence that older child age (two studies) and parental disagreement (two studies) with closure were predictive of children leaving the home, and mixed evidence regarding the relationship between infection status and such. Parental agreement with closure was generally high, but some disagreed because of perceived low risk of infection and issues regarding childcare and financial impact.ConclusionEvidence suggests that many children continue to leave home and mix with others during school closures despite public health recommendations to avoid social contact. This review of behaviour during unplanned school closures could be used to improve infectious disease modelling.

The impact of unplanned school closure on children's social contact: rapid evidence review

BackgroundEmergency school closures are often used as public health interventions during infectious disease outbreaks to minimise the spread of infection. However, if children continue mixing with others outside the home during closures, the effect of these measures may be limited.AimThis review aimed to summarise existing literature on children's activities and contacts made outside the home during unplanned school closures.MethodsIn February 2020, we searched four databases, MEDLINE, PsycInfo, Embase and Web of Science, from inception to 5 February 2020 for papers published in English or Italian in peer-reviewed journals reporting on primary research exploring children's social activities during unplanned school closures. Main findings were extracted.ResultsA total of 3,343 citations were screened and 19 included in the review. Activities and social contacts appeared to decrease during closures, but contact remained common. All studies reported children leaving the home or being cared for by non-household members. There was some evidence that older child age (two studies) and parental disagreement (two studies) with closure were predictive of children leaving the home, and mixed evidence regarding the relationship between infection status and such. Parental agreement with closure was generally high, but some disagreed because of perceived low risk of infection and issues regarding childcare and financial impact.ConclusionEvidence suggests that many children continue to leave home and mix with others during school closures despite public health recommendations to avoid social contact. This review of behaviour during unplanned school closures could be used to improve infectious disease modelling.

Preventive Effects of Vitamin D on Seasonal Influenza A in Infants: A Multicenter, Randomized, Open, Controlled Clinical Trial

OBJECTIVES

This study aimed to evaluate the clinical efficacy and safety of vitamin D for preventing influenza A in 400 infants in a multicenter, randomized, open, controlled clinical trial.

METHODS

The infants were randomized into low-dose and high-dose vitamin D groups, and serum calcium, inorganic phosphorus and 25-hydroxyvitamin D levels were detected thrice in 4 months. Infants infected with influenza A were monitored for symptoms including fever, cough and wheezing. Pathogen levels and safety of vitamin D treatment were also evaluated.

RESULTS

Of 121 cases in total, 78 and 43 cases of influenza A infection occurred in the low-dose and high-dose vitamin D groups, respectively. There was a significant difference between the groups (χ = 14.6324, P = 0.0001). Among the cases of influenza infection, the median durations for fever, cough and wheezing were shorter in the high-dose vitamin D group than in the low-dose vitamin D group. The viral loads showed a downward trend in both groups and were significantly different between the groups at the second and third detections. Additionally, the incidences of adverse events and severe adverse events were very low and not significantly different between the 2 groups.

CONCLUSION

High-dose vitamin D (1200 IU) is suitable for the prevention of seasonal influenza as evidenced by rapid relief from symptoms, rapid decrease in viral loads and disease recovery. In addition, high-dose vitamin D is probably safe for infants.

The impact of hand, foot and mouth disease control policies in Singapore: A qualitative analysis of public perceptions

Hand foot and mouth disease (HFMD) is a widespread pediatric disease in Asia. Most cases are relatively mild and caused by Coxsackie viruses, but in epidemics caused by Enterovirus 71, severe complications can occur. In response to the deaths of dozens of children in a 1997 outbreak (Podin in BMC Public Health 6:180,1 Abubakar in Virus Res 61(1):1-9,2 WHO in3), Singapore practices childcare centre surveillance, case-isolation, and short-term closure of centres. We conducted 44 in-depth interviews with teachers, principals, and parents at four childcare centres in Singapore to better understand experiences with current control policies. We used applied thematic analysis to identify recurrent and unique themes. Participants were conflicted by perceiving HFMD as a severe illness and reported a sense of helplessness when hygiene and social-isolation efforts failed. They perceived that severity of HFMD influenced Singapore's choice of existing policies despite a lack of evidence of their effectiveness. Documenting stakeholders' perspectives clarifies the impact of control measures and how to communicate policy changes.

Contact, Travel, and Transmission: The Impact of Winter Holidays on Influenza Dynamics in the United States

Background

The seasonality of influenza is thought to vary according to environmental factors and human behavior. During winter holidays, potential disease-causing contact and travel deviate from typical patterns. We aim to understand these changes on age-specific and spatial influenza transmission.

Methods

We characterized the changes to transmission and epidemic trajectories among children and adults in a spatial context before, during, and after the winter holidays among aggregated physician medical claims in the United States from 2001 to 2009 and among synthetic data simulated from a deterministic, age-specific spatial metapopulation model.

Results

Winter holidays reduced influenza transmission and delayed the trajectory of influenza season epidemics. The holiday period was marked by a shift in the relative risk of disease from children toward adults. Model results indicated that holidays delayed epidemic peaks and synchronized incidence across locations, and that contact reductions from school closures, rather than age-specific mixing and travel, produced these observed holiday influenza dynamics.

Conclusions

Winter holidays delay seasonal influenza epidemic peaks and shift disease risk toward adults because of changes in contact patterns. These findings may inform targeted influenza information and vaccination campaigns during holiday periods.

Influence of School Year on Seasonality of Norovirus Outbreaks in Developed Countries

Factors affecting the seasonal distribution of norovirus outbreaks are not well understood. This study examined whether grade school settings at the start of the school year may be a factor. We searched Ovid Medline from January 2002 to June 2014 for studies that provided all reported norovirus outbreaks in a developed country by month for a minimum of three years. Historical school years were obtained from verifiable sources. The start of the norovirus seasonal outbreak peak and peak outbreak month were determined for each study and compared to the start month of school. Northern hemisphere and southern hemisphere countries had a different norovirus seasonality and different school year structures (traditional compared to year round). In the two studies that provided outbreaks by age, outbreaks among children started several months before outbreaks in the adult population. The median number of months between school start and start of the seasonal outbreak peak was two months (interquartile range [IQR] = 2.0-3.0), while the median number of months between school start and peak outbreak month was four months (IQR = 3.0-4.0). These findings suggest the possibility the school setting at the start of the school year may be a factor in the seasonality of norovirus.

Reactive School Closure During Increased Influenza-Like Illness (ILI) Activity in Western Kentucky, 2013: A Field Evaluation of Effect on ILI Incidence and Economic and Social Consequences for Families

A reactive school closure following high influenza-like illness-related student absenteeism in a Kentucky school district did not influence reported influenza-like illness transmission in student households.

Background. School closures are an important mitigation strategy during influenza pandemic: if implemented early in a local outbreak, they can slow the disease spread in the surrounding community. During seasonal influenza epidemics, school closures may occur reactively, after the disease is already widespread in the community. Such reactive closures are often too late to reduce influenza transmission. However, they can provide data to determine under which circumstances they might be effective in reducing influenza-like illness (ILI) transmission.

Methods. We conducted a household survey in a school district in Kentucky. District A closed after high student absenteeism due to influenza-like illness (ILI), whereas adjacent Districts B and C remained open. We collected data on self-reported ILI among household members in these 3 districts 2 weeks before the District A closure, during closure, and 2 weeks after reopening, and we evaluated economic and social consequences of school closure on student households in District A. The difference-in-differences method was applied to compare changes in ILI rates from before to after closure between districts.

Results. Estimated average daily ILI rate decreased less in District A than in District B or C for the entire sample and when stratified by age groups (0–5 years old, 6–18 years old, and above 18 years old). Twenty-five percent of District A households reported ≥1 closure-related economic or social difficulty.

Conclusions. Closing schools after a widespread ILI activity in District A did not reduce ILI transmission but caused difficulties for some households.

Evidence compendium and advice on social distancing and other related measures for response to an influenza pandemic

The role of social distancing measures in mitigating pandemic influenza is not precisely understood. To this end, we have conducted a systematised review, particularly in light of the 2009 pandemic influenza, to better inform the role of social distancing measures against pandemic influenza. Articles were identified from relevant databases and the data were synthesised to provide evidence on the role of school or work place-based interventions, case-based distancing (self-isolation, quarantine), and restriction of mobility and mass gatherings. School closure, whether proactive or reactive, appears to be moderately effective and acceptable in reducing the transmission of influenza and in delaying the peak of an epidemic but is associated with very high secondary costs. Voluntary home isolation and quarantine are also effective and acceptable measures but there is an increased risk of intra-household transmission from index cases to contacts. Work place-related interventions like work closure and home working are also modestly effective and are acceptable, but likely to be economically disruptive. Internal mobility restriction is effective only if prohibitively high (50% of travel) restrictions are applied and mass gatherings occurring within 10 days before the epidemic peak are likely to increase the risk of transmission of influenza.

Prevention of influenza in healthy children

Healthy children are high transmitters of influenza and can experience poor influenza outcomes. Many questions remain about the efficacy and impect of preventive measures because most existing studies report imprecise proxies of influenza incidence, do not follow subjects throughout the entire influenza season and across multiple influenza seasons, or do not control for important factors such as timing of implementation and social contact patterns. Modeling and simulation are key methodologies to answer questions regarding influenza prevention. While vaccination may be the most efficacious existing intervention, variations in circulating strains and children's immune systems keep current vaccines from being fully protective, necessitating further clinical and economic studies and technology improvements. Hand hygiene appears to be an important adjunct but improving compliance, standardizing regimens and quantifying its impact remain challenging. Future studies should help better define the specific indications and circumstances for antiviral use and the role of nutritional supplements and nonpharmaceutical interventions.

School closures and influenza: systematic review of epidemiological studies

OBJECTIVE

To review the effects of school closures on pandemic and seasonal influenza outbreaks.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE and EMBASE, reference lists of identified articles, hand searches of key journals and additional papers from the authors' collections.

STUDY SELECTION

Studies were included if they reported on a seasonal or pandemic influenza outbreak coinciding with a planned or unplanned school closure.

RESULTS

Of 2579 papers identified through MEDLINE and EMBASE, 65 were eligible for inclusion in the review along with 14 identified from other sources. Influenza incidence frequently declined after school closure. The effect was sometimes reversed when schools reopened, supporting a causal role for school closure in reducing incidence. Any benefits associated with school closure appeared to be greatest among school-aged children. However, as schools often closed late in the outbreak or other interventions were used concurrently, it was sometimes unclear how much school closure contributed to the reductions in incidence.

CONCLUSIONS

School closures appear to have the potential to reduce influenza transmission, but the heterogeneity in the data available means that the optimum strategy (eg, the ideal length and timing of closure) remains unclear.