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Masumoto Y, Kawasaki H, Tsunematsu M, Matsuyama R, Kakehashi M. Decisions and Influential Factors Regarding Class-Specific School Closures Against Seasonal Influenza Outbreak. Cureus 2024; 16:e62394. [PMID: 39006659 PMCID: PMC11246727 DOI: 10.7759/cureus.62394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
Background One of the characteristics of school closure in Japan is class-specific school closure, which involves a reactive, short-term closure in the event of an infectious disease outbreak. These closures are implemented at each school in reaction to the annual seasonal influenza outbreaks. Very little research has addressed the formation of class-specific school closures to combat infectious diseases in elementary schools. We carried out a survey on factors involved in the decision to close classes and the determination of the timing and duration of class closures in elementary schools in Japan. Methods A mail-based questionnaire survey of elementary schools from four prefectures in western Japan was conducted between August and September 2021. The questions addressed the criteria for school closures (the timing and duration of class closure), various considerations, and confusion regarding class closures, with answers analyzed using descriptive statistical methods. Results In total, 714 elementary schools responded to the survey (37.9%). Furthermore, 398 (55.7%) schools established criteria for class closures during seasonal influenza. Class closure was most frequently initiated in schools with criteria when either 20% or 30% of class pupils were absent; the most common duration was three days. The duration of class closures was decided upon depending on the outbreak in some schools (69.8%), depending on the circumstances of the outbreak. Regarding class closure decisions, schools viewed school physicians' opinions as a priority, followed by school events, adjustments for Saturdays and Sundays, and Yogo teachers' opinions. Schools answering "no criteria for class closure" or "adjustments for Saturdays and Sundays" had difficulty determining class closure duration. Conclusion To guarantee the continuation of children's education and improve the effectiveness of preventive efforts against seasonal influenza, the following were considered important and helpful in class closure decision-making in elementary schools: scientific evidence, the school physician's opinion, and Yogo teachers' analysis of children's health information.
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Affiliation(s)
- Yukiko Masumoto
- School and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Hiromi Kawasaki
- Department of Health Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Miwako Tsunematsu
- Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Ryota Matsuyama
- Department of Veterinary Medicine, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, JPN
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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2
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Jit M, Cook AR. Informing Public Health Policies with Models for Disease Burden, Impact Evaluation, and Economic Evaluation. Annu Rev Public Health 2024; 45:133-150. [PMID: 37871140 DOI: 10.1146/annurev-publhealth-060222-025149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Conducting real-world public health experiments is often costly, time-consuming, and ethically challenging, so mathematical models have a long-standing history of being used to inform policy. Applications include estimating disease burden, performing economic evaluation of interventions, and responding to health emergencies such as pandemics. Models played a pivotal role during the COVID-19 pandemic, providing early detection of SARS-CoV-2's pandemic potential and informing subsequent public health measures. While models offer valuable policy insights, they often carry limitations, especially when they depend on assumptions and incomplete data. Striking a balance between accuracy and timely decision-making in rapidly evolving situations such as disease outbreaks is challenging. Modelers need to explore the extent to which their models deviate from representing the real world. The uncertainties inherent in models must be effectively communicated to policy makers and the public. As the field becomes increasingly influential, it needs to develop reporting standards that enable rigorous external scrutiny.
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Affiliation(s)
- Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom;
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Health System, Singapore
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3
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Guzzetta G, Ajelli M, Miglietta A, Fazio C, Neri A, Merler S, Rezza G, Stefanelli P. Evaluating the effect of targeted strategies as control tools for hypervirulent meningococcal C outbreaks: a case study from Tuscany, Italy, 2015 to 2016. Euro Surveill 2023; 28:2200650. [PMID: 37166763 PMCID: PMC10176827 DOI: 10.2807/1560-7917.es.2023.28.19.2200650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/13/2022] [Indexed: 05/12/2023] Open
Abstract
BackgroundMeningococcus (Neisseria meningitidis) is the causative bacteria of invasive meningococcal disease (IMD), a major cause of meningitis and sepsis. In 2015-16, an outbreak caused by serogroup C meningococci (MenC), belonging to the hyperinvasive strain ST-11(cc-11), resulted in 62 IMD cases in the region of Tuscany, Italy.AimWe aimed to estimate the key outbreak parameters and assess the impact of interventions used in the outbreak response.MethodsWe developed a susceptible-carrier-susceptible individual-based model of MenC transmission, accounting for transmission in households, schools, discos/clubs and the general community, which was informed by detailed data on the 2015-16 outbreak (derived from epidemiological investigations) and on the implemented control measures.ResultsThe outbreak reproduction number (Re) was 1.35 (95% prediction interval: 1.13-1.47) and the IMD probability was 4.6 for every 1,000 new MenC carriage episodes (95% confidence interval: 1.8-12.2). The interventions, i.e. chemoprophylaxis and vaccination of close contacts of IMD cases as well as age-targeted vaccination, were effective in reducing Re and ending the outbreak. Case-based interventions (including ring vaccination) alone would have been insufficient to achieve outbreak control. The definition of age groups to prioritise vaccination had a critical impact on the effectiveness and efficiency of control measures.ConclusionsOur findings suggest that there are no effective alternatives to widespread reactive vaccination during outbreaks of highly transmissible MenC strains. Age-targeted campaigns can increase the effectiveness of vaccination campaigns. These results can be instrumental to define effective guidelines for the control of future meningococcal outbreaks caused by hypervirulent strains.
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Affiliation(s)
- Giorgio Guzzetta
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Marco Ajelli
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, United States
| | - Alessandro Miglietta
- Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence , Italy
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cecilia Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Giovanni Rezza
- Health Prevention Directorate, Ministry of Health, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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4
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Xue Y, Chen D, Smith SR, Ruan X, Tang S. Coupling the Within-Host Process and Between-Host Transmission of COVID-19 Suggests Vaccination and School Closures are Critical. Bull Math Biol 2022; 85:6. [PMID: 36536179 PMCID: PMC9762651 DOI: 10.1007/s11538-022-01104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/02/2022] [Indexed: 12/23/2022]
Abstract
Most models of COVID-19 are implemented at a single micro or macro scale, ignoring the interplay between immune response, viral dynamics, individual infectiousness and epidemiological contact networks. Here we develop a data-driven model linking the within-host viral dynamics to the between-host transmission dynamics on a multilayer contact network to investigate the potential factors driving transmission dynamics and to inform how school closures and antiviral treatment can influence the epidemic. Using multi-source data, we initially determine the viral dynamics and estimate the relationship between viral load and infectiousness. Then, we embed the viral dynamics model into a four-layer contact network and formulate an agent-based model to simulate between-host transmission. The results illustrate that the heterogeneity of immune response between children and adults and between vaccinated and unvaccinated infections can produce different transmission patterns. We find that school closures play a significant effect on mitigating the pandemic as more adults get vaccinated and the virus mutates. If enough infected individuals are diagnosed by testing before symptom onset and then treated quickly, the transmission can be effectively curbed. Our multiscale model reveals the critical role played by younger individuals and antiviral treatment with testing in controlling the epidemic.
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Affiliation(s)
- Yuyi Xue
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Daipeng Chen
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Stacey R Smith
- The Department of Mathematics and Faculty of Medicine, The University of Ottawa, Ottawa, Canada
| | - Xiaoe Ruan
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Sanyi Tang
- School of Mathematics and Statistics, Shaanxi Normal university, Xi'an, 710062, People's Republic of China.
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5
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Ertem Z, Araz OM, Cruz-Aponte M. A decision analytic approach for social distancing policies during early stages of COVID-19 pandemic. DECISION SUPPORT SYSTEMS 2022; 161:113630. [PMID: 34219851 PMCID: PMC8233412 DOI: 10.1016/j.dss.2021.113630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 05/24/2023]
Abstract
The COVID-19 pandemic has become a crucial public health problem in the world that disrupted the lives of millions in many countries including the United States. In this study, we present a decision analytic approach which is an efficient tool to assess the effectiveness of early social distancing measures in communities with different population characteristics. First, we empirically estimate the reproduction numbers for two different states. Then, we develop an age-structured compartmental simulation model for the disease spread to demonstrate the variation in the observed outbreak. Finally, we analyze the computational results and show that early trigger social distancing strategies result in smaller death tolls; however, there are relatively larger second waves. Conversely, late trigger social distancing strategies result in higher initial death tolls but relatively smaller second waves. This study shows that decision analytic tools can help policy makers simulate different social distancing scenarios at the early stages of a global outbreak. Policy makers should expect multiple waves of cases as a result of the social distancing policies implemented when there are no vaccines available for mass immunization and appropriate antiviral treatments.
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Affiliation(s)
- Zeynep Ertem
- Systems Science and Industrial Engineering Department, SUNY Binghamton, Binghamton, NY, USA
| | - Ozgur M Araz
- Supply Chain Management and Analytics Department, College of Business, University of Nebraska Lincoln, NE, USA
| | - Mayteé Cruz-Aponte
- Mathematics and Physics Department, University of Puerto Rico - Cayey, PR, USA
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6
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Franco C, Ferreira LS, Sudbrack V, Borges ME, Poloni S, Prado PI, White LJ, Águas R, Kraenkel RA, Coutinho RM. Percolation across households in mechanistic models of non-pharmaceutical interventions in SARS-CoV-2 disease dynamics. Epidemics 2022; 39:100551. [PMID: 35325705 PMCID: PMC8916837 DOI: 10.1016/j.epidem.2022.100551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 11/03/2022] Open
Abstract
Since the emergence of the novel coronavirus disease 2019 (COVID-19), mathematical modelling has become an important tool for planning strategies to combat the pandemic by supporting decision-making and public policies, as well as allowing an assessment of the effect of different intervention scenarios. A proliferation of compartmental models were developed by the mathematical modelling community in order to understand and make predictions about the spread of COVID-19. While compartmental models are suitable for simulating large populations, the underlying assumption of a well-mixed population might be problematic when considering non-pharmaceutical interventions (NPIs) which have a major impact on the connectivity between individuals in a population. Here we propose a modification to an extended age-structured SEIR (susceptible-exposed-infected-recovered) framework, with dynamic transmission modelled using contact matrices for various settings in Brazil. By assuming that the mitigation strategies for COVID-19 affect the connections among different households, network percolation theory predicts that the connectivity among all households decreases drastically above a certain threshold of removed connections. We incorporated this emergent effect at population level by modulating home contact matrices through a percolation correction function, with the few additional parameters fitted to hospitalisation and mortality data from the city of São Paulo. Our model with percolation effects was better supported by the data than the same model without such effects. By allowing a more reliable assessment of the impact of NPIs, our improved model provides a better description of the epidemiological dynamics and, consequently, better policy recommendations.
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Affiliation(s)
- Caroline Franco
- Institute of Theoretical Physics, São Paulo State University, São Paulo, Brazil; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Observatório COVID-19 BR, Brazil.
| | - Leonardo Souto Ferreira
- Institute of Theoretical Physics, São Paulo State University, São Paulo, Brazil; Observatório COVID-19 BR, Brazil
| | - Vítor Sudbrack
- Institute of Theoretical Physics, São Paulo State University, São Paulo, Brazil; Observatório COVID-19 BR, Brazil; Department of Ecology and Evolution, University of Lausanne, Lausanne, Switzerland
| | | | - Silas Poloni
- Institute of Theoretical Physics, São Paulo State University, São Paulo, Brazil; Observatório COVID-19 BR, Brazil
| | - Paulo Inácio Prado
- Observatório COVID-19 BR, Brazil; Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
| | - Lisa J White
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ricardo Águas
- Nuffield Department of Medicine, University of Oxford, Centre for Tropical Medicine and Global Health, Oxford, UK
| | - Roberto André Kraenkel
- Institute of Theoretical Physics, São Paulo State University, São Paulo, Brazil; Observatório COVID-19 BR, Brazil
| | - Renato Mendes Coutinho
- Observatório COVID-19 BR, Brazil; Centro de Matemática, Computação e Cognição - Universidade Federal do ABC, Santo André, Brazil
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Meng X, Zhao H, Ou R, Zeng Q, Lv H, Zhu H, Ye M. Epidemiological and Clinical Characteristics of Influenza Outbreaks Among Children in Chongqing, China. Front Public Health 2022; 10:760746. [PMID: 35493383 PMCID: PMC9051075 DOI: 10.3389/fpubh.2022.760746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Influenza is a global serious public health threat. Seasonal influenza among children in Chongqing has been a heavy health burden. To date, few studies have examined the spatial and temporal characteristics of influenza. This research sheds new light on correlating them with influenza outbreaks with data of over 5 years (2014–2018). All cluster outbreaks among preschool and school-age children reported in Chongqing were collected through the Public Health Emergency Management Information System. The demographical, epidemiological, and clinical data of the cases were analyzed. From 2014 to 2018, a total of 111 preschool- and school-based influenza-like illness outbreaks involving 3,549 cases were identified. Several clinical symptoms that were analyzed in this study showed significant contrast between influenza A and B. Spatial autocorrelation analysis over the 5-year data detected Xiushan district being the most likely cluster. The exploration of the spatial distribution and clinical characteristics of influenza cluster of children in Chongqing could help the effective implementation of health policies. Future studies should be conducted to monitor the outbreaks of influenza among children.
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Affiliation(s)
- Xuchen Meng
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Clinical College, Chongqing Medical University, Chongqing, China
| | - Han Zhao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Rong Ou
- The Library, Chongqing Medical University, Chongqing, China
| | - Qing Zeng
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Huiqun Lv
- The Library, Chongqing Medical University, Chongqing, China
| | - Hua Zhu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Mengliang Ye
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
- *Correspondence: Mengliang Ye
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8
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Trentini F, Pariani E, Bella A, Diurno G, Crottogini L, Rizzo C, Merler S, Ajelli M. Characterizing the transmission patterns of seasonal influenza in Italy: lessons from the last decade. BMC Public Health 2022; 22:19. [PMID: 34991544 PMCID: PMC8734132 DOI: 10.1186/s12889-021-12426-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite thousands of influenza cases annually recorded by surveillance systems around the globe, estimating the transmission patterns of seasonal influenza is challenging. METHODS We develop an age-structured mathematical model to influenza transmission to analyze ten consecutive seasons (from 2010 to 2011 to 2019-2020) of influenza epidemiological and virological data reported to the Italian surveillance system. RESULTS We estimate that 18.4-29.3% of influenza infections are detected by the surveillance system. Influenza infection attack rate varied between 12.7 and 30.5% and is generally larger for seasons characterized by the circulation of A/H3N2 and/or B types/subtypes. Individuals aged 14 years or less are the most affected age-segment of the population, with A viruses especially affecting children aged 0-4 years. For all influenza types/subtypes, the mean effective reproduction number is estimated to be generally in the range 1.09-1.33 (9 out of 10 seasons) and never exceeding 1.41. The age-specific susceptibility to infection appears to be a type/subtype-specific feature. CONCLUSIONS The results presented in this study provide insights on type/subtype-specific transmission patterns of seasonal influenza that could be instrumental to fine-tune immunization strategies and non-pharmaceutical interventions aimed at limiting seasonal influenza spread and burden.
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Affiliation(s)
- Filippo Trentini
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy. .,Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy.
| | - Elena Pariani
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Italian National Institute of Health (ISS), Rome, Italy
| | - Giulio Diurno
- General Directorate for Health Planning, Ministry of Health, Rome, Italy
| | - Lucia Crottogini
- Unità Organizzativa Prevenzione, Regione Lombardia, Milan, Italy
| | - Caterina Rizzo
- Clinical Pathways and Epidemiology Functional Area, Bambino Gesù Children's Hospital, IRCCS IT, Rome, Italy
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
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9
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Wang J, Wang Y, Lin H, Chen X, Wang H, Liang H, Guo X, Fu C. Mental Health Problems Among School-Aged Children After School Reopening: A Cross-Sectional Study During the COVID-19 Post-pandemic in East China. Front Psychol 2021; 12:773134. [PMID: 34858298 PMCID: PMC8631808 DOI: 10.3389/fpsyg.2021.773134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Most studies on mental health problems caused by COVID-19 crisis in children were limited to the period of home quarantine. It remained unclear what adverse impact of the psychosocial stressors caused by school reopening, as well as the transitions in daily activities and social interactions had on mental health in children. Methods: A total of 6400 students in primary schools were enrolled in a cross-sectional study conducted in East China, between June 26 and July 6, 2020, when schools reopened. Children’s mental health status was assessed by the parent version of Strengths and Difficulties Questionnaire (SDQ). Ultimately, data on a total of 6017 children with completed information on mental health, psychosocial stressors, daily activities, and social interactions were eligible for analysis. The associations of mental health with psychosocial stressors, daily activities, and social interactions were determined by ordinal logistic regression models. Stratified analyses were conducted according to grade, gender, school level, area, and caregiver–child relationship to further observe the effects of stressors on mental status. Results: The prevalence of borderline, moderately abnormal, and prominently abnormal scores were 7.16, 3.34, and 1.96% for total difficulties, and 13.83, 13.45, and 17.85% for prosocial behavior, respectively. Children with psychological stressors had a significantly higher risk of being in a worse category of mental health status, with the maximum adjusted OR of 7.90 (95% CI 3.33–18.75) in those definitely afraid of inadaptation to study and life styles. Time used in home work and computer games was positively related to mental health problems, while physical exercises and frequency of communication with others was negatively related. The effects of psychological stressors on total difficulties were more evident in middle-high grade students (OR = 7.52, 95% CI 4.16–8.61), boys (OR = 6.95, 95% CI 4.83–8.55), those who lived in Taizhou (OR = 7.62, 95% CI 4.72–8.61) and with poor caregiver–child relationship (OR = 7.79, 95% CI 2.26–8.65). Conclusion: Emotional and behavioral difficulties, especially less prosocial behavior, were prevalent in primary school children after schools reopened. The Chinese government, communities, schools, and families need to provide more effective support for students’ transition back into the school building and address emotional and behavioral problems for children with difficulties.
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Affiliation(s)
- Jingyi Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Yingying Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Haijiang Lin
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
| | - Hao Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Hongbiao Liang
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
| | - Xiaoqin Guo
- Songjiang District Center for Disease Prevention and Control, Shanghai, China
| | - Chaowei Fu
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
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10
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Within and between classroom transmission patterns of seasonal influenza among primary school students in Matsumoto city, Japan. Proc Natl Acad Sci U S A 2021; 118:2112605118. [PMID: 34753823 PMCID: PMC8609560 DOI: 10.1073/pnas.2112605118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Schools play a central role in the transmission of many respiratory infections. Heterogeneous social contact patterns associated with the social structures of schools (i.e., classes/grades) are likely to influence the within-school transmission dynamics, but data-driven evidence on fine-scale transmission patterns between students has been limited. Using a mathematical model, we analyzed a large-scale dataset of seasonal influenza outbreaks in Matsumoto city, Japan, to infer social interactions within and between classes/grades from observed transmission patterns. While the relative contribution of within-class and within-grade transmissions to the reproduction number varied with the number of classes per grade, the overall within-school reproduction number, which determines the initial growth of cases and the risk of sustained transmission, was only minimally associated with class sizes and the number of classes per grade. This finding suggests that interventions that change the size and number of classes, e.g., splitting classes and staggered attendance, may have a limited effect on the control of school outbreaks. We also found that vaccination and mask-wearing of students were associated with reduced susceptibility (vaccination and mask-wearing) and infectiousness (mask-wearing), and hand washing was associated with increased susceptibility. Our results show how analysis of fine-grained transmission patterns between students can improve understanding of within-school disease dynamics and provide insights into the relative impact of different approaches to outbreak control.
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11
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Yeo SC, Lai CKY, Tan J, Gooley JJ. A targeted e-learning approach for keeping universities open during the COVID-19 pandemic while reducing student physical interactions. PLoS One 2021; 16:e0249839. [PMID: 33831082 PMCID: PMC8031760 DOI: 10.1371/journal.pone.0249839] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic led to widespread closure of universities. Many universities turned to e-learning to provide educational continuity, but they now face the challenge of how to reopen safely and resume in-class learning. This is difficult to achieve without methods for measuring the impact of school policies on student physical interactions. Here, we show that selectively deploying e-learning for larger classes is highly effective at decreasing campus-wide opportunities for student-to-student contact, while allowing most in-class learning to continue uninterrupted. We conducted a natural experiment at a large university that implemented a series of e-learning interventions during the COVID-19 outbreak. The numbers and locations of 24,000 students on campus were measured over a 17-week period by analysing >24 million student connections to the university Wi-Fi network. We show that daily population size can be manipulated by e-learning in a targeted manner according to class size characteristics. Student mixing showed accelerated growth with population size according to a power law distribution. Therefore, a small e-learning dependent decrease in population size resulted in a large reduction in student clustering behaviour. Our results suggest that converting a small number of classes to e-learning can decrease potential for disease transmission while minimising disruption to university operations. Universities should consider targeted e-learning a viable strategy for providing educational continuity during periods of low community disease transmission.
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Affiliation(s)
- Sing Chen Yeo
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Clin K. Y. Lai
- Institute for Applied Learning Sciences and Educational Technology, National University of Singapore, Singapore, Singapore
| | - Jacinda Tan
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Joshua J. Gooley
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
- Institute for Applied Learning Sciences and Educational Technology, National University of Singapore, Singapore, Singapore
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12
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Munday JD, Sherratt K, Meakin S, Endo A, Pearson CAB, Hellewell J, Abbott S, Bosse NI, Atkins KE, Wallinga J, Edmunds WJ, van Hoek AJ, Funk S. Implications of the school-household network structure on SARS-CoV-2 transmission under school reopening strategies in England. Nat Commun 2021; 12:1942. [PMID: 33782396 PMCID: PMC8007691 DOI: 10.1038/s41467-021-22213-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/02/2021] [Indexed: 12/28/2022] Open
Abstract
In early 2020 many countries closed schools to mitigate the spread of SARS-CoV-2. Since then, governments have sought to relax the closures, engendering a need to understand associated risks. Using address records, we construct a network of schools in England connected through pupils who share households. We evaluate the risk of transmission between schools under different reopening scenarios. We show that whilst reopening select year-groups causes low risk of large-scale transmission, reopening secondary schools could result in outbreaks affecting up to 2.5 million households if unmitigated, highlighting the importance of careful monitoring and within-school infection control to avoid further school closures or other restrictions. Many countries have closed schools as part of their COVID-19 response. Here, the authors model SARS-CoV-2 transmission on a network of schools and households in England, and find that risk of transmission between schools is lower if primary schools are open than if secondary schools are open.
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Affiliation(s)
- James D Munday
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Katharine Sherratt
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Meakin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Akira Endo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Carl A B Pearson
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Joel Hellewell
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sam Abbott
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nikos I Bosse
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Katherine E Atkins
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Health, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jacco Wallinga
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - W John Edmunds
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Albert Jan van Hoek
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sebastian Funk
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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13
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Dimka J, Sattenspiel L. "We didn't get much schooling because we were fishing all the time": Potential impacts of irregular school attendance on the spread of epidemics. Am J Hum Biol 2021; 34:e23578. [PMID: 33599037 PMCID: PMC7995059 DOI: 10.1002/ajhb.23578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/17/2020] [Accepted: 01/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives Especially in traditional, rural, and low‐income areas, children attend school irregularly. School‐based interventions are common mitigation strategies for infectious disease epidemics, but if daily attendance is not the norm, the impact of schools on disease spread might be overestimated. Methods We use an agent‐based model of an early 20th century Newfoundland community to compare epidemic size and duration in three scenarios: (1) all school‐aged children attend school each weekday, (2) students aged 10–15 have a chance of engaging in adult activities each day, and (3) students aged 10–15 have a chance of being reassigned to adult roles at the start of each simulation and thus never attend school. Results As the probability of not attending school increases, epidemics become smaller and peak earlier. The change in final size is larger with permanent reassignment (35% at baseline, 18% at maximum reassignment) than with daily nonattendance (35% vs. 22%). For both scenarios, the peak occurs 3 days earlier with maximum absence compared to the baseline. Benefits extend beyond the reassigned agents, as all school‐aged agents are more likely to escape infection with increasing reassignment, and on average, 3–6 additional agents (2.6%–5.3%) escape infection compared to the baseline. Conclusions This study demonstrates that absenteeism can have important impacts on epidemic outcomes. Thus, socioeconomic and other reasons for nonattendance of school, as well as how rates vary in different contexts, must be considered in models predicting epidemic outcomes or evaluating public health interventions in the face of major pandemics.
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Affiliation(s)
- Jessica Dimka
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Lisa Sattenspiel
- Department of Anthropology, University of Missouri, Columbia, Missouri, USA
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14
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Tanniru MR. Transforming public health using value lens and extended partner networks. Learn Health Syst 2021; 5:e10234. [PMID: 33490383 PMCID: PMC7805004 DOI: 10.1002/lrh2.10234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Organizational transformations have focused on creating and fulfilling value for customers, leveraging advanced technologies. Transforming public health (PH) faces an interesting challenge. The value created (preventive practices) to fulfill policy makers' desire to reduce healthcare costs is realized by several external partners with varying goals and is practiced by the public (value in use), which often places low priority on prevention. METHODS This paper uses value lens to argue that PH transformation strategy must align the goals of all stakeholders involved. This may include allowing partners and the public to contextualize the preventive practices to see the value in near term and as relevant. It also means extending the number of partners PH uses and helping them connect with the public to seek shared alignment in shared goals of value fulfillment and value-in-use. RESULTS Using lessons from Covid-19 and PH experience with partners in four different sectors: business, healthcare, public and community, the paper illustrates how PH transformation strategy can be implemented going forward. CONCLUSIONS We conclude the paper with five distinct directions for future research to create and sustain value using the framework of learning health systems.
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Weigl J. Mit Immanuel Kant in die zweite Welle der gegenwärtigen Pandemie. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2020. [PMCID: PMC7149306 DOI: 10.1007/s11553-020-00783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Litvinova M, Liu QH, Kulikov ES, Ajelli M. Reactive school closure weakens the network of social interactions and reduces the spread of influenza. Proc Natl Acad Sci U S A 2019; 116:13174-13181. [PMID: 31209042 PMCID: PMC6613079 DOI: 10.1073/pnas.1821298116] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
School-closure policies are considered one of the most promising nonpharmaceutical interventions for mitigating seasonal and pandemic influenza. However, their effectiveness is still debated, primarily due to the lack of empirical evidence about the behavior of the population during the implementation of the policy. Over the course of the 2015 to 2016 influenza season in Russia, we performed a diary-based contact survey to estimate the patterns of social interactions before and during the implementation of reactive school-closure strategies. We develop an innovative hybrid survey-modeling framework to estimate the time-varying network of human social interactions. By integrating this network with an infection transmission model, we reduce the uncertainty surrounding the impact of school-closure policies in mitigating the spread of influenza. When the school-closure policy is in place, we measure a significant reduction in the number of contacts made by students (14.2 vs. 6.5 contacts per day) and workers (11.2 vs. 8.7 contacts per day). This reduction is not offset by the measured increase in the number of contacts between students and nonhousehold relatives. Model simulations suggest that gradual reactive school-closure policies based on monitoring student absenteeism rates are capable of mitigating influenza spread. We estimate that without the implemented reactive strategies the attack rate of the 2015 to 2016 influenza season would have been 33% larger. Our study sheds light on the social mixing patterns of the population during the implementation of reactive school closures and provides key instruments for future cost-effectiveness analyses of school-closure policies.
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Affiliation(s)
- Maria Litvinova
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA 02115
- ISI Foundation, 10126 Turin, Italy
| | - Quan-Hui Liu
- CompleX Lab, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan, China
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan, China
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA 02115
| | - Evgeny S Kulikov
- Division of General Medical Practice, Siberian State Medical University, 634050 Tomsk, Russia
| | - Marco Ajelli
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA 02115;
- Bruno Kessler Foundation, 38123 Trento, Italy
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Germann TC, Gao H, Gambhir M, Plummer A, Biggerstaff M, Reed C, Uzicanin A. School dismissal as a pandemic influenza response: When, where and for how long? Epidemics 2019; 28:100348. [PMID: 31235334 PMCID: PMC6956848 DOI: 10.1016/j.epidem.2019.100348] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 01/02/2023] Open
Abstract
We used individual-based computer simulation models at community,
regional and national levels to evaluate the likely impact of coordinated
pre-emptive school dismissal policies during an influenza pandemic. Such
policies involve three key decisions: when, over what geographical scale, and
how long to keep schools closed. Our evaluation includes uncertainty and
sensitivity analyses, as well as model output uncertainties arising from
variability in serial intervals and presumed modifications of social contacts
during school dismissal periods. During the period before vaccines become widely
available, school dismissals are particularly effective in delaying the epidemic
peak, typically by 4–6 days for each additional week of dismissal.
Assuming the surveillance is able to correctly and promptly diagnose at least
5–10% of symptomatic individuals within the jurisdiction, dismissals at
the city or county level yield the greatest reduction in disease incidence for a
given dismissal duration for all but the most severe pandemic scenarios
considered here. Broader (multi-county) dismissals should be considered for the
most severe and fast-spreading (1918-like) pandemics, in which multi-month
closures may be necessary to delay the epidemic peak sufficiently to allow for
vaccines to be implemented.
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Affiliation(s)
- Timothy C Germann
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM 87545 USA
| | - Hongjiang Gao
- Community Interventions for Infection Control Unit, Centers for Disease Control and Prevention, Atlanta, GA 30329 USA.
| | - Manoj Gambhir
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333 USA; School of Public Health and Preventive Medicine, Monash University, Victoria 3800 Australia
| | - Andrew Plummer
- Community Interventions for Infection Control Unit, Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Matthew Biggerstaff
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333 USA
| | - Carrie Reed
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333 USA
| | - Amra Uzicanin
- Community Interventions for Infection Control Unit, Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
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18
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Libin PJK, Verstraeten T, Roijers DM, Grujic J, Theys K, Lemey P, Nowé A. Bayesian Best-Arm Identification for Selecting Influenza Mitigation Strategies. MACHINE LEARNING AND KNOWLEDGE DISCOVERY IN DATABASES 2019. [DOI: 10.1007/978-3-030-10997-4_28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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19
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Goscé L, Johansson A. Analysing the link between public transport use and airborne transmission: mobility and contagion in the London underground. Environ Health 2018; 17:84. [PMID: 30514301 PMCID: PMC6280530 DOI: 10.1186/s12940-018-0427-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/13/2018] [Indexed: 05/18/2023]
Abstract
BACKGROUND The transmission of infectious diseases is dependent on the amount and nature of contacts between infectious and healthy individuals. Confined and crowded environments that people visit in their day-to-day life (such as town squares, business districts, transport hubs, etc) can act as hot-spots for spreading disease. In this study we explore the link between the use of public transport and the spread of airborne infections in urban environments. METHODS We study a large number of journeys on the London Underground, which is known to be particularly crowded at certain times. We use publically available Oyster card data (the electronic ticket used for public transport in Greater London), to infer passengers' routes on the underground network. In order to estimate the spread of a generic airborne disease in each station, we use and extend an analytical microscopic model that was initially designed to study people moving in a corridor. RESULTS Comparing our results with influenza-like illnesses (ILI) data collected by Public Health England (PHE) in London boroughs, shows a correlation between the use of public transport and the spread of ILI. Specifically, we show that passengers departing from boroughs with higher ILI rates have higher number of contacts when travelling on the underground. Moreover, by comparing our results with other demographic key factors, we are able to discuss the role that the Underground plays in the spread of airborne infections in the English capital. CONCLUSIONS Our study suggests a link between public transport use and infectious diseases transmission and encourages further research into that area. Results could be used to inform the development of non-pharmacological interventions that can act on preventing instead of curing infections and are, potentially, more cost-effective.
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Affiliation(s)
- Lara Goscé
- University College London, London, UK
- University of Bristol, Bristol, UK
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20
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Abstract
The basic reproduction number is one of the conceptual cornerstones of mathematical epidemiology. Its classical definition as the number of secondary cases generated by a typical infected individual in a fully susceptible population finds a clear analytical expression in homogeneous and stratified mixing models. Along with the generation time (the interval between primary and secondary cases), the reproduction number allows for the characterization of the dynamics of an epidemic. A clear-cut theoretical picture, however, is hardly found in real data. Here, we infer from highly detailed sociodemographic data two multiplex contact networks representative of a subset of the Italian and Dutch populations. We then simulate an infection transmission process on these networks accounting for the natural history of influenza and calibrated on empirical epidemiological data. We explicitly measure the reproduction number and generation time, recording all individual-level transmission events. We find that the classical concept of the basic reproduction number is untenable in realistic populations, and it does not provide any conceptual understanding of the epidemic evolution. This departure from the classical theoretical picture is not due to behavioral changes and other exogenous epidemiological determinants. Rather, it can be simply explained by the (clustered) contact structure of the population. Finally, we provide evidence that methodologies aimed at estimating the instantaneous reproduction number can operationally be used to characterize the correct epidemic dynamics from incidence data.
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Abstract
Pandemic influenza remains the single greatest threat to global heath security. Efforts to increase our preparedness, by improving predictions of viral emergence, spread and disease severity, by targeting reduced transmission and improved vaccination and by mitigating health impacts in low- and middle-income countries, should receive renewed urgency.
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Affiliation(s)
- Peter Horby
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
- International Severe Acute Respiratory and Emerging Infections Consortium, Oxford, UK.
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22
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Uscher-Pines L, Schwartz HL, Ahmed F, Zheteyeva Y, Meza E, Baker G, Uzicanin A. School practices to promote social distancing in K-12 schools: review of influenza pandemic policies and practices. BMC Public Health 2018; 18:406. [PMID: 29587707 PMCID: PMC5870081 DOI: 10.1186/s12889-018-5302-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 03/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During an evolving influenza pandemic, community mitigation strategies, such as social distancing, can slow down virus transmission in schools and surrounding communities. To date, research on school practices to promote social distancing in primary and secondary schools has focused on prolonged school closure, with little attention paid to the identification and feasibility of other more sustainable interventions. To develop a list and typology of school practices that have been proposed and/or implemented in an influenza pandemic and to uncover any barriers identified, lessons learned from their use, and documented impacts. METHODS We conducted a review of the peer-reviewed and grey literature on social distancing interventions in schools other than school closure. We also collected state government guidance documents directed to local education agencies or schools to assess state policies regarding social distancing. We collected standardized information from each document using an abstraction form and generated descriptive statistics on common plan elements. RESULTS The document review revealed limited literature on school practices to promote social distancing, as well as limited incorporation of school practices to promote social distancing into state government guidance documents. Among the 38 states that had guidance documents that met inclusion criteria, fewer than half (42%) mentioned a single school practice to promote social distancing, and none provided any substantive detail about the policies or practices needed to enact them. The most frequently identified school practices were cancelling or postponing after-school activities, canceling classes or activities with a high rate of mixing/contact that occur within the school day, and reducing mixing during transport. CONCLUSION Little information is available to schools to develop policies and procedures on social distancing. Additional research and guidance are needed to assess the feasibility and effectiveness of school practices to promote social distancing.
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Affiliation(s)
| | | | - Faruque Ahmed
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Yenlik Zheteyeva
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | | | | | - Amra Uzicanin
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
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Bin Nafisah S, Alamery AH, Al Nafesa A, Aleid B, Brazanji NA. School closure during novel influenza: A systematic review. J Infect Public Health 2018; 11:657-661. [PMID: 29396256 DOI: 10.1016/j.jiph.2018.01.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 01/02/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND School closure as a non-pharmaceutical measure appeared as an efficient strategy in previous epidemics. We investigated the impact of school closure on the epidemic peak whether implemented before or after the epidemic reaches its peak. We also investigated the optimal duration of closure. METHODS Data sources included Medline-PubMed, ProQuest and Cochrane databases. The inclusion criteria were all articles that reported a quantified effect on school closure on an influenza epidemic. Exclusion criteria were non-English articles that have no translation and articles that only reported school closure effect as a combination with another measure. Out of 668 articles, we included 31 articles. RESULTS The mean reduction of the peak of the epidemic was M=29.65%. Implementing school closure before or after the epidemic reaches its peak reduced the overall influenza epidemic. School closure reduced and delayed the epidemic peak especially if implemented earlier. The longer the duration of closure the more the epidemic peak delayed. Additionally, closure containment effect also correlated with organisms having high attack rate and longer infectiveness duration. CONCLUSION We conclude with several implications for school closure taking into consideration the feasibility and the cost.
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Affiliation(s)
| | - Aliyah H Alamery
- Ophthalmology Department-King Faisal Specialist Hospital & Research Center, Saudi Arabia.
| | - Aminah Al Nafesa
- General Surgery Department-King Faisal Specialist Hospital & Research Center, Saudi Arabia.
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24
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Luca GD, Kerckhove KV, Coletti P, Poletto C, Bossuyt N, Hens N, Colizza V. The impact of regular school closure on seasonal influenza epidemics: a data-driven spatial transmission model for Belgium. BMC Infect Dis 2018; 18:29. [PMID: 29321005 PMCID: PMC5764028 DOI: 10.1186/s12879-017-2934-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 12/20/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND School closure is often considered as an option to mitigate influenza epidemics because of its potential to reduce transmission in children and then in the community. The policy is still however highly debated because of controversial evidence. Moreover, the specific mechanisms leading to mitigation are not clearly identified. METHODS We introduced a stochastic spatial age-specific metapopulation model to assess the role of holiday-associated behavioral changes and how they affect seasonal influenza dynamics. The model is applied to Belgium, parameterized with country-specific data on social mixing and travel, and calibrated to the 2008/2009 influenza season. It includes behavioral changes occurring during weekend vs. weekday, and holiday vs. school-term. Several experimental scenarios are explored to identify the relevant social and behavioral mechanisms. RESULTS Stochastic numerical simulations show that holidays considerably delay the peak of the season and mitigate its impact. Changes in mixing patterns are responsible for the observed effects, whereas changes in travel behavior do not alter the epidemic. Weekends are important in slowing down the season by periodically dampening transmission. Christmas holidays have the largest impact on the epidemic, however later school breaks may help in reducing the epidemic size, stressing the importance of considering the full calendar. An extension of the Christmas holiday of 1 week may further mitigate the epidemic. CONCLUSION Changes in the way individuals establish contacts during holidays are the key ingredient explaining the mitigating effect of regular school closure. Our findings highlight the need to quantify these changes in different demographic and epidemic contexts in order to provide accurate and reliable evaluations of closure effectiveness. They also suggest strategic policies in the distribution of holiday periods to minimize the epidemic impact.
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Affiliation(s)
- Giancarlo De Luca
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMR-S 1136), Paris, 75012, France
| | - Kim Van Kerckhove
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Agoralaan Gebouw D, Diepenbeek, 3590, Belgium
| | - Pietro Coletti
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Agoralaan Gebouw D, Diepenbeek, 3590, Belgium
| | - Chiara Poletto
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMR-S 1136), Paris, 75012, France
| | - Nathalie Bossuyt
- Scientific Institute of Public Health (WIV-ISP), Public Health and Surveillance Directorate, Epidemiology of infectious diseases Service, Rue Juliette/Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Agoralaan Gebouw D, Diepenbeek, 3590, Belgium.,Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
| | - Vittoria Colizza
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMR-S 1136), Paris, 75012, France. .,ISI Foundation, Torino, 10126, Italy.
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EpiK: A Knowledge Base for Epidemiological Modeling and Analytics of Infectious Diseases. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2017; 1:260-303. [DOI: 10.1007/s41666-017-0010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Marziano V, Pugliese A, Merler S, Ajelli M. Detecting a Surprisingly Low Transmission Distance in the Early Phase of the 2009 Influenza Pandemic. Sci Rep 2017; 7:12324. [PMID: 28951551 PMCID: PMC5615056 DOI: 10.1038/s41598-017-12415-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/07/2017] [Indexed: 11/09/2022] Open
Abstract
The spread of the 2009 H1N1 influenza pandemic in England was characterized by two major waves of infections: the first one was highly spatially localized (mainly in the London area), while the second one spread homogeneously through the entire country. The reasons behind this complex spatiotemporal dynamics have yet to be clarified. In this study, we perform a Bayesian analysis of five models entailing different hypotheses on the possible determinants of the observed pattern. We find a consensus among all models in showing a surprisingly low transmission distance (defined as the geographic distance between the place of residence of the infectors and her/his infectees) during the first wave: about 1.5 km (2.2 km if infections linked to household and school transmission are excluded). The best-fitting model entails a change in human activity regarding contacts not related to household and school. By using this model we estimate that the transmission distance sharply increased to 5.3 km (10 km when excluding infections linked to household and school transmission) during the second wave. Our study reveals a possible explanation for the observed pattern and highlights the need of better understanding human mobility and activity patterns under the pressure posed by a pandemic threat.
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Affiliation(s)
- Valentina Marziano
- Bruno Kessler Foundation, Trento, Italy.,Department of Mathematics, University of Trento, Trento, Italy
| | - Andrea Pugliese
- Department of Mathematics, University of Trento, Trento, Italy
| | | | - Marco Ajelli
- Bruno Kessler Foundation, Trento, Italy. .,Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA.
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Prem K, Cook AR, Jit M. Projecting social contact matrices in 152 countries using contact surveys and demographic data. PLoS Comput Biol 2017; 13:e1005697. [PMID: 28898249 PMCID: PMC5609774 DOI: 10.1371/journal.pcbi.1005697] [Citation(s) in RCA: 454] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 09/22/2017] [Accepted: 07/25/2017] [Indexed: 11/19/2022] Open
Abstract
Heterogeneities in contact networks have a major effect in determining whether a pathogen can become epidemic or persist at endemic levels. Epidemic models that determine which interventions can successfully prevent an outbreak need to account for social structure and mixing patterns. Contact patterns vary across age and locations (e.g. home, work, and school), and including them as predictors in transmission dynamic models of pathogens that spread socially will improve the models' realism. Data from population-based contact diaries in eight European countries from the POLYMOD study were projected to 144 other countries using a Bayesian hierarchical model that estimated the proclivity of age-and-location-specific contact patterns for the countries, using Markov chain Monte Carlo simulation. Household level data from the Demographic and Health Surveys for nine lower-income countries and socio-demographic factors from several on-line databases for 152 countries were used to quantify similarity of countries to estimate contact patterns in the home, work, school and other locations for countries for which no contact data are available, accounting for demographic structure, household structure where known, and a variety of metrics including workforce participation and school enrolment. Contacts are highly assortative with age across all countries considered, but pronounced regional differences in the age-specific contacts at home were noticeable, with more inter-generational contacts in Asian countries than in other settings. Moreover, there were variations in contact patterns by location, with work-place contacts being least assortative. These variations led to differences in the effect of social distancing measures in an age structured epidemic model. Contacts have an important role in transmission dynamic models that use contact rates to characterize the spread of contact-transmissible diseases. This study provides estimates of mixing patterns for societies for which contact data such as POLYMOD are not yet available.
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Affiliation(s)
- Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alex R. Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Modelling and Economics Unit, Health Protection Agency Centre for Infections, London, United Kingdom
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Ciavarella C, Fumanelli L, Merler S, Cattuto C, Ajelli M. School closure policies at municipality level for mitigating influenza spread: a model-based evaluation. BMC Infect Dis 2016; 16:576. [PMID: 27756233 PMCID: PMC5070162 DOI: 10.1186/s12879-016-1918-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Nearly every year Influenza affects most countries worldwide and the risk of a new pandemic is always present. Therefore, influenza is a major concern for public health. School-age individuals are often the most affected group, suggesting that the inclusion in preparedness plans of school closure policies may represent an option for influenza mitigation. However, their applicability remains uncertain and their implementation should carefully be weighed on the basis of cost-benefit considerations. Methods We developed an individual-based model for influenza transmission integrating data on sociodemography and time use of the Italian population, face-to-face contacts in schools, and influenza natural history. The model was calibrated on the basis of epidemiological data from the 2009 influenza pandemic and was used to evaluate the effectiveness of three reactive school closure strategies, all based on school absenteeism. Results In the case of a new influenza pandemic sharing similar features with the 2009 H1N1 pandemic, gradual school closure strategies (i.e., strategies closing classes first, then grades or the entire school) could lead to attack rate reduction up to 20–25 % and to peak weekly incidence reduction up to 50–55 %, at the cost of about three school weeks lost per student. Gradual strategies are quite stable to variations in the start of policy application and to the threshold on student absenteeism triggering class (and school) closures. In the case of a new influenza pandemic showing different characteristics with respect to the 2009 H1N1 pandemic, we found that the most critical features determining the effectiveness of school closure policies are the reproduction number and the age-specific susceptibility to infection, suggesting that these two epidemiological quantities should be estimated early on in the spread of a new pandemic for properly informing response planners. Conclusions Our results highlight a potential beneficial effect of reactive gradual school closure policies in mitigating influenza spread, conditioned on the effort that decision makers are willing to afford. Moreover, the suggested strategies are solely based on routinely collected and easily accessible data (such as student absenteeism irrespective of the cause and ILI incidence) and thus they appear to be applicable in real world situations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1918-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Laura Fumanelli
- Bruno Kessler Foundation, Via Sommarive 18, 38123, Trento, Italy
| | - Stefano Merler
- Bruno Kessler Foundation, Via Sommarive 18, 38123, Trento, Italy
| | | | - Marco Ajelli
- Bruno Kessler Foundation, Via Sommarive 18, 38123, Trento, Italy.
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Clamer V, Dorigatti I, Fumanelli L, Rizzo C, Pugliese A. Estimating transmission probability in schools for the 2009 H1N1 influenza pandemic in Italy. Theor Biol Med Model 2016; 13:19. [PMID: 27729047 PMCID: PMC5059896 DOI: 10.1186/s12976-016-0045-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemic models are being extensively used to understand the main pathways of spread of infectious diseases, and thus to assess control methods. Schools are well known to represent hot spots for epidemic spread; hence, understanding typical patterns of infection transmission within schools is crucial for designing adequate control strategies. The attention that was given to the 2009 A/H1N1pdm09 flu pandemic has made it possible to collect detailed data on the occurrence of influenza-like illness (ILI) symptoms in two primary schools of Trento, Italy. RESULTS The data collected in the two schools were used to calibrate a discrete-time SIR model, which was designed to estimate the probabilities of influenza transmission within the classes, grades and schools using Markov Chain Monte Carlo (MCMC) methods. We found that the virus was mainly transmitted within class, with lower levels of transmission between students in the same grade and even lower, though not significantly so, among different grades within the schools. We estimated median values of R 0 from the epidemic curves in the two schools of 1.16 and 1.40; on the other hand, we estimated the average number of students infected by the first school case to be 0.85 and 1.09 in the two schools. CONCLUSIONS The discrepancy between the values of R 0 estimated from the epidemic curve or from the within-school transmission probabilities suggests that household and community transmission played an important role in sustaining the school epidemics. The high probability of infection between students in the same class confirms that targeting within-class transmission is key to controlling the spread of influenza in school settings and, as a consequence, in the general population.
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Affiliation(s)
- Valentina Clamer
- Department of Mathematics, University of Trento, Via Sommarive 14, Trento, 38123 Italy
| | - Ilaria Dorigatti
- MRC Centre for Outbreak Analysis & Modelling, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Laura Fumanelli
- Center for Information Technology, Bruno Kessler Foundation, Trento, Italy
| | | | - Andrea Pugliese
- Department of Mathematics, University of Trento, Via Sommarive 14, Trento, 38123 Italy
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