House, Thomas A., Baguelin, Marc, Hoek, Albert Jan Van, White, Peter J., Sadique, Zia, Eames, Ken T. D., Read, Jonathan M., Hens, Niel, Melegaro, Alessia, Edmunds, W. John and Keeling, Matthew James. (2011) Modelling the impact of local reactive school closures on critical care provision during an influenza pandemic. Proceedings of the Royal Society B: Biological Sciences, Vol.278 (No.1719). pp. 2753-2760. ISSN 0962-8452

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Abstract

Despite the fact that the 2009 H1N1 pandemic influenza strain was less severe than had been feared, both seasonal epidemics of influenza-like-illness and future influenza pandemics have the potential to place a serious burden on health services. The closure of schools has been postulated as a means of reducing transmission between children and hence reducing the number of cases at the peak of an epidemic; this is supported by the marked reduction in cases during school holidays observed across the world during the 2009 pandemic. However, a national policy of long-duration school closures could have severe economic costs. Reactive short-duration closure of schools in regions where health services are close to capacity offers a potential compromise, but it is unclear over what spatial scale and time frame closures would need to be made to be effective. Here, using detailed geographical information for England, we assess how localized school closures could alleviate the burden on hospital intensive care units (ICUs) that are reaching capacity. We show that, for a range of epidemiologically plausible assumptions, considerable local coordination of school closures is needed to achieve a substantial reduction in the number of hospitals where capacity is exceeded at the peak of the epidemic. The heterogeneity in demand per hospital ICU bed means that even widespread school closures are unlikely to have an impact on whether demand will exceed capacity for many hospitals. These results support the UK decision not to use localized school closures as a control mechanism, but have far wider international public-health implications. The spatial heterogeneities in both population density and hospital capacity that give rise to our results exist in many developed countries, while our model assumptions are sufficiently general to cover a wide range of pathogens. This leads us to believe that when a pandemic has severe implications for ICU capacity, only widespread school closures (with their associated costs and organizational challenges) are sufficient to mitigate the burden on the worst-affected hospitals.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Science > Life Sciences (2010- ) Faculty of Science > Mathematics
Library of Congress Subject Headings (LCSH):	Epidemics -- Great Britain -- Mathematical models, Influenza -- Prevention, Influenza -- Transmission -- Mathematical models, School closings -- Great Britain -- Mathematical models
Journal or Publication Title:	Proceedings of the Royal Society B: Biological Sciences
Publisher:	The Royal Society Publishing
ISSN:	0962-8452
Date:	22 September 2011
Volume:	Vol.278
Number:	No.1719
Number of Pages:	8
Page Range:	pp. 2753-2760
Identification Number:	10.1098/rspb.2010.2688
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	Economic and Social Research Council (Great Britain) (ESRC), Medical Research Council (Great Britain) (MRC), European Union (EU), National Vaccine Evaluation Consortium, Agentschap voor Innovatie door Wetenschap en Technologie (Belgium) (IWT)
Grant number:	FP7-GA-201601 (EU), 060081 (IWT)
References:	1 World Health Organisation 2009 Swine influenza— update 3, 27 April 2009. See URL http://www. who.int/csr/don/2009_04_27/en/index.html (accessed 13, 2011). 2 Health Protection Agency 2009 HPA weekly national influenza report, 17 September 2009 (Week 38). See URL http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/ 1253114178962 (accessed 13, 2011). 3 Department of Health 2009 Critical care strategy: managing the H1N1 flu pandemic September 2009. See URL http://www.dh.gov.uk/en/Publichealth/Flu/Swineflu/ DH_104989 (accessed 13, 2011). 4 Cauchemez, S., Ferguson, N. M., Wachtel, C., Tegnell, A., Saour, G., Duncan, B. & Nicoll, A. 2009 Closure of schools during an influenza pandemic. Lancet Infect. Dis. 9, 473–481. (doi:10.1016/S1473-3099(09) 70176-8) 5 Cauchemez, S., Valleron, A.-J., Boe¨lle, P.-Y., Flahault, A. & Ferguson, N. M. 2008 Estimating the impact of school closure on influenza transmission from Sentinel data. Nature 452, 750–754. (doi:10.1038/nature06732) 6 Mossong, J. et al. 2008 Social contacts and mixing patterns relevant to the spread of infectious diseases. PLoS Med. 5, 381–391. (doi:10.1371/journal.pmed.0050074) 7 Hens, N., Minalu Ayele, G., Goeyvaerts, N., Aerts, M., Mossong, J., Edmunds, W. J. & Beutels, P. 2009 Estimating the impact of school closure on social mixing behaviour and the transmission of close contact infections in eight European countries. BMC Infect. Dis. 9, 187. (doi:10.1186/1471-2334-9-187) 8 Baguelin, M., Van Hoek, A. J., Jit, M., Flasche, S., White, P. J. & Edmunds, W. J. 2010 Vaccination against pandemic influenza A/H1N1v in England: a real-time economic evaluation. Vaccine 28, 2370–2384. (doi:10. 1016/j.vaccine.2010.01.002) 9 Sadique, M. Z., Adams, E. J. & Edmunds, W. J. 2008 Estimating the costs of school closure for mitigating an influenza pandemic. BMC Public Health 8. (doi:10. 1186/1471-2458-8-135) 10 Smith, R. D., Keogh-Brown, M. R., Barnett, T. & Tait, J. 2009 The economy-wide impact of pandemic influenza on theUK: a computable general equilibrium modelling experiment. Br. Med. J. 339, 4571. (doi:10.1136/bmj.b4571)
URI:	http://wrap.warwick.ac.uk/id/eprint/36878

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