Yan, Lei, Gao, Yan, Zhang, Yong, Tildesley, Michael J., Liu, L, Zhang, Y, Wen, Leying, Wang, Wei, Li, Xiaodan, Hu, Ying, Bai, Tian, Wang, Min, Zeng, Yuhong, Wang, Dingming, Wang, Xianjun, Lan, Yu, Wang, Shiwen and Shu, Yuelong (2012) Epidemiological and virological characteristics of pandemic influenza A (H1N1) 2009 in school outbreaks in China. PLoS One, Vol.7 (No.9). e45898. doi:10.1371/journal.pone.0045898

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Abstract

Background: During the 2009 pandemic influenza H1N1 (2009) virus (pH1N1) outbreak, school students were at an
increased risk of infection by the pH1N1 virus. However, the estimation of the attack rate showed significant variability.
Methods: Two school outbreaks were investigated in this study. A questionnaire was designed to collect information by
interview. Throat samples were collected from all the subjects in this study 6 times and sero samples 3 times to confirm the
infection and to determine viral shedding. Data analysis was performed using the software STATA 9.0.
Findings: The attack rate of the pH1N1 outbreak was 58.3% for the primary school, and 52.9% for the middle school. The
asymptomatic infection rates of the two schools were 35.8% and 37.6% respectively. Peak virus shedding occurred on the
day of ARI symptoms onset, followed by a steady decrease over subsequent days (p = 0.026). No difference was found either
in viral shedding or HI titer between the symptomatic and the asymptomatic infectious groups.
Conclusions: School children were found to be at a high risk of infection by the novel virus. This may be because of a
heightened risk of transmission owing to increased mixing at boarding school, or a lack of immunity owing to socioeconomic
status. We conclude that asymptomatically infectious cases may play an important role in transmission of the
pH1N1 virus.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Science > Centre for Complexity Science Faculty of Science > Mathematics
Library of Congress Subject Headings (LCSH):	H1N1 influenza -- Transmission, School children -- Health and hygiene -- China
Journal or Publication Title:	PLoS One
Publisher:	Public Library of Science
ISSN:	1932-6203
Official Date:	September 2012
Dates:	Date Event September 2012 Published
Volume:	Vol.7
Number:	No.9
Page Range:	e45898
DOI:	10.1371/journal.pone.0045898
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	National Institutes of Health (U.S.) (NIH), National Institute of Allergy and Infectious Diseases (U.S.) (NIAID), Wellcome Trust (London, England), United States. Dept. of Homeland Security. Science and Technology Directorate
Grant number:	2008ZX10004-012 (NIH), 5-U54-AI-057157-08 (NIH/NIAID)

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