Abstract
BackgroundEpidemic 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.ResultsThe 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.ConclusionsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12976-016-0045-2) contains supplementary material, which is available to authorized users.
Highlights
Epidemic models are being extensively used to understand the main pathways of spread of infectious diseases, and to assess control methods
The discrepancy between the values of R0 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
Summary
The attention that was given to the 2009 A/H1N1pdm 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. Epidemic models are being extensively used to understand the main pathways of spread of infectious diseases, and to assess control methods They are fitted to rather aggregated datasets reporting the number of new cases (possibly stratified by age or other variables of interest) in each time interval (often a week, sometimes daily reports are available, especially at the initial outbreak of an infection). In this work we provide estimates for transmission rates of 2009 A/H1N1pdm pandemic influenza at the three levels of class, grade and school by analyzing data on the occurrence of influenza-like illness (ILI) symptoms among pupils of two primary schools in Trento (Italy). This work on simulated data made us, on the one hand, get a better interpretation of the results obtained, showing for instance to which degree parameters are identifiable; on the other hand, assess the loss in accuracy resulting from missing data and other sources of error
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