Abstract
BackgroundSchool closure is a common mitigation strategy during severe influenza epidemics and pandemics. However, the effectiveness of this strategy remains controversial. In this study, we aimed to explore the effectiveness of school closure on seasonal influenza epidemics in provincial-level administrative divisions (PLADs) with varying urbanization rates in China.MethodsThis study analyzed influenza surveillance data between 2010 and 2019 provided by the Chinese National Influenza Center. Taking into consideration the climate, this study included a region with 3 adjacent PLADs in Northern China and another region with 4 adjacent PLADs in Southern China. The effect of school closure on influenza transmission was evaluated by the reduction of the effective reproductive number of seasonal influenza during school winter breaks compared with that before school winter breaks. An age-structured Susceptible-Infected-Recovered-Susceptible (SIRS) model was built to model influenza transmission in different levels of urbanization. Parameters were determined using the surveillance data via robust Bayesian method.ResultsBetween 2010 and 2019, in the less urbanized provinces: Hebei, Zhejiang, Jiangsu and Anhui, during school winter breaks, the effective reproductive number of seasonal influenza epidemics reduced 14.6% [95% confidential interval (CI): 6.2–22.9%], 9.6% (95% CI: 2.5–16.6%), 7.3% (95% CI: 0.1–14.4%) and 8.2% (95% CI: 1.1–15.3%) respectively. However, in the highly urbanized cities: Beijing, Tianjin and Shanghai, it reduced only 5.2% (95% CI: -0.7–11.2%), 4.1% (95% CI: -0.9–9.1%) and 3.9% (95% CI: -1.6–9.4%) respectively. In China, urbanization is associated with decreased proportion of children and increased social contact. According to the SIRS model, both factors could reduce the impact of school closure on seasonal influenza epidemics, and the proportion of children in the population is thought to be the dominant influencing factor.ConclusionsEffectiveness of school closure on the epidemics varies with the age structure in the population and social contact patterns. School closure should be recommended in the low urbanized regions in China in the influenza seasons.Graphical abstract
Highlights
School closure is a common mitigation strategy during severe influenza epidemics and pandemics
We proposed an age-structured Susceptible-InfectedRecovered-Susceptible (SIRS) model to explore the association between urbanization level and the effect of school closure on seasonal influenza epidemics in China
For 4 provincial-level administrative divisions (PLADs) in region 2, the mean percentage reduction of influenza transmissibility in Shanghai was 3.9% during winter school breaks
Summary
School closure is a common mitigation strategy during severe influenza epidemics and pandemics. We aimed to explore the effectiveness of school closure on seasonal influenza epidemics in provincial-level administrative divisions (PLADs) with varying urbanization rates in China. School-aged children are a key source of influenza transmission. This is largely because they have higher social contact [1] and are more susceptible to seasonal influenza virus than adults [2]. School closure is a common mitigation strategy to generate social distancing during severe influenza epidemics and pandemics [3]. A study in Hong Kong, China showed that school closure did not have a significant effect on influenza transmission [7]. The overlap between school winter breaks and the winterspring waves of influenza epidemics provides a unique opportunity to explore the impact of school closure on seasonal influenza epidemics
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