Abstract
BackgroundSchool 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.MethodsWe 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.ResultsStochastic 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.ConclusionChanges 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.
Highlights
School closure is often considered as an option to mitigate influenza epidemics because of its potential to reduce transmission in children and in the community
Given the central role of mixing patterns largely supported by evidence [7, 8, 20, 48], the heterogeneous country-specific contact variations measured in Europe [4, 32], and the marked difference expected in individual behavior during a seasonal flu epidemic vs. a pandemic, here we extend prior approaches to introduce a data-driven spatially explicit model fully parameterized on Belgium
In order to study the role of changes in contact patterns and in travel behavior along the calendar, we considered a mathematical approach for the spatial transmission of influenza in Belgium
Summary
School closure is often considered as an option to mitigate influenza epidemics because of its potential to reduce transmission in children and in the community. Children represent an epidemiological group of central importance for the transmission of influenza [1,2,3] They often have a larger vulnerability to infections because of limited prior immunity, and they mix at school with high contact rates [4] representing key drivers for influenza spread. De Luca et al BMC Infectious Diseases (2018) 18:29 compared to adults are expected to be more sensitive to the closure of schools [9] This experience was reported in many countries during the 2009 H1N1 influenza pandemic, where closed schools coincided with a marked reduction of influenza activity [10,11,12,13,14,15,16,17,18,19,20,21,22]. No clear trend is observed in the impact of school closure on the epidemic burden depending on the time of closure – before, around, or after the peak [8]
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