Closure of schools during an influenza pandemic

Abstract

In response to WHO raising the influenza pandemic alert level from phase five to phase six, health officials around the world are carefully reviewing pandemic mitigation protocols. School closure (also called class dismissal in North America) is a non-pharmaceutical intervention that is commonly suggested for mitigating influenza pandemics. Health officials taking the decision to close schools must weigh the potential health benefits of reducing transmission and thus case numbers against high economic and social costs, difficult ethical issues, and the possible disruption of key services such as health care. Also, if schools are expected to close as a deliberate policy option, or just because of high levels of staff absenteeism, it is important to plan to mitigate the negative features of closure. In this context, there is still debate about if, when, and how school closure policy should be used. In this Review, we take a multidisciplinary and holistic perspective and review the multiple aspects of school closure as a public health policy. Implications for the mitigation of the swine-origin influenza A H1N1 pandemic are also discussed.

Figure 1

Influenza-like illness consultation rate in Hong Kong in 2007 and 2008 In 2007 (blue line) schools remained open after the peak and in 2008 (red line) they were closed just after the peak (blue rectangle).

Figure 2

Proportion of the UK workforce likely to be the main caregivers for dependant children by sector

Figure 3

Illness attack rates in 1918, 1957, and 1968 pandemics 1918—transmission in children and young adults. 1957—transmission focused especially in the school-age population. 1968—transmission across all age groups.