School closures during the 2009 influenza pandemic: national and local experiences

Abstract

Background: School closure is a non-pharmaceutical intervention that was considered in many national pandemic plans developed prior to the start of the influenza A(H1N1)pdm09 pandemic, and received considerable attention during the event. Here, we retrospectively review and compare national and local experiences with school closures in several countries during the A(H1N1)pdm09 pandemic. Our intention is not to make a systematic review of country experiences; rather, it is to present the diversity of school closure experiences and provide examples from national and local perspectives.

Methods: Data were gathered during and following a meeting, organized by the European Centres for Disease Control, on school closures held in October 2010 in Stockholm, Sweden. A standard data collection form was developed and sent to all participants. The twelve participating countries and administrative regions (Bulgaria, China, France, Hong Kong Special Administrative Region (SAR), Italy, Japan, New Zealand, Serbia, South Africa, Thailand, United Kingdom, and United States) provided data.

Results: Our review highlights the very diverse national and local experiences on school closures during the A(H1N1)pdm09 pandemic. The processes including who was in charge of making recommendations and who was in charge of making the decision to close, the school-based control strategies, the extent of school closures, the public health tradition of responses and expectations on school closure varied greatly between countries. Our review also discusses the many challenges associated with the implementation of this intervention and makes recommendations for further practical work in this area.

Conclusions: The single most important factor to explain differences observed between countries may have been the different public health practises and public expectations concerning school closures and influenza in the selected countries.

Figure 1

Epidemiological characteristics and relevance of school closures.

Figure 2

Number of classes that were affected by school, grade or class closures in Japan during seasonal influenza epidemics between 1997 and 2008. (Source: http://idsc.nih.go.jp/idwr/kanja/infreport/report.html).

Figure 3

Extent of school, grade and class closures in participating countries. A: total number of schools affected by closures* during the 2009 H1N1pdm09 influenza pandemic; B: number of schools affected by closures during the 2009 H1N1pdm09 influenza pandemic per 1 million inhabitants. ( ^*: e.g., may include complete school closure, grade closure and/or class closure).

Figure 4

Effective duration of closure (square: average; vertical line: range) in participating countries. Countries are sorted by decreasing number of schools affected by closures.