Estimating the impact of school closure on influenza transmission from Sentinel data
Estimating the impact of school closure on influenza transmission from Sentinel data
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DOI：
10.1038/nature06732
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发表时间：
2008-04-10
期刊：
影响因子：
64.8
通讯作者：
Ferguson, Neil M.
中科院分区：
文献类型：
--
作者：
Cauchemez, Simon;Valleron, Alain-Jacques;Ferguson, Neil M.
高致病性H5 N1流感病毒构成的威胁要求公共卫生当局为人类大流行做好准备。尽管大流行前的疫苗和抗病毒药物可能会显著降低发病率（1，2），但其储存成本太高，对许多国家来说不切实际。因此，基于非药物干预措施的替代控制策略是一个潜在的有吸引力的政策选择。关闭学校是最常考虑的措施。关闭学校数月的高昂社会和经济成本使其成为一项昂贵的政策，因此引起争议，目前缺乏关于流感流行期间学校作用的定量数据，这意味着对学校关闭在减少流行病影响方面的可能有效性几乎没有共识。在这里，通过对法国监测数据和假期时间的联合分析，我们量化了学校在流感流行中的作用，并预测了大流行期间学校关闭的影响。我们发现，假期导致流感传播给儿童的比率降低20 - 29%，但对成人的接触模式没有可检测的影响。假期可预防16 - 18%的季节性流感病例（儿童为18 - 21%）。通过外推，我们发现，在大流行期间延长学校关闭可能会使累计病例数减少13 - 17%（儿童为18 - 23%），高峰发病率减少39 - 45%（儿童为47 - 52%）。如果事实证明很难长期保持儿童之间的低接触率，关闭学校的影响就会减少。
The threat posed by the highly pathogenic H5N1 influenza virus requires public health authorities to prepare for a human pandemic. Although pre-pandemic vaccines and antiviral drugs might significantly reduce illness rates(1,2), their stockpiling is too expensive to be practical for many countries. Consequently, alternative control strategies, based on non-pharmaceutical interventions, are a potentially attractive policy option. School closure is the measure most often considered. The high social and economic costs of closing schools for months make it an expensive and therefore controversial policy, and the current absence of quantitative data on the role of schools during influenza epidemics means there is little consensus on the probable effectiveness of school closure in reducing the impact of a pandemic. Here, from the joint analysis of surveillance data and holiday timing in France, we quantify the role of schools in influenza epidemics and predict the effect of school closure during a pandemic. We show that holidays lead to a 20 - 29% reduction in the rate at which influenza is transmitted to children, but that they have no detectable effect on the contact patterns of adults. Holidays prevent 16 - 18% of seasonal influenza cases (18 - 21% in children). By extrapolation, we find that prolonged school closure during a pandemic might reduce the cumulative number of cases by 13 - 17% (18 - 23% in children) and peak attack rates by up to 39 - 45% (47 - 52% in children). The impact of school closure would be reduced if it proved difficult to maintain low contact rates among children for a prolonged period.