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Open Access Research article

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

Simon Cauchemez12*, Maria D Van Kerkhove1, Brett N Archer3, Martin Cetron4, Benjamin J Cowling5, Peter Grove6, Darren Hunt7, Mira Kojouharova8, Predrag Kon9, Kumnuan Ungchusak10, Hitoshi Oshitani11, Andrea Pugliese12, Caterina Rizzo13, Guillaume Saour14, Tomimase Sunagawa15, Amra Uzicanin4, Claude Wachtel16, Isaac Weisfuse17, Hongjie Yu18 and Angus Nicoll19

Author Affiliations

1 Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, School of Public Health, Imperial College, London, UK

2 Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, 28 rue du Dr Roux, 75724 Paris, Cedex 15, France

3 National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa

4 Global Migration and Quarantine, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, USA

5 School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China

6 Department of Health, London, UK

7 Office of the Director of Public Health, New Zealand Ministry of Health, Wellington, New Zealand

8 National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria

9 Center for Disease Control and Prevention, City Institute of Public Health Belgrade, Belgrade, Serbia

10 Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand

11 Department of Virology, Tohoku University Graduate School of Medicine, Tokyo, Japan

12 Dipartimento di Matematica, Università di Trento, Trento, Italy

13 National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy

14 Ministère de l’intérieur, Paris, France

15 Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Sendai, Japan

16 Secretariat général de la défense et de la sécurite nationale – Prime minister Office, Paris, France

17 Department of Health and Mental Hygiene, New York City, USA

18 Division for Infectious Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

19 Influenza coordination, European Centre for Disease Prevention and Control, Stockholm, Sweden

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BMC Infectious Diseases 2014, 14:207  doi:10.1186/1471-2334-14-207

Published: 16 April 2014

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.