Open Access Highly Accessed Research article

Estimating the impact of school closure on social mixing behaviour and the transmission of close contact infections in eight European countries

Niel Hens12*, Girma Minalu Ayele1, Nele Goeyvaerts1, Marc Aerts1, Joel Mossong3, John W Edmunds4 and Philippe Beutels2

Author Affiliations

1 Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Agoralaan 1, B3590 Diepenbeek, Belgium

2 Centre for Health Economics Research and Modeling Infectious Diseases Centre for the Evaluation of Vaccination (WHO Collaborating Centre) Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium

3 Surveillance and Epidemiology of Infectious Diseases, Laboratoire National de Santé, Luxembourg, Luxembourg

4 London School of Hygiene and Tropical Medicine, London, UK

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BMC Infectious Diseases 2009, 9:187  doi:10.1186/1471-2334-9-187

Published: 27 November 2009



Mathematical modelling of infectious disease is increasingly used to help guide public health policy. As directly transmitted infections, such as influenza and tuberculosis, require contact between individuals, knowledge about contact patterns is a necessary pre-requisite of accurate model predictions. Of particular interest is the potential impact of school closure as a means of controlling pandemic influenza (and potentially other pathogens).


This paper uses a population-based prospective survey of mixing patterns in eight European countries to study the relative change in the basic reproduction number (R0 - the average number of secondary cases from a typical primary case in a fully susceptible population) on weekdays versus weekends and during regular versus holiday periods. The relative change in R0 during holiday periods and weekends gives an indication of the impact collective school closures (and prophylactic absenteeism) may have during a pandemic.


Social contact patterns differ substantially when comparing weekdays to the weekend and regular to holiday periods mainly due to the reduction in work and/or school contacts. For most countries the basic reproduction number decreases from the week to weekends and regular to holiday periods by about 21% and 17%, respectively. However for other countries no significant decrease was observed.


We use a large-scale social contact survey in eight different European countries to gain insights in the relative change in the basic reproduction number on weekdays versus weekends and during regular versus holiday periods. The resulting estimates indicate that school closure can have a substantial impact on the spread of a newly emerging infectious disease that is transmitted via close (non sexual) contacts.