title: Recommendations for and compliance with social restrictions during implementation of school closures in the early phase of the influenza A (H1N1) 2009 outbreak in Melbourne, Australia.
abstract: BACKGROUND
  Localized reactive school and classroom closures were implemented as part of a suite of pandemic containment measures during the initial response to influenza A (H1N1) 2009 in Melbourne, Australia. Infected individuals, and those who had been in close contact with a case, were asked to stay in voluntary home quarantine and refrain from contact with visitors for seven days from the date of symptom onset or exposure to an infected person. Oseltamivir (Tamiflu) was available for treatment or prophylaxis.
  
  
  METHODS
  We surveyed affected families through schools involved in the closures. Analyses of responses were descriptive. We characterized recommendations made to case and contact households and quantified adherence to guidelines and antiviral therapy.
  
  
  RESULTS
  Of the 314 respondent households, 51 contained a confirmed case. The prescribed quarantine period ranged from 1-14 days, reflecting logistic difficulties in reactive implementation relative to the stated guidelines. Household-level compliance with the requirement to stay at home was high (84.5%, 95% CI 79.3,88.5) and contact with children outside the immediate family infrequent.
  
  
  CONCLUSIONS
  Levels of compliance with recommendations in our sample were high compared with other studies, likely due to heightened public awareness of a newly introduced virus of uncertain severity. The variability of reported recommendations highlighted the difficulties inherent in implementing a targeted reactive strategy, such as that employed in Melbourne, on a large scale during a public health emergency. This study emphasizes the need to understand how public health measures are implemented when seeking to evaluate their effectiveness.
authors.affiliation: Vaccine & Immunisation Research Group, Murdoch Children's Research Institute and Melbourne School of Population Health, University of Melbourne, Australia. j.mcvernon@unimelb.edu.au
authors.forename: Jodie
authors.initials: J
authors.lastname: McVernon
authors.forename: Kate
authors.initials: K
authors.lastname: Mason
authors.forename: Sylvia
authors.initials: S
authors.lastname: Petrony
authors.forename: Paula
authors.initials: P
authors.lastname: Nathan
authors.forename: Anthony D
authors.initials: AD
authors.lastname: LaMontagne
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bentley
authors.forename: James
authors.initials: J
authors.lastname: Fielding
authors.forename: David M
authors.initials: DM
authors.lastname: Studdert
authors.forename: Anne
authors.initials: A
authors.lastname: Kavanagh
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D018890:Chemoprevention / Q000379:methods; D002648:Child; D004196:Disease Outbreaks; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D053139:Oseltamivir / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011790:Quarantine / Q000379:methods*; D012574:Schools
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir