title: Effectiveness of a school district closure for pandemic influenza A (H1N1) on acute respiratory illnesses in the community: a natural experiment.
abstract: BACKGROUND
  Following detection of pandemic influenza A H1N1 (pH1N1) in Dallas/Fort Worth, Texas, a school district (intervention community, [IC]) closed all public schools for 8 days to reduce transmission. Nearby school districts (control community [CC]) mostly remained open.
  
  
  METHODS
  We collected household data to measure self-reported acute respiratory illness (ARI), before, during, and after school closures. We also collected influenza-related visits to emergency departments (ED(flu)).
  
  
  RESULTS
  In both communities, self-reported ARIs and ED(flu) visits increased from before to during the school closure, but the increase in ARI rates was 45% lower in the IC (0.6% before to 1.2% during) than in the CC (0.4% before to 1.5% during) (RRR(During)(/Before) = 0.55, P < .001; adjusted OR(During/Before) = 0.49, P < .03). For households with school-aged children only (no children 0-5 years), IC had even lower increases in adjusted ARI than in the CC (adjusted OR(During/Before) = 0.28, P < .001). The relative increase of total ED(flu) visits in the IC was 27% lower (2.8% before to 4.4% during) compared with the CC (2.9% before to 6.2% during). Among children aged 6-18 years, the percentage of ED(flu) in IC remained constant (5.1% before vs 5.2% during), whereas in the CC it more than doubled (5.2% before vs 10.9% during). After schools reopened, ARI rates and ED(flu) visits decreased in both communities.
  
  
  CONCLUSIONS
  Our study documents a reduction in ARI and ED(flu) visits in the intervention community. Our findings can be used to assess the potential benefit of school closures during pandemics.
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. dcopela55@gmail.com
authors.forename: Daphne L
authors.initials: DL
authors.lastname: Copeland
authors.forename: Ricardo
authors.initials: R
authors.lastname: Basurto-Davila
authors.forename: Wendy
authors.initials: W
authors.lastname: Chung
authors.forename: Anita
authors.initials: A
authors.lastname: Kurian
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Fishbein
authors.forename: Paige
authors.initials: P
authors.lastname: Szymanowski
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zipprich
authors.forename: Harvey
authors.initials: H
authors.lastname: Lipman
authors.forename: Martin S
authors.initials: MS
authors.lastname: Cetron
authors.forename: Martin I
authors.initials: MI
authors.lastname: Meltzer
authors.forename: Francisco
authors.initials: F
authors.lastname: Averhoff
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D058873:Pandemics / Q000517:prevention & control*; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012574:Schools / Q000458:organization & administration*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult