title: School closure as an influenza mitigation strategy: how variations in legal authority and plan criteria can alter the impact.
abstract: BACKGROUND
  States' pandemic influenza plans and school closure statutes are intended to guide state and local officials, but most faced a great deal of uncertainty during the 2009 influenza H1N1 epidemic. Questions remained about whether, when, and for how long to close schools and about which agencies and officials had legal authority over school closures.
  
  
  METHODS
  This study began with analysis of states' school-closure statutes and pandemic influenza plans to identify the variations among them. An agent-based model of one state was used to represent as constants a population's demographics, commuting patterns, work and school attendance, and community mixing patterns while repeated simulations explored the effects of variations in school closure authority, duration, closure thresholds, and reopening criteria.
  
  
  RESULTS
  The results show no basis on which to justify statewide rather than school-specific or community-specific authority for school closures. Nor do these simulations offer evidence to require school closures promptly at the earliest stage of an epidemic. More important are criteria based on monitoring of local case incidence and on authority to sustain closure periods sufficiently to achieve epidemic mitigation.
  
  
  CONCLUSIONS
  This agent-based simulation suggests several ways to improve statutes and influenza plans. First, school closure should remain available to state and local authorities as an influenza mitigation strategy. Second, influenza plans need not necessarily specify the threshold for school closures but should clearly define provisions for early and ongoing local monitoring. Finally, school closure authority may be exercised at the statewide or local level, so long as decisions are informed by monitoring incidence in local communities and schools.
authors.affiliation: Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA. mapotter@pitt.edu
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Potter
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Cooley
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Sweeney
authors.forename: Tina B
authors.initials: TB
authors.lastname: Hershey
authors.forename: Sherrianne M
authors.initials: SM
authors.lastname: Gleason
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Keane
authors.forename: John
authors.initials: J
authors.lastname: Grefenstette
authors.forename: Donald S
authors.initials: DS
authors.lastname: Burke
mesh_terms: D003198:Computer Simulation; D058872:Epidemics / Q000517:prevention & control*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D017146:Models, Organizational; D012574:Schools / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology