title: Effective school actions for mitigating seasonal influenza outbreaks in Niigata, Japan.
abstract: BACKGROUND
  Japan has implemented various school actions during seasonal influenza outbreaks since the 1950's under the School Health Law. However, the effective duration, extent, and timing of closures remain unresolved.
  
  
  METHODS
  We conducted a retrospective study on the relationship between elementary class closures and influenza outbreak control during four consecutive influenza seasons from the 2004-2005 to 2007-2008 school years in Joetsu, Niigata, Japan. Among a total of 1,061 classes of 72 schools, 624 cases of influenza outbreaks were documented among 61 schools.
  
  
  RESULTS
  Class closures were carried out in a total of 62 cases in response to influenza outbreak, which was defined as a student absentee rate of greater than 10% due to influenza or influenza-like illness. Of these cases, two-day class closures were conducted the day after reaching a 10% student absentee rate in 28 cases and other types of closures were initiated in 34 cases. A markedly higher number of outbreak cases ended within one week for two-day class closures compared to the other types of closures (82.1% vs. 20.6%, respectively). The significant association between two-day class closures and interruption of an outbreak within one week was confirmed using a multivariable model adjusted for the season, grade, day of the week of an outbreak start, and absentee rate on the day of an outbreak start (OR, 3.18; 95% CI, 1.12-9.07; p = 0.030).
  
  
  CONCLUSIONS
  Our results suggest that a two-day class closure carried out the day after reaching a 10% absentee rate is an effective approach for mitigating influenza outbreaks in elementary schools.
authors.affiliation: Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan.
authors.forename: Koshu
authors.initials: K
authors.lastname: Sugisaki
authors.forename: Nao
authors.initials: N
authors.lastname: Seki
authors.forename: Naohito
authors.initials: N
authors.lastname: Tanabe
authors.forename: Reiko
authors.initials: R
authors.lastname: Saito
authors.forename: Asami
authors.initials: A
authors.lastname: Sasaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D000041:Absenteeism; D002648:Child; D004196:Disease Outbreaks / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control*; D007564:Japan / Q000453:epidemiology; D012189:Retrospective Studies; D012574:Schools; D012621:Seasons
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