title: Effects of school breaks on influenza-like illness incidence in a temperate Chinese region: an ecological study from 2008 to 2015.
abstract: To assess the effects of winter/summer school breaks on occurrences of influenza-like illness (ILI).
  
  
  
  We jointly analysed ILI surveillance data with the timing of school breaks in a temperate district in Beijing, China from 2008 to 2015. ILI incidence rate ratios (IRRs) of schoolchildren (5-14 and 15-24 years of age) to adults (25-59 and >60 years of age) were used to measure the age shift of ILI incidence before, during and after the 4-week winter/7-week summer breaks. Serfling-based Poisson regression model with adjustment for unmeasured confounders was built to further assess the effect of winter school breaks.
  
  
  
  ILI incidences were consistently lower during winter breaks than before winter breaks for all age groups. IRRs of younger schoolchildren aged 5-14 to adults were higher during winter school breaks than before breaks, while the opposite was true for the IRRs of older schoolchildren aged 15-24 to adults. Schoolchildren-to-adults IRRs during summer breaks were significantly lower than before or after school breaks (p<0.001).
  
  
  
  Both winter and summer breaks were associated with reductions of ILI incidences among schoolchildren and adults. Our study contributes additional evidence on the effects of school breaks on ILI incidence, suggesting school closure could be effective in controlling influenza transmission in developing countries.
authors.affiliation: Centers for Disease Control and Prevention in Xicheng District, Beijing, China.
authors.forename: Yanhui
authors.initials: Y
authors.lastname: Chu
authors.affiliation: Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
authors.forename: Jiayi
authors.initials: J
authors.lastname: Ji
authors.affiliation: Centers for Disease Control and Prevention in Xicheng District, Beijing, China.
authors.forename: Jingyi
authors.initials: J
authors.lastname: Sun
authors.affiliation: Centers for Disease Control and Prevention in Xicheng District, Beijing, China.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
authors.forename: Guoyou
authors.initials: G
authors.lastname: Qin
authors.affiliation: Centers for Disease Control and Prevention in Xicheng District, Beijing, China.
authors.forename: Jingning
authors.initials: J
authors.lastname: Qin
authors.affiliation: Centers for Disease Control and Prevention in Xicheng District, Beijing, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Xiao
authors.affiliation: Centers for Disease Control and Prevention in Xicheng District, Beijing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Ren
authors.affiliation: Centers for Disease Control and Prevention in Xicheng District, Beijing, China.
authors.forename: Di
authors.initials: D
authors.lastname: Qin
authors.affiliation: Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
authors.forename: Xueying
authors.initials: X
authors.lastname: Zheng
authors.affiliation: Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.|Shanghai Key Laboratory of Meteorology and Health, Shanghai, China.
authors.forename: Xi-Ling
authors.initials: XL
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000068476:Beijing / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006693:Holidays; D006801:Humans; D015994:Incidence; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D012574:Schools; D012621:Seasons; D055815:Young Adult
keywords: incidence rate; influenza-like illness; school break