Infectious Disease
April 2020
Question
What does the research say about evidence-based strategies for schools to temper or deal with the spread of infectious disease in a pro-active or reactive approach and how schools should handle their position in the community?
Ask A REL Response
Thank you for your request to our Regional Educational Laboratory (REL) Reference Desk. Ask A REL is a collaborative reference desk service provided by the 10 RELs that, by design, functions much in the same way as a technical reference library. Ask A REL provides references, referrals, and brief responses in the form of citations in response to questions about available education research.
Following an established REL Northwest research protocol, we conducted a search for evidence- based research. The sources included ERIC and other federally funded databases and organizations, research institutions, academic research databases, Google Scholar, and general Internet search engines. For more details, please see the methods section at the end of this document.
The research team has not evaluated the quality of the references and resources provided in this response; we offer them only for your reference. The search included the most commonly used research databases and search engines to produce the references presented here. References are listed in alphabetical order, not necessarily in order of relevance. The research references are not necessarily comprehensive and other relevant research references may exist. In addition to evidence-based, peer-reviewed research references, we have also included other resources that you may find useful. We provide only publicly available resources, unless there is a lack of such resources or an article is considered seminal in the topic area.
References
Cauchemez, S., Van Kerkhove, M. D., Archer, B. N., Cetron, M., Cowling, B. J., Grove, P. et al. (2014). School closures during the 2009 influenza pandemic: National and local experiences. BMC Infectious Diseases, 14(1), 207. Retrieved from https://link.springer.com/
From the Abstract:
"Background: School closure is a non-pharmaceutical intervention that was considered in many national pandemic plans developed prior to the start of the influenza A(H1N1)pdm09 pandemic, and received considerable attention during the event. Here, we retrospectively review and compare national and local experiences with school closures in several countries during the A(H1N1)pdm09 pandemic. Our intention is not to make a systematic review of country experiences; rather, it is to present the diversity of school closure experiences and provide examples from national and local perspectives."
Methods: Data were gathered during and following a meeting, organized by the European Centres for Disease Control, on school closures held in October 2010 in Stockholm, Sweden. A standard data collection form was developed and sent to all participants. The twelve participating countries and administrative regions (Bulgaria, China, France, Hong Kong Special Administrative Region (SAR), Italy, Japan, New Zealand, Serbia, South Africa, Thailand, United Kingdom, and United States) provided data.
Results: Our review highlights the very diverse national and local experiences on school closures during the A(H1N1)pdm09 pandemic. The processes including who was in charge of making recommendations and who was in charge of making the decision to close, the school-based control strategies, the extent of school closures, the public health tradition of responses and expectations on school closure varied greatly between countries. Our review also discusses the many challenges associated with the implementation of this intervention and makes recommendations for further practical work in this area.
Conclusions: The single most important factor to explain differences observed between countries may have been the different public health practises and public expectations concerning school closures and influenza in the selected countries."
Faherty, L. J., Schwartz, H. L., Ahmed, F., Zheteyeva, Y., Uzicanin, A., & Uscher-Pines, L. (2019). School and preparedness officials' perspectives on social distancing practices to reduce influenza transmission during a pandemic: Considerations to guide future work. Preventive Medicine Reports, 14, 100871. https://www.sciencedirect.com/
From the Abstract:
"The objective of this qualitative study was to explore the perspectives of school and preparedness officials on the feasibility of implementing a range of social distancing practices to reduce influenza transmission during a pandemic. In the summer of 2017, we conducted 36 focus groups by teleconference and webinar lasting 90 min with school and preparedness stakeholders from across the United States. We identified and characterized 11 themes arising from the focus group protocol's domains as well as unanticipated emergent themes. These themes were: the need for effective stakeholder communication, the importance of partnering for buy-in, the role of social distancing in heightening anxiety, ensuring student safety, how practices work in combination, challenges with enforcement, lack of funding for school nurses, differing views about schools' role in protecting public health, the need for education and community engagement to ensure consistent implementation, the need for collaborative decision-making, and tension between standardizing public health guidance and adapting to local contexts. Addressing several crosscutting considerations can increase the likelihood that social distancing practices will be feasible and acceptable to school stakeholders."
Gemmetto, V., Barrat, A., & Cattuto, C. (2014). Mitigation of infectious disease at school: Targeted class closure vs school closure. BMC Infectious Diseases, 14(1), 695. Retrieved from https://bmcinfectdis.biomedcentral.com/
From the Abstract:
"Background: School environments are thought to play an important role in the community spread of infectious diseases such as influenza because of the high mixing rates of school children. The closure of schools has therefore been proposed as an efficient mitigation strategy. Such measures come however with high associated social and economic costs, making alternative, less disruptive interventions highly desirable. The recent availability of high-resolution contact network data from school environments provides an opportunity to design models of micro-interventions and compare the outcomes of alternative mitigation measures. Methods and results: We model mitigation measures that involve the targeted closure of school classes or grades based on readily available information such as the number of symptomatic infectious children in a class. We focus on the specific case of a primary school for which we have high-resolution data on the close-range interactions of children and teachers. We simulate the spread of an influenza-like illness in this population by using an SEIR model with asymptomatics, and compare the outcomes of different mitigation strategies. We find that targeted class closure affords strong mitigation effects: closing a class for a fixed period of time - equal to the sum of the average infectious and latent durations - whenever two infectious individuals are detected in that class decreases the attack rate by almost 70% and significantly decreases the probability of a severe outbreak. The closure of all classes of the same grade mitigates the spread almost as much as closing the whole school. Conclusions: Our model of targeted class closure strategies based on readily available information on symptomatic subjects and on limited information on mixing patterns, such as the grade structure of the school, shows that these strategies might be almost as effective as whole-school closure, at a much lower cost. This may inform public health policies for the management and mitigation of influenza-like outbreaks in the community."
Germann, T. C., Gao, H., Gambhir, M., Plummer, A., Biggerstaff, M., Reed, C., & Uzicanin, A. (2019). School dismissal as a pandemic influenza response: When, where and for how long? Epidemics, 28, 100348. Retrieved from https://www.ncbi.nlm.nih.gov/
From the Abstract:
"We used individual-based computer simulation models at community, regional and national levels to evaluate the likely impact of coordinated pre-emptive school dismissal policies during an influenza pandemic. Such policies involve three key decisions: when, over what geographical scale, and how long to keep schools closed. Our evaluation includes uncertainty and sensitivity analyses, as well as model output uncertainties arising from variability in serial intervals and presumed modifications of social contacts during school dismissal periods. During the period before vaccines become widely available, school dismissals are particularly effective in delaying the epidemic peak, typically by 4–6 days for each additional week of dismissal. Assuming the surveillance is able to correctly and promptly diagnose at least 5–10% of symptomatic individuals within the jurisdiction, dismissals at the city or county level yield the greatest reduction in disease incidence for a given dismissal duration for all but the most severe pandemic scenarios considered here. Broader (multi-county) dismissals should be considered for the most severe and fast-spreading (1918-like) pandemics, in which multi-month closures may be necessary to delay the epidemic peak sufficiently to allow for vaccines to be implemented."
Lee, B. Y., Brown, S. T., Cooley, P., Potter, M. A., Wheaton, W. D., Voorhees, R. E., et al. (2010). Simulating school closure strategies to mitigate an influenza epidemic. Journal of Public Health Management and Practice: JPHMP, 16(3), 252. https://www.ncbi.nlm.nih.gov/
From the Abstract:
"Background—There remains substantial debate over the impact of school closure as a mitigation strategy during an influenza pandemic. The ongoing 2009 H1N1 influenza pandemic has provided an unparalleled opportunity to test interventions with the most up-to-date simulations. Methods—To assist the Allegheny County Health Department during the 2009 H1N1 influenza pandemic, the University of Pittsburgh Models of Infectious Disease Agents Study group employed an agent-based computer simulation model (ABM) of Allegheny County, Pennsylvania, to explore the effects of various school closure strategies on mitigating influenza epidemics of different reproductive rates (R0). Results—Entire school system closures were not more effective than individual school closures. Any type of school closure may need to be maintained throughout most of the epidemic (i.e., at least 8 weeks) to have any significant effect on the overall serologic attack rate. In fact, relatively short school closures (i.e., 2 weeks or less) may actually slightly increase the overall attack rate by returning susceptible students back into schools in the middle of the epidemic. Varying the illness threshold at which school closures are triggered did not seem to have substantial impact on the effectiveness of school closures, suggesting that short delays in closing schools should not cause concern. Conclusions—School closures alone may not be able to quell an epidemic but, when maintained for at least 8 weeks, could delay the epidemic peak for up to a week, providing additional time to implement a second more effective intervention such as vaccination."
Litvinova, M., Liu, Q. H., Kulikov, E. S., & Ajelli, M. (2019). Reactive school closure weakens the network of social interactions and reduces the spread of influenza. Proceedings of the National Academy of Sciences, 116(27), 13174–13181. Retrieved from https://www.pnas.org/
From the Abstract:
"School-closure policies are considered one of the most promising nonpharmaceutical interventions for mitigating seasonal and pandemic influenza. However, their effectiveness is still debated, primarily due to the lack of empirical evidence about the behavior of the population during the implementation of the policy. Over the course of the 2015 to 2016 influenza season in Russia, we performed a diary-based contact survey to estimate the patterns of social interactions before and during the implementation of reactive school-closure strategies. We develop an innovative hybrid survey-modeling framework to estimate the time-varying network of human social interactions. By integrating this network with an infection transmission model, we reduce the uncertainty surrounding the impact of school-closure policies in mitigating the spread of influenza. When the school-closure policy is in place, we measure a significant reduction in the number of contacts made by students (14.2 vs. 6.5 contacts per day) and workers (11.2 vs. 8.7 contacts per day). This reduction is not offset by the measured increase in the number of contacts between students and nonhousehold relatives. Model simulations suggest that gradual reactive school closure policies based on monitoring student absenteeism rates are capable of mitigating influenza spread. We estimate that without the implemented reactive strategies the attack rate of the 2015 to 2016 influenza season would have been 33% larger. Our study sheds light on the social mixing patterns of the population during the implementation of reactive school closures and provides key instruments for future cost-effectiveness analyses of school-closure policies."
Ridenhour, B. J., Braun, A., Teyrasse, T., & Goldsman, D. (2011). Controlling the spread of disease in schools. PloS One, 6(12), 1–7. Retrieved from https://journals.plos.org/
From the Abstract:
"Pandemic and seasonal infectious diseases such as influenza may have serious negative health and economic consequences. Certain non-pharmaceutical intervention strategies - including school closures - can be implemented rapidly as a first line of defense against spread. Such interventions attempt to reduce the effective number of contacts between individuals within a community; yet the efficacy of closing schools to reduce disease transmission is unclear, and closures certainly result in significant economic impacts for caregivers who must stay at home to care for their children. Using individual-based computer simulation models to trace contacts among schoolchildren within a stereotypical school setting, we show how alternative school-based disease interventions have great potential to be as effective as traditional school closures without the corresponding loss of workforce and economic impacts."
Stein, B. D., Tanielian, T. L., Vaiana, M. E., Rhodes, H. J., & Burnam, M. A. (2003). The role of schools in meeting community needs during bioterrorism. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 1(4), 273–281. Retrieved from https://citeseerx.ist.psu.edu/
From the Document:
"In this article, we examine the potential role of schools and school districts in meeting community needs during a bioterrorism attack. Others have written about schools’ role in meeting the needs of children after terrorism and other forms of mass violence.9–11 These documents provide a useful summary of current knowledge regarding the acute and long-term psychological effects of such events on children, and they present current consensus recommendations for preparing for and responding to such events. We focus here specifically on the challenges posed by bioterrorism, particularly with respect to those areas in which the differences inherent in a bioterrorism event may create challenges unlike those of other crises."
Uscher-Pines, L., Schwartz, H. L., Ahmed, F., Zheteyeva, Y., Meza, E., Baker, G. et al. (2018). School practices to promote social distancing in K-12 schools: Review of influenza pandemic policies and practices. BMC Public Health, 18(1), 406. Retrieved from https://link.springer.com/
From the Abstract:
"Background: During an evolving influenza pandemic, community mitigation strategies, such as social distancing, can slow down virus transmission in schools and surrounding communities. To date, research on school practices to promote social distancing in primary and secondary schools has focused on prolonged school closure, with little attention paid to the identification and feasibility of other more sustainable interventions. To develop a list and typology of school practices that have been proposed and/or implemented in an influenza pandemic and to uncover any barriers identified, lessons learned from their use, and documented impacts."
Methods
Keywords and Search Strings: The following keywords, subject headings, and search strings were used to search reference databases and other sources: (School OR "school district"), (Pandemic OR "infectious disease" OR crisis), (Role OR response OR strategies)
Databases and Resources: We searched ERIC for relevant resources. ERIC is a free online library of more than 1.6 million citations of education research sponsored by the Institute of Education Sciences (IES). Additionally, we searched Google Scholar and EBSCO databases (Academic Search Premier, Education Research Complete, and Professional Development Collection).
Reference Search and Selection Criteria
When we were searching and reviewing resources, we considered the following criteria:
Date of publications: This search and review included references and resources published in the last 10 years.
Search priorities of reference sources: Search priority was given to study reports, briefs, and other documents that are published and/or reviewed by IES and other federal or federally funded organizations, as well as academic databases, including ERIC, EBSCO databases, and Google Scholar.
Methodology: The following methodological priorities/considerations were given in the review and selection of the references:
- Study types: randomized control trials, quasi experiments, surveys, descriptive data analyses, literature reviews, and policy briefs, generally in this order
- Target population and samples: representativeness of the target population, sample size, and whether participants volunteered or were randomly selected
- Study duration
- Limitations and generalizability of the findings and conclusions
This memorandum is one in a series of quick-turnaround responses to specific questions posed by stakeholders in Alaska, Idaho, Montana, Oregon, and Washington, which is served by the Regional Educational Laboratory (REL) Northwest. It was prepared under Contract ED-IES-17-C-0009 by REL Northwest, administered by Education Northwest. The content does not necessarily reflect the views or policies of IES or the U.S. Department of Education, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.