Cost-effective length and timing of school closure during an influenza pandemic depend on the severity

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• 作者：Hiroshi Nishiura (1)
  Keisuke Ejima (1) (2)
  Kenji Mizumoto (1) (3)
  Shinji Nakaoka (4)
  Hisashi Inaba (5)
  Seiya Imoto (6)
  Rui Yamaguchi (6)
  Masaya M Saito (7)
  
• 刊名：Theoretical Biology and Medical Modelling
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：11
• 期：1
• 全文大小：521 KB
• 作者单位：Hiroshi Nishiura (1)
  Keisuke Ejima (1) (2)
  Kenji Mizumoto (1) (3)
  Shinji Nakaoka (4)
  Hisashi Inaba (5)
  Seiya Imoto (6)
  Rui Yamaguchi (6)
  Masaya M Saito (7)
  
  1. Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
  2. Department of Mathematical Informatics, Graduate School of Information Science and Technology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138656, Japan
  3. Institute of Tropical Medicine and the Global Center of Excellence Program, Nagasaki University, Nagasaki, 8528523, Japan
  4. Laboratory for Mathematical Modeling of Immune System, RIKEN Center for Integrative Medical Science Center (IMS-RCAI), 1-7-22, Suehiro-cho, Tsurumi-ku, Yokohama-city, Kanagawa, 2300045, Japan
  5. Graduate School of Mathematical Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 1538914, Japan
  6. Human Genome Center, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 1088639, Japan
  7. Research and Development Center for Data Assimilation, Institute of Statistical Mathematics, 10-3 Midoricho, Tachikawa, Tokyo, 1908562, Japan
  
• ISSN：1742-4682

文摘

Background There has been a variation in published opinions toward the effectiveness of school closure which is implemented reactively when substantial influenza transmissions are seen at schools. Parameterizing an age-structured epidemic model using published estimates of the pandemic H1N1-2009 and accounting for the cost effectiveness, we examined if the timing and length of school closure could be optimized. Methods Age-structured renewal equation was employed to describe the epidemic dynamics of an influenza pandemic. School closure was assumed to take place only once during the course of the pandemic, abruptly reducing child-to-child transmission for a fixed length of time and also influencing the transmission between children and adults. Public health effectiveness was measured by reduction in the cumulative incidence, and cost effectiveness was also examined by calculating the incremental cost effectiveness ratio and adopting a threshold of 1.0?×-07 Japanese Yen/life-year. Results School closure at the epidemic peak appeared to yield the largest reduction in the final size, while the time of epidemic peak was shown to depend on the transmissibility. As the length of school closure was extended, we observed larger reduction in the cumulative incidence. Nevertheless, the cost effectiveness analysis showed that the cost of our school closure scenario with the parameters derived from H1N1-2009 was not justifiable. If the risk of death is three times or greater than that of H1N1-2009, the school closure could be regarded as cost effective. Conclusions There is no fixed timing and duration of school closure that can be recommended as universal guideline for different types of influenza viruses. The effectiveness of school closure depends on the transmission dynamics of a particular influenza virus strain, especially the virulence (i.e. the infection fatality risk).