Many common respiratory infectious diseases transmit readily among school-age children. In major epidemics, school closures and class suspensions may be implemented to attempt to control transmission in the community. However, such intervention measures have been subject to an extensive debate as well as questions of its effectiveness and adverse social impacts. In the meanwhile, engineering intervention methods are also available, but their impacts at the community level were not well studied. A better understanding of how different school interventions contribute to the airborne disease prevention can provide public health officials important information to design infection control strategies, in particular how engineering control methods such as ventilation are compared to other intervention methods. In this study a hypothetical indoor social contact network was constructed based on census and statistical data of Hong Kong. Detailed school contact structures were modeled and predicted. Influenza outbreaks were simulated within indoor contact networks, allowing for airborne transmission. Local infection risks were calculated from the modified Wells-Riley equation, and the transmission dynamics of the disease were simulated using the SEPIR model. Both school-based general public health interventions (such as school closures, household isolation) and engineering control methods (including increasing ventilation rate in schools and homes) were evaluated in this study. The results showed that among different school-based interventions, increasing ventilation rate together with household isolation could be as effective as school closure.
Archer BN, Cohen C, Naidoo D, Thomas J, Makunga C, Blumberg L, Venter M, Timothy GA, Puren A, McAnerney JM, Cengimbo A, Schoub BD (2009). Interim report on pandemic H1N1 influenza virus infections in South Africa, April to October 2009: Epidemiology and factors associated with fatal cases. Eurosurveillance, 14(42): pii=19369.
Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M (2007). Transmission of influenza A in human beings. Lancet Infectious Disease, 7: 257–265.
Calatayud L, Kurkela S, Neave PE, Brock A, Perkins S, Zuckerman M, Sudhanva M, Bermingham A, Ellis J, Pebody R, Catchpole M, Heathcock R, Maguire H (2010). Pandemic (H1N1) 2009 virus outbreak in a school in London, April–May 2009: an observational study. Epidemiology and Infection, 138: 183–191.
Cauchemez S, Valleron A J, Boelle PY, Flahault A, Ferguson NM (2008). Estimating the impact of school closure on influenza transmission from Sentinel data. Nature, 452: 750–754.
Cauchemez S, Ferguson NM, Wachtel C, Tegnell A, Saour G, Duncan B, Nicoll A (2009). Closure of schools during an influenza pandemic. Lancet Infectious Diseases, 9: 473–481.
CDC (2009a). 2009 pandemic influenza A (H1N1) virus infections—Chicago, Illinois, April–July 2009. MMWR Morbidity and Mortality Weekly Report, 58: 913–918.
CDC (2009b). Swine-Origin Influenza A (H1N1) Virus Infections in a School-New York City, April 2009. Available via http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5817a6.htm. Accessed 12 Nov. 2009.
Census and Statistics Department Hong Kong Government (2007). Hong Kong 2006 Population By-census Main Report: Volume I.
Chao CYH (2001). Comparison between indoor and outdoor air contaminant levels in residential buildings from passive sampler study. Building and Environment, 36: 999–1007.
Chen SC, Chang CF, Liao CM (2006). Predictive models of control strategies involved in containing indoor airborne infections. Indoor Air, 16: 469–481.
Chen SC, Liao CM (2008). Modelling control measures to reduce the impact of pandemic influenza among schoolchildren. Epidemiology and Infection, 136: 1035–1045.
Cowling BJ, Lau EH, Lam CL, Cheng CK, Kovar J, Chan KH, Peiris JS, Leung GM (2008). Effects of school closures, 2008 winter influenza season, Hong Kong. Emerging Infectious Diseases, 14: 1660–1662.
Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ, Gubareva LV, Xu X, Bridges CB, Uyeki TM (2009). Emergence of a novel swine-origin influenza A (H1N1) virus in humans. New England Journal of Medicine, 360: 2605–2615.
Department of Health Hong Government (2009). Swine and Seasonal Flu Monitor 2009 (Volume 1). Available via http://www.chp.gov.hk/guideline1_year.asp?lang=en&id=518&pid=441&ppid=134. Accessed 11 Nov. 2009.
Dyer DL, Shinder A, Shinder F (2000). Alcohol-free instant hand sanitizer reduces elementary school illness absenteeism. Family Medicine, 32: 633–638.
Escombe AR, Oeser CC, Gilman RH, Navincopa M, Ticona E, Pan W, Martinez C, Chacaltana J, Rodriguez R, Moore DAJ, Friedland JS, Evans CA (2007). Natural ventilation for the prevention of airborne contagion. PLoS Medicine, 4: e68.
Eubank S, Guclu H, Anil Kumar VS, Marathe MV, Srinivasan A, Toroczkai Z, Wang N (2004). Modelling disease outbreaks in realistic urban social networks. Nature, 429: 180–184.
Ferguson NM, Cummings DA, Fraser C, Cajka JC, Cooley PC, Burke DS (2006). Strategies for mitigating an influenza pandemic. Nature, 442: 448–452.
Fielding JE, Higgins N, Gregory JE, Grant KA, Catton MG, Bergeri I, Lester RA, Kelly HA (2009). Pandemic H1N1 influenza surveillance in Victoria, Australia, April–September, 2009. Eurosurveillance, 14(42): pii=19368.
Fraser C, Donnelly CA, Cauchemez S, Hanage WP, Van Kerkhove MD, Hollingsworth TD, Griffin J, Baggaley RF, Jenkins HE, Lyons EJ, et al. (2009). Pandemic potential of a strain of influenza A (H1N1): early findings. Science, 324: 1557–1561.
Gao X (2011). Relative effectiveness of ventilation in community indoor environments for controlling infection. PhD Thesis, The University of Hong Kong.
Gianella A, Walter A, Revollo R, Loayza R, Vargas J, Roca Y (2009). Epidemiological analysis of the influenza A(H1N1)v outbreak in Bolivia, May–August 2009. Eurosurveillance, 14(35): pii=19323.
Gilsdorf A, Poggensee G (2009). Influenza A(H1N1)v in Germany: The first 10,000 cases. Eurosurveillance, 14(34): pii=19318.
Halloran ME, Ferguson NM, Eubank S, Longini IM, Jr., Cummings DA, Lewis B, Xu S, Fraser C, Vullikanti A, Germann TC, et al. (2008). Modeling targeted layered containment of an influenza pandemic in the United States. Proceedings of the National Academy of Sciences of the United States of America, 105: 4639–4644.
Health Protection Agency, Health Protection Scotland, National Public Health Service for Wales, HPA Northern Ireland Swine influenza investigation teams (2009). Epidemiology of new influenza A(H1N1) in the United Kingdom, April–May 2009. Eurosurveillance, 14(22): pii=19232.
Hurwitz ES, Haber M, Chang A, Shope T, Teo S, Ginsberg M, Waecker N, Cox NJ (2000). Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts. JAMA, 284: 1677–1682.
Jefferson T, Smith S, Demicheli V, Harnden A, Rivetti A, Di Pietrantonj C (2005). Assessment of the efficacy and effectiveness of influenza vaccines in healthy children: systematic review. Lancet, 365: 773–780.
Kar-Purkayastha I, Ingram C, Maguire H, Roche A (2009). The importance of school and social activities in the transmission of influenza A(H1N1)v: England, April–June 2009. Eurosurveillance, 14(33): pii=19311.
Kawaguchi R, Miyazono M, Noda T, Takayama Y, Sasai Y, Iso H (2009). Influenza (H1N1) 2009 outbreak and school closure, Osaka Prefecture, Japan. Emerging Infectious Diseases, 15: 1685.
Kelly H, Grant K (2009). Interim analysis of pandemic influenza (H1N1) 2009 in Australia: surveillance trends, age of infection and effectiveness of seasonal vaccination. Eurosurveillance, 14(31): pii=19288.
King JC, Jr., Stoddard JJ, Gaglani MJ, Moore KA, Magder L, McClure E, Rubin JD, Englund JA, Neuzil K (2006). Effectiveness of school-based influenza vaccination. New England Journal of Medicine, 355: 2523–2532.
Lee BY, Brown ST, Cooley P, Potter MA, Wheaton WD, Voorhees RE, Stebbins S, Grefenstette JJ, Zimmer SM, Zimmerman RK, et al. (2010). Simulating school closure strategies to mitigate an influenza epidemic. Journal of Public Health Management and Practice, 16: 252–261.
Longini IM, Jr., Halloran ME, Nizam A, Yang Y (2004). Containing pandemic influenza with antiviral agents. American Journal of Epidemiology, 159: 623–633.
Longini IM, Jr., Halloran ME (2005). Strategy for distribution of influenza vaccine to high-risk groups and children. American Journal of Epidemiology, 161: 303–306.
Meadows E, Le Saux N (2004). A systematic review of the effectiveness of antimicrobial rinse-free hand sanitizers for prevention of illness-related absenteeism in elementary school children. BMC Public Health, 4: 50.
Mermel LA (2009). Swine-origin influenza virus in young age groups. Lancet, 373: 2108–2109.
Morton JL, Schultz AA (2004). Healthy hands: Use of alcohol gel as an adjunct to handwashing in elementary school children. The Journal of School Nursing, 20: 161–167.
Munayco CV, Gomez J, Laguna-Torres VA, Arrasco J, Kochel TJ, Fiestas V, Garcia J, Perez J, Torres I, Condori F, Nishiura H, Chowell G (2009). Epidemiological and transmissibility analysis of influenza A(H1N1)v in a southern hemisphere setting: Peru. Eurosurveillance, 14(32): pii=19299.
Nishiura H, Castillo-Chavez C, Safan M, Chowell G (2009). Transmission potential of the new influenza A(H1N1) virus and its age-specificity in Japan. Eurosurveillance, 14(22): pii=19227.
Reichert TA, Sugaya N, Fedson DS, Glezen WP, Simonsen L, Tashiro M (2001). The Japanese experience with vaccinating school-children against influenza. New England Journal of Medicine, 344: 889–896.
Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, Kandeel A, Mohareb E, El-Sayed N (2011). Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerging Infectious Diseases, 17: 619–625.
Tellier R (2006). Review of aerosol transmission of influenza A virus. Emerging Infectious Diseases, 12: 1657–1662.
Wells WF (1955). Airborne Contagion And Air Hygiene; An Ecological Study Of Droplet Infections. Cambridge: Harvard University Press.
Weycker D, Edelsberg J, Halloran ME, Longini IM, Jr., Nizam A, Ciuryla V, Oster G (2005). Population-wide benefits of routine vaccination of children against influenza. Vaccine, 23: 1284–1293.
White T, Lavoie S, Nettleman MD (1999). Potential cost savings attributable to influenza vaccination of school-aged children. Pediatrics, 103: e73.
White CG, Shinder FS, Shinder AL, Dyer DL (2001). Reduction of illness absenteeism in elementary schools using an alcohol-free instant hand sanitizer. The Journal of School Nursing, 17: 258–265.
WHO (2009a). The A/2009 H1N1 influenza virus pandemic. Retrieved 11 Nov. 2009, from The A/2009 H1N1 influenza virus pandemic.
WHO (2009b). Measures in school settings, Pandemic (H1N1) 2009 briefing note 10. Available via http://www.who.int/csr/disease/swineflu/notes/h1n1_school_measures_20090911/en/. Accessed 12 Nov. 2009.
Wu JT, Riley S, Fraser C, Leung GM (2006). Reducing the impact of the next influenza pandemic using household-based public health interventions. PLoS Medicine, 3: e361.
Wu JT, Ma ES, Lee CK, Chu DK, Ho PL, Shen AL, Ho A, Hung IF, Riley S, Ho LM, Lin CK, Tsang T, Lo SV, Lau YL, Leung GM, Cowling BJ, Malik Peiris JS (2010a). The infection attack rate and severity of 2009 pandemic H1N1 influenza in Hong Kong. Clinical Infectious Diseases, 51: 1184–1191.
Wu JT, Cowling BJ, Lau EH, Ip DK, Ho LM, Tsang T, Chuang SK, Leung PY, Lo SV, Liu SH, Riley S (2010b). School closure and mitigation of pandemic (H1N1) 2009, Hong Kong. Emerging Infectious Diseases, 16: 538–541.
About this article
Cite this article
Gao, X., Li, Y., Xu, P. et al. Evaluation of intervention strategies in schools including ventilation for influenza transmission control. Build. Simul. 5, 29–37 (2012). https://doi.org/10.1007/s12273-011-0034-7
- airborne infection
- social network
- engineering control
- school interventions