Cited by 224Influenza Virus Research StudiesRespiratory viral infections researchVaccine Coverage and Hesitancy

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School closures and influenza: systematic review of epidemiological studies

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Jackson, Charlotte, Vynnycky, Emilia, Hawker, Jeremy, Olowokure, Babatunde, Mangtani, Punam·2013·BMJ Open

DOI 10.1136/bmjopen-2012-002149PMC PMC3586057

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Abstract

Objective: To review the effects of school closures on pandemic and seasonal influenza outbreaks. Design: Systematic review. Data sources: MEDLINE and EMBASE, reference lists of identified articles, hand searches of key journals and additional papers from the authors' collections. Study selection: Studies were included if they reported on a seasonal or pandemic influenza outbreak coinciding with a planned or unplanned school closure. Results: Of 2579 papers identified through MEDLINE and EMBASE, 65 were eligible for inclusion in the review along with 14 identified from other sources. Influenza incidence frequently declined after school closure. The effect was sometimes reversed when schools reopened, supporting a causal role for school closure in reducing incidence. Any benefits associated with school closure appeared to be greatest among school-aged children. However, as schools often closed late in the outbreak or other interventions were used concurrently, it was sometimes unclear how much school closure contributed to the reductions in incidence. Conclusions: School closures appear to have the potential to reduce influenza transmission, but the heterogeneity in the data available means that the optimum strategy (eg, the ideal length and timing of closure) remains unclear.

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Figure 1 Identification of epidemiological studies of the effects of school closure on influenza outbreaks.CC BY-NC · PubMed Central

Figure 2 Peak cumulative attack rates recorded in the identified studies. Case definitions varied between studies (see online supplementary appendix); only studies which included a denominator are shown. Studies which reported peak prevalence of absenteeism are denoted by an asterisk. See online supplementary appendix for full details of datasets. All pandemic data are from 2009 except for Kelleys Island. BC, British Columbia; CT, Connecticut; IL, Illinois; KI, Kelleys Island; NC, North Carolina.CC BY-NC · PubMed Central

Figure 3 Normalised peak attack rates (estimated as peak attack rate/median attack rate) recorded in the identified studies; one study with an estimate normalised peak of 128 is excluded for clarity.82 Case definitions varied between studies (see online supplementary appendix). Studies which reported peak prevalence of absenteeism are denoted by an asterisk. HK, Hong Kong; IL, Illinois; KI, Kelleys Island; NC, North Carolina; SARI, severe acute respiratory infection.CC BY-NC · PubMed Central

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“…one hand, as recognised in research and strategies by the WHO (2019), ECDC (2020a) and others, school closures have for long been known as a potentially effective intervention for reducing the spread of infectious diseases by increasing social distancing (Hatchett et al. 2007; Jackson et al. 2013).”
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Authors: Jackson, C., Vynnycky, E., Hawker, J., Olowokure, B., & Mangtani, P.
Affiliations: London School of Hygiene & Tropical Medicine (GB)
Health Protection Agency, London, UK
Health Protection Agency (GB)
Corresponding author: Jackson, Charlotte
ORCID: Jackson, Charlotte
Vynnycky, Emilia
Hawker, Jeremy
Olowokure, Babatunde
Mangtani, Punam
Venue: BMJ Open
Publisher: BMJ
Published: 2013
Volume: 3
Issue: 2
Pages: e002149
ISSN: 2044-6055 (ISSN-L)
DOI: 10.1136/bmjopen-2012-002149
PMC: PMC3586057
OpenAlex: W2121157266
Cited by: 224
References: 85
Citations by year: 2026: 6 · 2025: 8 · 2024: 23 · 2023: 18 · 2022: 20 · 2021: 66 · 2020: 42 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 7 · 2015: 7 · 2014: 9 · 2013: 2
FWCI: 0.99
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
Locations: BMJ Open (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
UCL Discovery (University College London) (submittedVersion)
Funders: London School of Hygiene and Tropical Medicine
National Institute for Health and Care Research (RTF/01/038)
Topics: Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
Social Sciences › Health › Vaccine Coverage and Hesitancy
Keywords: school closures, influenza, pandemic influenza, seasonal influenza, influenza transmission, influenza incidence, school-aged children, school reopening, non-pharmaceutical interventions

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School closures and influenza: systematic review of epidemiological studies

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