Pre-symptomatic Influenza Transmission, Surveillance, and School Closings: Implications for Novel Influenza A (H1N1)

¹ Department of Mathematics, Vanderbilt University, Nashville, Tennessee, 37240 USA
² Department of Public Health and Center for Infectious Disease Epidemiology Research, China Medical University, Taichung, Taiwan
³ Laboratory for Industrial and Applied Mathematics, Centre for Disease Modeling, Department of Mathematics and Statistics, York University, Toronto, Canada M3J 1P3
⁴ Department of Medicine and Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA

^* Corresponding author. E-mail glenn.f.webb@vanderbilt.edu

Abstract

Early studies of the novel swine-origin 2009 influenza A (H1N1) epidemic indicate clinical attack rates in children much higher than in adults. Non-medical interventions such as school closings are constrained by their large socio-economic costs. Here we develop a mathematical model to ascertain the roles of pre-symptomatic influenza transmission as well as symptoms surveillance of children to assess the utility of school closures. Our model analysis indicates that school closings are advisable when pre-symptomatic transmission is significant or when removal of symptomatic children is inefficient. Our objective is to provide a rational basis for school closings decisions dependent on virulence characteristics and local surveillance implementation, applicable to the current epidemic and future epidemics.