tetano
Editor, Senior Moderator
Clinical Infectious Diseases
Investigating 2009 Pandemic Influenza A (H1N1) in US Schools: What Have We Learned?
1. A. Danielle Iuliano1,*,
2. Fatimah S. Dawood2,*,
3. Benjamin J. Silk3,*,
4. Achuyt Bhattarai4,*,
5. Daphne Copeland5,
6. Saumil Doshi2,*,
7. Anne Marie France*,
8. Michael L. Jackson3,*,
9. Erin Kennedy2,*,
10. Fleetwood Loustalot6,*,
11. Tiffany Marchbanks7,?,
12. Tarissa Mitchell5,*,
13. Francisco Averhoff5,
14. Sonja J. Olsen8,
15. David L. Swerdlow9, and
16. Lyn Finelli9
+ Author Affiliations
1.
1Division of HIV AIDS Prevention
2.
2Influenza Division
3.
3Division of Bacterial Diseases
4.
4Division of Foodborne, Bacterial and Mycotic Diseases
5.
5Division of Global Migration and Quarantine
6.
6Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
7.
7Pennsylvania Department of Health
8.
8Division of Emerging Infections and Surveillance Services
9.
9National Center for Immunizations and Respiratory Diseases
10.
*Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA
11.
?Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologist Applied Epidemiology Fellowship Program
1. Correspondence: Danielle Iuliano, PhD, MPH, 1600 Clifton Rd, MS A-32, Atlanta, GA 30329 (e-mail: aiuliano@cdc.gov).
Abstract
US investigations of school-based outbreaks of 2009 pandemic influenza A (H1N1) virus infection characterized influenza-like illness (ILI) attack rates, transmission risk factors, and adherence to nonpharmaceutical interventions. We summarize seven school-based investigations conducted during April?June 2009 to determine what questions might be answered by future investigations. Surveys were administered 5?28 days after identification of the outbreaks, and participation rates varied among households (39?86%) and individuals (24?49%). Compared with adults (4%?10%) and children aged <4 years (2%?7%), elementary through university students had higher ILI attack rates (4%?32%). Large gatherings or close contact with sick persons were identified as transmission risk factors. More participants reported adherence to hygiene measures, but fewer reported adherence to isolation measures. Challenges included low participation and delays in survey initiation that potentially introduced bias. Although school-based investigations can increase our understanding of epidemiology and prevention strategy effectiveness, investigators should decide which objectives are most feasible, given timing and design constraints.
http://cid.oxfordjournals.org/content/52/suppl_1/S161.full
Investigating 2009 Pandemic Influenza A (H1N1) in US Schools: What Have We Learned?
1. A. Danielle Iuliano1,*,
2. Fatimah S. Dawood2,*,
3. Benjamin J. Silk3,*,
4. Achuyt Bhattarai4,*,
5. Daphne Copeland5,
6. Saumil Doshi2,*,
7. Anne Marie France*,
8. Michael L. Jackson3,*,
9. Erin Kennedy2,*,
10. Fleetwood Loustalot6,*,
11. Tiffany Marchbanks7,?,
12. Tarissa Mitchell5,*,
13. Francisco Averhoff5,
14. Sonja J. Olsen8,
15. David L. Swerdlow9, and
16. Lyn Finelli9
+ Author Affiliations
1.
1Division of HIV AIDS Prevention
2.
2Influenza Division
3.
3Division of Bacterial Diseases
4.
4Division of Foodborne, Bacterial and Mycotic Diseases
5.
5Division of Global Migration and Quarantine
6.
6Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
7.
7Pennsylvania Department of Health
8.
8Division of Emerging Infections and Surveillance Services
9.
9National Center for Immunizations and Respiratory Diseases
10.
*Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA
11.
?Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologist Applied Epidemiology Fellowship Program
1. Correspondence: Danielle Iuliano, PhD, MPH, 1600 Clifton Rd, MS A-32, Atlanta, GA 30329 (e-mail: aiuliano@cdc.gov).
Abstract
US investigations of school-based outbreaks of 2009 pandemic influenza A (H1N1) virus infection characterized influenza-like illness (ILI) attack rates, transmission risk factors, and adherence to nonpharmaceutical interventions. We summarize seven school-based investigations conducted during April?June 2009 to determine what questions might be answered by future investigations. Surveys were administered 5?28 days after identification of the outbreaks, and participation rates varied among households (39?86%) and individuals (24?49%). Compared with adults (4%?10%) and children aged <4 years (2%?7%), elementary through university students had higher ILI attack rates (4%?32%). Large gatherings or close contact with sick persons were identified as transmission risk factors. More participants reported adherence to hygiene measures, but fewer reported adherence to isolation measures. Challenges included low participation and delays in survey initiation that potentially introduced bias. Although school-based investigations can increase our understanding of epidemiology and prevention strategy effectiveness, investigators should decide which objectives are most feasible, given timing and design constraints.
http://cid.oxfordjournals.org/content/52/suppl_1/S161.full