May 29, 2008 (CIDRAP News) A survey of North Carolina families affected by a 10-day school closure due to a sharp rise in influenza-related absences found that the measure didn't cause families major hardships, but many did not heed a recommendation to avoid large gatherings.
The findings by researchers at the US Centers for Disease Control and Prevention (CDC) and the North Carolina Department of Health and Human Services were published yesterday as an early online article in Emerging Infectious Diseases (EID).
School closures are among the nonpharmaceutical interventions that public health experts hope could mitigate the effects of a flu pandemic. Few studies have gauged the negative effects of school closures, which could include conflicts with parents' work schedules, forced changes in childcare arrangements, and a lack of meals for children who depend on federally subsidized school breakfast and lunch programs.
Up close to a school closure
The authors of the EID report seized a relatively rare opportunity to study the effects of a school closure in November 2006, when officials from a rural school district in western North Carolina canceled school for 10 days after a widespread influenza B outbreak struck many students and staff.
The day before officials closed the schools, 17% of children in the school district were sick along with 10% of staff members. Officials said they closed the schools because of a shortage of staff.
On Nov 2, officials closed all nine Yancey County schools through Nov 10. The county health department offered vaccination clinics and issued a reverse 911 call advising residents to avoid large gatherings, wash their hands frequently, cover their coughs, and stay away from those who were ill.
Researchers contacted a random sample of households by phone from Nov 16 through 18, according to the report. Using a standard questionnaire, they asked about children's activities during the closure, special child-care arrangements that were needed, how the closure affected work and home routines, and parents' or guardians' opinions regarding the closure. Families were also asked about children's flu and hospitalization risks and recent flu-like illnesses.
Over the 3-day survey period, 220 households completed the questionnaires. The sample covered 9.4% of all children younger than 18 in the county. Thirty seven (17%) of the households were headed by just one adult, which is lower than the national rate of 27%. Children from 87 (41%) households received free or reduced-cost lunches, about the same as the national average of 37.8%, the authors reported.
Minimal impact, but new concerns
The researchers found that 89% (195) of households visited at least one public place during the school closure interval; about half of them had traveled outside the county. Sites varied by age and illness status. Older children were more likely to visit fast-food restaurants and attend parties, and younger children were more likely to visit grocery stores.
Among adults in the households, 72% (315) were employed outside the home. Of the 315 employed adults, 24% (76) missed 1 or more days of work from Oct 23 through the survey date, nearly half because of their own illness. Fourteen of the 76 (18%), all of whom were school employees, missed work because of the school closure.
Most (76%) households reported that someone was regularly available during the day to look after children. Twenty-two (10%) said they had to make special child-care arrangements, such as sending children to grandparents, taking them to work, or using child-care programs.
When asked about the decision to close schools, 92% (201) of households said the move was appropriate. Most felt they had enough time to prepare for the closure.
The authors concluded that the school closure didn't cause major inconveniences for the families that took part in the survey; however, they said pandemic planners should be aware that most families didn't heed warnings to avoid public gatherings.
"Lastly, the effect of school closure on work absenteeism and childcare expenditures appeared to be minimal in this community," they wrote.
Lessons for pandemic planners?
However, they pointed out that the Yancey County results might not be generalizable to other locales. Yancey County is in the Blue Ridge Mountains and often copes with weather-related school closures. Also, the county had a below-average proportion of single-parent households, which could have made it easier for families to adjust to changing child-care needs.
The researchers also acknowledged that their findings run counter to a couple of other studies that have shown that substantial numbers of adults miss work to take care of sick children during the winter cold and flu season.
"Results might also have been different if schools were closed for a longer period or if a more clinically severe strain of influenza were present," they wrote.
Jeffrey Duchin, MD, chief of communicable disease control for Seattle King County Public Health in Washington, told CIDRAP News that the study paints a picture of how families might cope with a short school closure in response to an influenza outbreak. "We don't know, however, how effective the closure was in preventing the spread of influenza either among students or in the surrounding community," he said.
Though the finding that the majority of children visited public places despite warnings is worrying, Duchin said, a larger concern is how families and communities could cope with a 6- to 12-week school closure that might be warranted in a pandemic scenario.
Johnson AJ, Moore ZS, Edelson PJ, et al. Household response to school closure resulting from outbreak of influenza B, North Carolina. Emerg Infect Dis 2008 Jul;14(7) [Full text]
