School closures and other strategies to reduce an epidemic's spread can save lives, particularly when they are implemented soon after an outbreak begins in a community, according to a new study.
Scientists from the Centers for Disease Control and Prevention (CDC) and the University of Michigan Medical School's Center for the History of Medicine based their findings on an exhaustive review of public records from the 1918-1919 influenza pandemic, including health department reports, U.S. Census mortality data and newspaper archives.
The study, published in the Journal of the American Medical Association (JAMA) earlier this month, provides vital clues to help public officials planning for the next influenza pandemic and highlights the importance of community strategies, the CDC said.
Dr. Martin Cetron, director of CDC?s Division of Global Migration and Quarantine and senior author of the study, said in a statement: "Those planning for the next pandemic need to carefully consider how to best use these strategies to protect people and decrease the potential impact of the next pandemic in their communities."
The strategies–voluntary isolation and quarantine, dismissal of students from school classrooms, and social distancing in the workplace and community–form the basis for CDC's guidelines for how American communities can empower themselves to confront the next influenza pandemic.
These strategies are particularly important because the intervention most likely to provide the best protection against pandemic influenza–a vaccine–is unlikely to be available at the outset of a pandemic, the CDC said.
Community strategies that delay or reduce the impact of a pandemic may help reduce the spread of disease until a vaccine that is well matched to the virus is available, CDC advised.
The JAMA study evaluated public health measures, such as school closures and cancellation of public events, taken by 43 American cities during the 1918 pandemic. The researchers sought to determine whether the timing, duration and combination of such measures impacted a city's death rate during the pandemic.
To determine the public health measures? effectiveness, the researchers analyzed each city's excess death rate–the number of pneumonia and influenza deaths in excess of the amount expected for the time period.
During a 24-week period in 1918-1919, more than 115,000 excess pneumonia and influenza deaths in the 43 cities were attributed to the pandemic.
Cities that began interventions earlier had more success in decreasing excess deaths than those that implemented the measures later, regardless of how long the later interventions were in place or how they were executed.
The interventions assessed fell into three major categories: school closures, bans on public gatherings, and isolation of sick people and quarantine of their healthy household contacts.
The most common approach was closing schools combined with banning public gatherings. All but three of the 43 communities closed schools during the 24-week period studied.
The 1918 pandemic sickened about 20 percent of the world's population and caused an estimated 40 million deaths worldwide, about 550,000 of them in the United States.
More information about community strategies for pandemic influenza is online at www.pandemicflu.gov/plan/community/community_mitigation.pdf
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