Influenza Tranmission School haldol Dismissals The Community Guide

The community preventive services task force recommends pre-emptive, coordinated school dismissals during a severe influenza pandemic (a pandemic with high rates of severe illness such as haldol dec that experienced in 1918) based on sufficient evidence of effectiveness in reducing or delaying haldol dec the spread of infection and illness within communities. Evidence was considered sufficient based on findings from retrospective assessments haldol dec of public health actions taken during the 1918 pandemic and haldol dec results from modeled simulations indicating that the benefits of timely, coordinated, and sustained dismissals outweigh the expected societal and economic costs haldol dec of these actions. Effectiveness of school closures during an influenza pandemic may vary haldol dec with unique characteristics of the pandemic, and with the abilities of national, state, and local decision makers, health care providers, and the public to quickly implement and sustain a broader haldol dec set of mitigation responses over an extended period of time haldol dec (weeks to months).

The community preventive services task force finds insufficient evidence to haldol dec determine the balance of benefits and harms of pre-emptive, coordinated school dismissals in the event of an influenza pandemic haldol dec of moderate or less severity (pandemics without high rates of severe illness). Evidence is considered insufficient because few studies provided information relevant haldol dec to an overall assessment of potential benefits and costs of haldol dec school dismissals for pandemics without high rates of severe illness. Although some studies evaluating school dismissals during the 2009 H1N1 haldol dec pandemic reported lower rates of infection or illness, short term follow-up and the absence of data on societal costs limit haldol dec the interpretation of these results. In addition, level of public concern would be unlikely to support or haldol dec sustain the extended duration of school dismissals (weeks to months) and the broader set of community actions necessary for meaningful haldol dec reduction of levels of infection and illness within the community.

During an influenza pandemic with low rates of severe illness, social and economic costs of community-wide dismissals would likely exceed potential benefits, especially for some segments of the population, such as families in which both parents work and no haldol dec other child care is available. Across pandemic scenarios with elevated rates of severe illness, the potential benefits of achievable (duration, combination, and coordination) school dismissals and community actions may be limited to slowing haldol dec transmission of infection and reducing peak burden of illness on haldol dec health care resources. Available evidence provides little information to inform current or future haldol dec determinations of threshold parameters for school dismissal actions (characteristics of both the pandemic and the pandemic response which haldol dec affect the balance of benefits to costs). Intervention

During an influenza pandemic, the coordinated closure of schools could be an important community-wide public health action. If implemented efficiently and maintained for an appropriate duration, school dismissals could reduce or delay transmission of infection; reduce the burden of illness on communities, health systems, and providers; provide time to implement additional public health actions (such as distribution of an effective vaccine); and reduce morbidity and mortality caused by the pandemic. The closure of educational facilities for the required duration, however, will involve costs to households and communities, due to social disruption and related economic effects. Against these costs, benefits from reduced morbidity and mortality (and related social and economic effects) could vary, depending on how easily the infection is spread, the severity of illness, and effectiveness of the overall public health response.

In conducting this review, the community preventive services task force considered the available evidence haldol dec regarding benefits and costs of coordinated school closures for an haldol dec extended duration (weeks to months). The task force finding is an assessment of the overall haldol dec value of coordinated school closures to the community during an haldol dec influenza pandemic. Many dismissal decisions will be made locally, by school and public health officials who incorporate local considerations haldol dec and information. Although the decision to close individual schools (especially schools with students at elevated risk for complications of haldol dec influenza) during high or increasing rates of illness, absenteeism, or public concern remains a local option, such actions alone are unlikely to affect community-wide transmission of pandemic influenza. Summary of results

Each community preventive services task force (task force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is haldol dec made. In cases when the task force finds insufficient evidence to haldol dec determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more haldol dec effectiveness studies. When the task force recommends an intervention, evidence gaps highlight missing information that would help users determine haldol dec if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will haldol dec work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to haldol dec ensure effectiveness. Finally, evidence may be missing for outcomes different from those on haldol dec which the task force recommendation is based.

• future simulations of influenza pandemics should explore the threshold margins haldol dec of effectiveness of school dismissals (points at which the benefits to costs trade-offs change) based on differences in pandemic impact, school dismissal timing and duration, and the presence or absence of additional community mitigation actions.

• community simulation models should include organized child care facilities as haldol dec an additional setting associated with influenza transmission. Simulations should model the timing and completeness of child care haldol dec closures separately from the timing of school dismissal decisions.

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