WHO recants H1N1 advice on schools

Almost six months after the bug made its presence felt, WHO has said closing schools at the start of an H1N1 flu outbreak could slow down the virus' spread by almost 30%-50% and help buy crucial time to build up defences against the highly infectious strain of influenza.

This is exactly what Indian schools, especially in Delhi and Pune, did. And interestingly, they did so against the Union health ministry's wishes. Following WHO's advice, the ministry had, for the past few months, been speaking of the lack of benefits in keeping entire schools shut after students tested positive for H1N1 infection.

The ministry's advice was to shut only those classes where a student had tested positive for H1N1. Health minister Ghulam Nabi Azad had held "shutting a school wouldn't mean you can stop students from attending parties and meeting friends in the evening where they can get the infection. Schools must stay open."

But on Saturday, WHO said experience to date has demonstrated the role of schools in amplifying transmission of the pandemic virus, both within and into the wider community. This has led to the revision of its opinion. After "drawing on recent experiences in several countries", WHO said school closure can operate as a proactive measure in reducing transmission of H1N1.

WHO said, "The main benefit of proactive school closure comes from slowing down the spread of an outbreak within a given area and thus flattening the peak of infections. School closure can also buy some time as countries intensify preparedness measures or build up supplies of vaccines and antiviral drugs."
WHO's modeling studies suggest school closure has its greatest benefits when this is effected very early in an outbreak. If schools close too late in the course of a community-wide outbreak, the resulting
reduction in transmission is likely to be very limited.

"The timing of school closure is critically important," WHO said. The H1N1 virus has killed at least 3,205 people worldwide since emerging last April in North America.

Despite the ministry's requests against school closure, TOI was the first to highlight an Imperial College, London, study that showed that closing down schools entirely during a flu pandemic may cut infection rates by 40%.

Mathematical models suggest that swine flu has an attack rate of 30% once it enters a country, that is, the likelihood is 30% of citizens will catch it at some point.

Children are thought to be important vectors of transmission and susceptible to most influenza strains than adults. High contact rates in schools also favour transmission.

WHO also highlighted that shutting down schools has a serious economic burden with cost arising from absenteeism of working parents or guardians who have to stay home to take care of their children.
Studies estimate that school closures can lead to the absence of 16% of the workforce.

WHO had earlier said that by the end of the pandemic, anywhere between 15% and 45% of a population would have been infected by the new pandemic virus. If one takes the mid-point figure of 30%, it'll mean two billion people getting the infection, WHO said.