1918 Flu Closings May Provide Lessons for Today

TUESDAY Sept. 29, 2009 -- An analysis of disease control measures used during the 1918 influenza pandemic offers lessons for dealing with the issue of school closures this fall in response to the H1N1 swine flu pandemic, say U.S. researchers.

Last spring, school closures were a common and controversial strategy for controlling the spread of the H1N1 virus. Intense debate about this type of action will likely occur again if the swine flu pandemic continues or worsens this fall, according to researchers at the University of Michigan and the U.S. Centers for Disease Control and Prevention.

They studied how 43 American cities and their public school systems responded during the 1918 flu pandemic and found that school closures were almost always issued with community-wide nonpharmaceutical interventions, such as quarantine, isolation and bans on public gatherings.

The smooth implementation of all these measures -- not just school closures -- was dependent upon clear lines of authority among municipal and other government agencies, and open communication between health authorities and the public.

"The recently issued CDC guidance for grades K-12 school dismissal provides a framework for communities to make decisions based on local factors and considerations, much like what we saw for cities in 1918," paper co-author Alexandra Minna Stern, a professor of history of medicine and associate director of the University of Michigan Center for the History of Medicine, said in a university news release. "Then and now, there are parallels in the social, political and organizational factors influencing the smooth implementation of school closure," she explained.

"Cities showing the greatest acceptance of and compliance with school closures and other community measures invariably exhibited established lines of trust and communication in government and the community that pre-existed the pandemic," co-author Dr. Howard Markel, a professor of history of medicine and director of the university's Center for the History of Medicine, said in the release.

"Their experiences present insights for contemporary pandemic preparedness and community mitigation planning," he said.

The paper appears online Sept. 29 in the journal Health Affairs.

More information

The U.S. Centers for Disease Control and Prevention has more about swine flu.

Posted: September 2009


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