School closures in response to A/H1N1: Issues for decision-makers

Because schools can be amplifiers of the spread of influenza and children seem to be particularly vulnerable to its complications, hundreds of U.S. schools closed in response to the 2009 A/H1N1 outbreaks in the Spring of 2009. This experience surfaced a number of challenges that can have important implications for the capability of the broader public health system to respond to pandemics and other public health emergencies. In an in-depth case study based on media reports, observations of public health meetings, and discussions with decision-makers, we will address: the goals of school closure, what closure means in practice, whether to close schools, who makes the closure decision, and when schools should re-open. Implications of these various challenges will be reviewed and considerations for decision-makers in future public health emergencies will be presented.