Within and between classroom transmission patterns of seasonal influenza and implications for pandemic management strategies at schools

Abstract Schools can play a central role in driving infectious disease transmission. Strategies for safe operation of schools during pandemics therefore need to carefully consider both the efficiency of measures for infection control and the impact on children through lost face-to face schooling time. Heterogeneous social contact patterns associated with the social structures of schools (i.e. classes/grades) are likely to influence the within-school transmission dynamics; however, empirical evidence on the fine-scale transmission patterns between students has been limited. Using a mathematical model, we analysed a large-scale dataset of seasonal influenza outbreaks in Matsumoto city, Japan to infer social interactions within and between classes/grades from observed transmission patterns. The overall within-school reproduction number, which determines the initial growth of cases and the risk of sustained transmission, was only minimally associated with class sizes and the number of classes per grade. We then used these patterns in a model parameterised separately to COVID-19 and pandemic influenza, and simulated school outbreaks under multiple strategies for minimising the risk of within-school transmission. Simulations suggested that with such transmission patterns, interventions changing class structures (e.g. reduced class sizes) may not be effective in reducing the risk of major school outbreaks upon introduction of a case and that other precautionary measures (e.g. screening and isolation) need to be employed. Class-level closures in response to detection of a case were suggested to be effective in reducing the size of an outbreak when regular screening tests for students are not available.