Temporal factors in school closure policy for mitigating the spread of influenza.

Is school closure effective in mitigating influenza outbreaks? For Singapore, we developed an individual-based simulation model using real-life contact data. We evaluated the impacts of temporal factors - trigger threshold and duration - on the effectiveness of school closure as a mitigation policy. We found an upper bound of the duration of school closure, where further extension beyond which will not bring additional benefits to suppressing the attack rate and peak incidence. For school closure with a relatively short duration (< 6 weeks), it is more effective to start closure after a relatively longer delay from the first day of infection; if the duration of school closure is long (>6 weeks), however, it is better to start it as early as reasonable. Our studies reveal the critical importance of timing in school closure, especially in cost-cautious situations. Our studies also demonstrate the great potential of a properly developed individual-based simulation model in evaluating various disease control policies.