Increased urbanization reduced the efectiveness of school closures on seasonal infuenza epidemics in China

Background:School closure is a common mitigation strategy during severe infuenza epidemics and pandemics.However,the efectiveness of this strategy remains controversial.In this study,we aimed to explore the efectiveness of school closure on seasonal infuenza epidemics in provincial-level administrative divisions(PLADs)with varying urbanization rates in China.Methods:This study analyzed infuenza surveillance data between 2010 and 2019 provided by the Chinese National Infuenza Center.Taking into consideration the climate,this study included a region with 3 adjacent PLADs in Northern China and another region with 4 adjacent PLADs in Southern China.The efect of school closure on infuenza transmission was evaluated by the reduction of the efective reproductive number of seasonal infuenza during school winter breaks compared with that before school winter breaks.An age-structured Susceptible-Infected-Recovered-Susceptible(SIRS)model was built to model infuenza transmission in diferent levels of urbanization.Parameters were determined using the surveillance data via robust Bayesian method.Results:Between 2010 and 2019,in the less urbanized provinces:Hebei,Zhejiang,Jiangsu and Anhui,during school winter breaks,the efective reproductive number of seasonal infuenza epidemics reduced 14.6%[95%confdential interval(CI):6.2–22.9%],9.6%(95%CI:2.5–16.6%),7.3%(95%CI:0.1–14.4%)and 8.2%(95%CI:1.1–15.3%)respectively.However,in the highly urbanized cities:Beijing,Tianjin and Shanghai,it reduced only 5.2%(95%CI:-0.7–11.2%),4.1%(95%CI:-0.9–9.1%)and 3.9%(95%CI:-1.6–9.4%)respectively.In China,urbanization is associated with decreased proportion of children and increased social contact.According to the SIRS model,both factors could reduce the impact of school closure on seasonal infuenza epidemics,and the proportion of children in the population is thought to be the dominant infuencing factor.Conclusions:Efectiveness of school closure on the epidemics varies with the age structure in the population and social contact patterns.School closure should be recommended in the low urbanized regions in China in the infuenza seasons.