within and between classroom transmission patterns of seasonal influenza among primary CORD-Papers-2021-10-25 (Version 1)

Title: Within and between classroom transmission patterns of seasonal influenza among primary school students in Matsumoto city, Japan
Abstract: Schools play a central role in the transmission of many respiratory infections. Heterogeneous social contact patterns associated with the social structures of schools (i.e. classes/grades) are likely to influence the within-school transmission dynamics, but data-driven evidence on 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. While the relative contribution of within-class and within-grade transmissions to the reproduction number varied with the number of classes per grade, tThe 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. This finding suggests that interventions that change the size and number of classes, e.g. splitting classes and staggered attendance, may have limited effect on the control of school outbreaks. We also found that vaccination and mask-wearing of students were associated with reduced susceptibility (vaccination and mask-wearing) and infectiousness (mask-wearing) and hand washing with increased susceptibility. Our results show how analysis of fine-grained transmission patterns between students can improve understanding of within-school disease dynamics and provide insights into the relative impact of different approaches to outbreak control.
Published: 7/15/2021
DOI: 10.1101/2021.07.08.21259917
DOI_URL: http://doi.org/10.1101/2021.07.08.21259917
Author Name: Endo, A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/endo_a
Author Name: Uchida, M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/uchida_m
Author Name: Hayashi, N
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hayashi_n
Author Name: Liu, Y
Author link: https://covid19-data.nist.gov/pid/rest/local/author/liu_y
Author Name: Atkins, K E
Author link: https://covid19-data.nist.gov/pid/rest/local/author/atkins_k_e
Author Name: Kucharski, A J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/kucharski_a_j
Author Name: Funk, S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/funk_s
Author Name: City, Matsumoto
Author link: https://covid19-data.nist.gov/pid/rest/local/author/city_matsumoto
sha: e8e92a9ec3edecb8f5f5e12fa0ba7be96b728de7
license: medrxiv
source_x: MedRxiv
url: http://medrxiv.org/cgi/content/short/2021.07.08.21259917v1?rss=1
has_full_text: TRUE
Keywords Extracted from Text Content: within-grade medRxiv medRxiv preprint https://doi.org/10.1101/2021.07.08.21259917 doi 10,923 grademates CrI medRxiv preprint ∑ h grademate Figures 2B 128 h student i 340 j medRxiv h * class/school 10,923 students within-grade children measles https://doi.org/10.1101/2021.07.08.21259917 doi lab-confirmed Vaccines R 4 1.4-2.5 COVID-19 throat line friends Figure 1D schoolmate participants
Extracted Text Content in Record: First 5000 Characters:Significance Empirical evidence on detailed transmission patterns of influenza among students within and between 20 classes and grades and how they are shaped by school population structure (e.g. class and school 21 sizes) has been limited to date. We analysed a detailed dataset of seasonal influenza incidence in 29 22 primary schools in Japan and found that the reproduction number at school did not show any clear 23 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 15, 2021. ; https://doi.org/10.1101/2021.07.08.21259917 doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. association with the size or the number of classes. Our findings suggest that the interventions that only 24 focus on reducing the number of students in class at any moment in time (e.g. reduced class sizes and 25 staggered attendance) may not be as effective as measures that aim to reduce within-class risk (e.g. 26 mask-wearing and vaccines). 27 Abstract 28 Schools play a central role in the transmission of many respiratory infections. Heterogeneous social 29 contact patterns associated with the social structures of schools (i.e. classes/grades) are likely to 30 influence the within-school transmission dynamics, but data-driven evidence on fine-scale 31 transmission patterns between students has been limited. Using a mathematical model, we analysed a 32 large-scale dataset of seasonal influenza outbreaks in Matsumoto city, Japan to infer social 33 interactions within and between classes/grades from observed transmission patterns. While the 34 relative contribution of within-class and within-grade transmissions to the reproduction number varied 35 with the number of classes per grade, the overall within-school reproduction number, which 36 determines the initial growth of cases and the risk of sustained transmission, was only minimally 37 associated with class sizes and the number of classes per grade. This finding suggests that 38 interventions that change the size and number of classes, e.g. splitting classes and staggered 39 attendance, may have limited effect on the control of school outbreaks. We also found that 40 vaccination and mask-wearing of students were associated with reduced susceptibility (vaccination 41 and mask-wearing) and infectiousness (mask-wearing) and hand washing with increased 42 susceptibility. Our results show how analysis of fine-grained transmission patterns between students 43 can improve understanding of within-school disease dynamics and provide insights into the relative 44 impact of different approaches to outbreak control. 45 Influenza virus and other directly transmitted pathogens typically spread over social contact 47 networks involving frequent conversational or physical contacts (1-4). There is evidence that schools 48 are important social environments that can facilitate the transmission of influenza via close contacts 49 between students (5-9). Previous studies have collected contact data between students using 50 questionnaires and wearable sensor devices and found strong assortativity of contact rates within 51 classes and grades (10-14), which is likely relevant to the within-school transmission dynamics of 52 respiratory infections and the effectiveness of school-based interventions. However, such insights 53 from contact data also need to be validated with real-world outbreak data because contacts as 54 measured in those studies may not necessarily be fully representative of the types of contacts that lead 55 to transmission (e.g. with regards to proximity and duration). In this light, the differential transmission 56 rates of influenza associated with classes and grades have also been estimated from empirical 57 outbreak data in a few studies (6, 15, 16). However, those studies are limited to the analysis of only 58 one or two schools and included a relatively small number of cases (< 300). Therefore, robust findings 59 across schools with different structures that capture the full range of heterogeneity in within-school 60 transmission dynamics have remained a crucial knowledge gap. 61 Understanding how school population structures (e.g. class and school sizes) shape 62 transmission dynamics is key to making predictions about outbreak dynamics and interventions in 63 these settings. Modelling studies of school outbreaks often require a choice between the 'density-64 dependent mixing' and 'frequency-dependent mixing' assumptions (17). The density-dependent 65 mixing assumes that the transmission rate between a pair of students is constant regardless of the 66 class/school sizes, while the frequency-dependent mixing assumes an inverse proportionality between 67 them. As a result, the reproduction number is expected to inc
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