School closure during novel influenza: A systematic review

School closure as a non-pharmaceutical measure appeared as an efficient strategy in previous epidemics. We investigated the impact of school closure on the epidemic peak whether implemented before or after the epidemic reaches its peak. We also investigated the optimal duration of closure. Data sources included Medline-PubMed, ProQuest and Cochrane databases. The inclusion criteria were all articles that reported a quantified effect on school closure on an influenza epidemic. Exclusion criteria were non-English articles that have no translation and articles that only reported school closure effect as a combination with another measure. Out of 668 articles, we included 31 articles. The mean reduction of the peak of the epidemic was M=29.65%. Implementing school closure before or after the epidemic reaches its peak reduced the overall influenza epidemic. School closure reduced and delayed the epidemic peak especially if implemented earlier. The longer the duration of closure the more the epidemic peak delayed. Additionally, closure containment effect also correlated with organisms having high attack rate and longer infectiveness duration. We conclude with several implications for school closure taking into consideration the feasibility and the cost.