Pandemic Influenza School Closure Policies

To the Editor: Holmberg et al. (1) are rightly concerned that state pandemic plans in the United States represent a patchwork without central coordination or direction. These concerns are particularly relevant for school closure decisions during an influenza pandemic. The US Department of Health and Human Services' checklist regarding school closures gives conflicting messages (2). For example, it recommends that schools stay open during a pandemic and develop school-based surveillance systems for absenteeism of students and sick-leave policies for staff and students. It also recommends developing alternate procedures to ensure the continuity of instruction in the event of district-wide school closures. These vague recommendations may reflect the paucity of data to recommend school closure. To assess the current status of school closure decisions in the United States, I conducted an internet survey of all 50 state health commissioners during the spring of 2006. I asked the respondents 2 questions: " Who makes the school closure decisions in your state? " and " What absenteeism rate, if any, would prompt a school in your state to close during a typical influenza year and/or during a pandemic influenza year? " Of the 44 responding states, I found that school closure decisions were primarily a local-level responsibility in half. Of these 22 states, closure decisions would be made either on a school-by-school or a school district–by–school district basis. Only 6 states indicated that school closure decisions would be made at the state level, and 16 states would have decisions made jointly at the state and local levels (Table). For a typical influenza season, only 6 states indicated that they close schools if a certain absenteeism rate due to illness were reached. For 5 of these states, the absenteeism rates ranged from 10% to 30%; the sixth state said its schools would close if the rates were anywhere from 7% to 31%. However, only 1 state reported a threshold absenteeism rate for closure during an influenza pandemic. Another state said that it was developing an absenteeism rate that would prompt closure for pandemic influenza. Forty-two states did not have threshold absenteeism rates that would prompt school closures during an influenza pandemic. In July 2006, the Department for Education and Skills in the United Kingdom published guidelines regarding school closure (D. O'Gorman, pers. comm.). Although the final decision for school closure would lie with local school officials, the national government might advise all schools and …