The impact of illness and the impact of school closure on social contact patterns.

Abstract

. It provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility.The NIHR provides the NHS with the support it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world-class facilities (both NHS and university), conducting leading-edge research focused on the needs of patients.This themed issue of the Health Technology Assessment journal series contains a collection of research commissioned by the NIHR as part of the Department of Health's (DH) response to the H1N1 swine flu pandemic. The NIHR through the NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC) commissioned a number of research projects looking into the treatment and management of H1N1 influenza.NETSCC managed the pandemic flu research over a very short timescale in two ways. Firstly, it responded to urgent national research priority areas identified by the Scientific Advisory Group in Emergencies (SAGE). Secondly, a call for research proposals to inform policy and patient care in the current influenza pandemic was issued in June 2009. All research proposals went through a process of academic peer review by clinicians and methodologists as well as being reviewed by a specially convened NIHR Flu Commissioning Board.The final reports from these projects have been peer reviewed by a number of independent expert referees before publication in this journal series. Criteria for inclusion in the HTA journal seriesReports are published in the HTA journal series if (1) they have resulted from work for the HTA programme or, in the case of this national priority, the NIHR, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.The research reports in this themed issue were funded through the Cochrane Collaboration; the Health Services Research programme (HSR); the Health Technology Assessment programme (HTA); the Policy Research Programme (PRP); the Public Health Research programme (PHR); and the Service Delivery and Organisation Programme (SDO).The Cochrane Collaboration is an international not-for-profit and independent organisation, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide. It produces and disseminates systematic reviews of health-care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Cochrane reviews and the Cochrane Central Register of Controlled Trials are published and updated in The Cochrane Library (www.cochranelibrary.com).The HSR programm...

Crossing the scale from within-host infection dynamics to between-host transmission fitness: a discussion of current assumptions and knowledge

“…The findings on contact patterns shown in Eames et al and Kerckhove et al [96,97], combined with studies showing that prolonged viral shedding correlated with more severe disease [98,99], also suggest that a virulence-transmission trade-off exists for influenza, akin to the one for HIV mentioned above. Additional data would be needed to confirm and further quantify this potential trade-off.…”

Calling in sick: impacts of fever on intra-urban human mobility

“…One of the few studies of this phenomenon in humans was based on self-completed written questionnaires administered by mail to 179 Britons diagnosed with swine flu [12]. That study, which focused on the measurement of contacts suitable for influenza transmission, showed that illness reduced contacts by approximately 50%.…”

“…Quantifying the impacts of illness on direct contacts [12,13] was a significant advance for understanding the epidemiology of influenza and other directly transmitted pathogens. Nonetheless, there remain a number of gaps in knowledge about the impacts of illness on contact that merit additional study.…”

“…Establishing that illness reduces direct contacts does not address how illness might affect time allocation at key locations for exposure to environmental contaminants or biting by insect vectors. Second, a gap that could not possibly be filled by the aforementioned study [12] alone is that it pertained to a single geographical and cultural context, leaving open the possibility of different behavioural consequences of illness under different circumstances. People in resourcepoor, tropical environments, for example, are known to have comparatively complex patterns of intra-urban mobility, which has important consequences for transmission dynamics [19].…”

Real-time modelling of a pandemic influenza outbreak

“…There are several studies that have estimated the changes in contact patterns during school holidays. 70 However, prolonged school closures may lead to wider differences in contact patterns that, to our knowledge, have not been rigorously studied. Further research may well be required to inform how the contact matrix would differ from that of school holiday periods.…”