On 27 May 2009, WHO convened via teleconference a technical consultation of public health officials from 6 countries, (1) as well as experts (2) in law and ethics, disease prevention and control, and management of mass gatherings and emergency situations. The purpose of the teleconference was to share experiences and early lessons learnt from recent outbreaks of new influenza A (H1N1) virus infection in communities or closed settings. As of 27 May 2009, >13 000 laboratory-confirmed cases of human infection with new influenza A (H1N1) virus had been officially reported to WHO. (3)
Countries in which laboratory-confirmed, albeit mild, cases of influenza A (H1N1) virus infection had occurred provided specific examples of outbreaks among schoolchildren or in academic settings, as well as the detailed measures taken to mitigate the spread of infection within schools and among communities. In most cases, decisions to suspend attendance at school had been taken by local rather than national authorities. The exception was Mexico, in which nationwide school closures had been mandated for 2 weeks in May 2009. All countries agreed that school suspensions had been effective in mitigating the spread of influenza A (H1N1) virus infection; however, such measures were often prohibitively expensive. (4) School closures during the early phases of an outbreak had reduced transmission within schools, but had not always been effective (or their measurable effect) in reducing levels of community transmission.
The legal aspects of school closures and non-discrimination should be closely monitored. Epidemiological considerations should take precedence over racial or ethnic stereotypes, while at the same time recognizing that special provisions may be necessary for schools in countries or areas containing poor populations. While school closures may reduce transmission within school settings, such measures may not affect transmission in community settings. Care therefore needs to be taken when evaluating how school closures will impact transmission.
Countries reporting to WHO, with the exception of Mexico, had not instituted restrictions on mass gatherings and were maintaining vigilance for any upcoming events in their respective countries. In Mexico, public participation in mass gatherings during national football matches had been banned in May 2009.
Community-level social distancing measures and use of masks
The Government of Mexico has encouraged its citizens to use masks, particularly when in contact with cases of influenza A (H1N1) virus infection. In Japan, efforts to enact social distancing have included encouraging commuters, in particular, to wear masks. Additional guidelines established in Mexico for mitigating the spread of illness include recommendations on hygiene and implementation of hygiene measures, particularly in schools, as well as guidelines for social distancing in restaurants, stadiums and enclosed areas.
The WHO technical consultation made the following recommendations:
* When considering school suspensions and/or restrictions on mass gatherings, authorities should ask "what is the legal authority and what are the legal processes" for such suspensions and/or restrictions? Decisions should be consistent and well-documented, and be taken within the parameters of each country's individual sovereignty and existing laws. Care should be taken to avoid...