Contact, travel, and transmission: The impact of winter holidays on influenza dynamics in the United States

Abstract

AbstractBackgroundThe seasonality of influenza is thought to vary according to environmental factors and human behavior. During winter holidays, potential disease-causing contact and travel deviate from typical patterns, and we aim to understand these changes on age-specific and spatial flu transmission.MethodsWe characterized the changes to transmission and epidemic trajectories among children and adults in a spatial context before, during, and after the winter holidays among aggregated physician medical claims in the United States from 2001 to 2009 and among synthetic data simulated from a deterministic, age-specific spatial metapopulation model.ResultsWinter holidays reduced flu transmission and delayed the trajectory of flu season epidemics. The holiday period itself observed a shift in relative risk of disease from children towards adults. Model results indicated that holidays delay epidemic peaks and synchronize incidence across locations, and contact reductions from school closures rather than age-specific mixing and travel produce these observed holiday dynamics.ConclusionsWinter holidays delay seasonal influenza epidemic peaks due to changes in contact patterns. These findings may improve the future design of influenza intervention strategies, such as the proper timing and duration of school closures, and the spatial and demographic allocation of vaccines.