R ESEARCH A RTICLE Factors Influencing School Closure and Dismissal Decisions: Influenza A (H1N1), Michigan 2009 CARRIE A. DOOYEMA, MSN, MPH, RN a DAPHNE COPELAND, MD, MPH b JULIE R. SINCLAIR, MA, DVM, MPH, DACVPM c JIANRONG SHI, MD, MS d MELINDA WILKINS, DVM, MPH, PhD e EDEN WELLS, MD, MPH f JIM COLLINS, MPH, RS g ABSTRACT BACKGROUND: In fall 2009, many US communities experienced school closures during the influenza A H1N1 pandemic (pH1N1) and the state of Michigan reported 567 closures. We conducted an investigation in Michigan to describe pH1N1-related school policies, practices, and identify factors related to school closures. METHODS: We distributed an online survey to all Michigan K-12 school principals. Descriptive statistics and chi-square tests summarize school policies, practices, adherence to government guidelines, and differences between schools that closed and those that remained open during the pandemic. RESULTS: Of 4441 traditional K-12 Michigan schools, 937 (21%) principals responded to our survey representing approximately 374,000 students and 17,700 teachers. The majority (88%) of schools had influenza preparedness plans and followed government school influenza guidelines. Among respondents, 15% (137/937) of schools closed in fall 2009 with high absenteeism as the primary reason for closure. Schools that closed reported significant illness in their school, had <300 students, and had invested substantial resources preparing and responding to influenza. CONCLUSIONS: Adherence to government guidelines for schools appears high in Michigan. Closures occurred in schools that reported significant illness and were likely motivated by excessive absenteeism. Understanding factors related to closures during pH1N1 may inform future pandemic preparedness efforts. Keywords: influenza; Michigan; non-pharmaceutical interventions; pandemic flu; school closure policy. Citation: Dooyema CA, Copeland D, Sinclair JR, Shi J, Wilkins M, Wells E, Collins J. Factors influencing school closure and dismissal decisions: influenza A (H1N1), Michigan 2009. J Sch Health. 2014; 84: 56-62. Received on September 27, 2012 Accepted on March 5, 2013 A pproximately 55 million children attend school each day in the United States. Schools are unique settings that can impact influenza (flu) transmission dynamics in a community. 1 The Centers for Dis- ease Control and Prevention (CDC) estimated that 41-84 million cases of pandemic influenza A H1N1 (pH1N1) occurred from April 2009 to mid-January 2010, with roughly 19 million (range 13-27 million) of the cases among ≤17-year-old children. 1 School clo- sure is cited in published reports as a possible strategy to mitigate pandemic flu. 2-11 To prepare for pH1N1 in the 2009-2010 school year, the CDC provided the following document, ‘‘Guidance for State and Local Public Health Officials and School Administrators a Epidemic Intelligence Service Officer, (igb7@cdc.gov), National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-26, Chamblee, GA 30341. b Senior Health Scientist, (dcopeland@cdc.gov), Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop D-18, Atlanta, GA 30333. c Quarantine Veterinary Medical Officer, (bwg5@cdc.gov), Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, CDC Quarantine Station - PHL, c/o CBP Reception, Terminal A West, Philadelphia, PA 19153. (K-12).’’ 12 Many states also provided guidance to school administrators regarding pH1N1. Federal rec- ommendations for the 2009-2010 school year included a variety of strategies, such as separating ill students and staff, promoting hand hygiene/respiratory eti- quette, and routine cleaning. School dismissal was recommended for certain circumstances based upon the local situation, such as high absenteeism, pro- tection of high-risk students, or increased severity of illness. School closures were reported from communities across the United States as a result of pH1N1, primarily due to high absenteeism. 13 In Michigan, the Department of Community Health (MDCH) recorded 567 school closures, affecting an estimated 56 • Journal of School Health • January 2014, Vol. 84, No. 1 • Published 2013. This article is a U.S. Government work and is in the public domain in the USA.