Shifts in student routines may explain 2009′s H1N1 surge, Bates researchers find

During the 2009 swine flu pandemic, which of these college events did not lead to a sharp increase in flu cases on their respective campuses?

  • July 4th social at the Air Force Academy.
  • Orientation at Bowdoin.
  • Homecoming at Colorado College.
  • Two swine flu vaccine clinics at Bates.

Trick question, really. All four events led to an uptick in flu cases at their respective colleges— even the vaccine clinics at Bates.

During a vaccine clinic in October 2009, Miljan Zecevic ’10 receives his vaccine injection. Photograph by Phyllis Graber Jensen/Bates College.

This curious fact, that a vaccine clinic could be linked to a surge in flu cases, is explained in a recent scholarly article, “The Effect of Mixing Events on the Dynamics of pH1N1 Outbreaks at Small Residential Colleges,” by Bates epidemiologist Karen Palin and mathematician Meredith Greer in the Journal of American College Health.

Of the many U.S. colleges that saw outbreaks of swine flu cases in the summer and fall of 2009, Palin and Greer looked at Bates, Bowdoin, Colorado College and the Air Force Academy because of their similar size and their residential, undergraduate structure.

It’s a no-brainer that a college mingling event like homecoming or orientation would create robust opportunities for human-to-human spread of a virus. But the vaccine clinics at Bates, held on Oct. 10 and 15 four years ago in Chase Lounge, followed protocols that did not allow students to come into infectious proximity with one another. (The researchers stress, too, that vaccines and vaccine clinics are Very Good Things.)

Instead, suggest Palin and Greer, the role of the clinics in the spread of H1N1 at Bates in 2009 has to do with how those clinics influenced events outside Chase Hall, specifically student traffic patterns.

To investigate the spread of H1N1 during the Bates outbreak, the researchers used a standard mathematical model that categorizes all community members as either susceptible to the disease, infected or recovered (hence the model’s acronym, SIR).

The SIR model assumes a small community that is “well-blended.” At a place like Bates, “well-blended” means members live in close proximity and encounter each other in classrooms, residence halls, the library, club activities, athletics facilities, arts venues and, of course, in Commons.

“The SIR model did not match the reality we observed,” Greer says.

“Bates is about as well-blended as any modern-day community,” says Greer, associate professor of mathematics.

Mathematician Meredith Greer found that the standard model for tracking the outbreak of disease didn’t work for the Bates H1N1 outbreak of 2009. Photograph by Phyllis Graber Jensen/Bates College.

Based on the initial Bates data, the SIR model suggested a slow, steady increase in flu cases. But what happened at Bates was “in stark contrast” to the model’s predictions. Three days after each flu clinic (a common incubation time for H1N1), the number of cases at Bates spiked.

Indeed, “the SIR model did not match the reality we observed,” Greer says.

But why? It wasn’t that students got infected at the clinic; a variety of established protocols made that very unlikely.

Instead, the researchers believe that the clinics created subtle changes in student traffic patterns on campus. Students took different routes to get from point A to point B, thus coming into contact not with more students on those days, but with different students.

Hosting a clinic may have “facilitat[ed] the spread of pH1N1 in unexpected and unknown ways,” the authors say.

Let’s say that on Oct. 15, 2009, student “Sarah” altered her routine by including the Chase Lounge vaccine clinic on her usual Parker-to-Pettengill afternoon route. In doing so, she came into contact with different students than usual, giving a hug to one she hadn’t seen in awhile and who, unbeknownst to her, was infectious.

It doesn’t stop there. If Sarah changed her routine, then maybe her roommate “Jessica” also changed hers, even if she didn’t plan to attend the clinic. And so on.

All of this means that “the concept of ‘well-blended’ is more complicated than originally thought,” Greer says.

Take Commons. At Bates, all students dine under one roof, blended together like stir-fry. A germophobe’s nightmare, right?

Karen Palin, an epidemiologist and lecturer in biology at Bates, discusses the H1N1 outbreak at Bates in October 2009. With her is is Associate Professor of Biology Lee Abrahamsen. Photograph by Phyllis Graber Jensen/Bates College.

Not really, says Palin, who had her students study Commons in another context. For one, they found that food-serving areas are remarkably free of germs, “which we expected,” Palin says, “given their protocols.”

Second, they found that students tend to sit with the same friends each meal, reducing the blending and lowering the likelihood that Commons was a major reason for the spread of H1N1.

“Again, this led us to the idea that changing social patterns [due to the clinics] could really be the culprit in spreading H1N1 in 2009,” Greer says.

Palin and Greer stress that their findings are not prescriptive; they “cannot by themselves determine circumstances in which vaccine clinics should, or should not, be offered.”

Instead, their results are more observational, intended to identify “when a vaccine clinic apparently functions as a mixing event” that disrupts normal student traffic patterns, hastening the spread of an infection.

And if you still want advice for the current or any flu epidemic?

“Get vaccinated, wash your hands, and cover your mouth if you cough or sneeze,” says Palin.

7 Responses to “Shifts in student routines may explain 2009′s H1N1 surge, Bates researchers find”

  1. Younq says:

    A healthy uennrstandidg of the impact of influenza on the population in general, at risk groups, and the health care system is important if you are going to debate the usefulness of the flu vaccine. It’s probably also wise to understand how the components of the vaccine are determined before passing judgement.On average, the flu and its complications send about 20,000 Canadians to hospital every year, and between 2,000 and 8,000 Canadians die. I would say that efforts to prevent an illness with these impacts is a relatively good use of time and resources.The components of the vaccine are determined by predicting what will be the most commonly circulating and severe strains of the flu in any given season. Strains of the flu are named based on when they are initially identified, and because the flu virus constantly changes (mutates), new strains are constantly being identified. So, because the name of the strain has 2009 in it, doesn’t make it an obsolete virus. And, because the flu vaccine is constantly being updated new recommendations are made every year for the components of the vaccine, it’s actually more like having a state of the art sound system or perhaps more like having the iPhone 4S loaded with iCloud and all the other latest and greatest apps.

  2. Alice Haines MD says:

    Only the nasal vaccine is live attenuated. The injected vaccine is “inactivate” (dead).

    • Jeng says:

      Whoa, whoa, whoa Are you arguing the point that those folks that do not fall in the high need caogtery should not have access to it? I believe the free clinic was intended to serve that audience, but it was left to each person to fill out the form truthfully. And we all know what happens when individuals are left to govern themselves Or, are you still trying to argue that it’s tough see a mass of people gather for a government hand out?And how is this different than when the Governor calls a State of Emergency for an unruly forest fire which allows the government (state and federal, right?) to step in and provide resources and money to help put it out?At any rate, I think we do agree that if the vaccine was distributed better everyone could get it just like they do with the seasonal vaccine (their doctor, Raley’s, Walgreen’s, their employer, etc.).

  3. Jay Burns says:

    One of the key points that I heard from researchers Palin and Greer as I did the story was that of the students who got the flu several days after the two clinics, some had attended the clinic and some did not attend the clinic. So there’s no link between the clinic itself and the spike — the reason has to do with how student traffic flow changed on those two days, bringing students into contact with different students on those days.

    Also, to repeat what Tpowell said, and Karen Palin just repeated to me, vaccines really don’t cause the flu. Really! If students felt ill at Bates in the third and fourth weeks of October 2009, there could be many other legitimate reasons! Best, Jay Burns, editor, Bates Magazine

  4. Tpowell says:

    Dear Anon,
    No!!! Flu vaccines cannot and do not give anyone the flu. That is a common myth for which there is no evidence. There is no scientific debate on this issue whatever. Vaccines are imperfect, however, in that they don’t provide 100% protection. You are much better off if you get a flu vaccine. Perhaps more importantly, you will not be able to spread the flu to those more vulnerable than you. Influenza is a serious cause of mortality among those with compromised immune systems, including the frail elderly, young children, and cancer patients.

  5. anon says:

    Could the vaccines have been faulty? Giving people the disease instead of protecting them from it?

    • anon says:

      I definitely recall a feeling around campus that the vaccine led to people feeling worse because of the live virus inside. There also was skepticism about whether the nasal vaccine or the other option (needle? not sure) was more effective or left you more prone to illness.

      Of course this is all from memory and I would be interested to hear if Meredith Greer and co. did consider these things.

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