Using a hybrid agent-based and equation based model to test school closure policies during a measles outbreak.

<bold>Background: </bold>In order to be prepared for an infectious disease outbreak it is important to know what interventions will or will not have an impact on reducing the outbreak. While some interventions might have a greater effect in mitigating an outbreak, others might only have a minor effect but all interventions will have a cost in implementation. Estimating the effectiveness of an intervention can be done using computational modelling. In particular, comparing the results of model runs with an intervention in place to control runs where no interventions were used can help to determine what interventions will have the greatest effect on an outbreak.<bold>Methods: </bold>To test the effects of a school closure policy on the spread of an infectious disease (in this case measles) we run simulations closing schools based on either the proximity of the town to the initial outbreak or the centrality of the town within the network of towns in the simulation. To do this we use a hybrid model that combines an agent-based model with an equation-based model. In our analysis, we use three measures to compare the effects of different intervention strategies: the total number of model runs leading to an outbreak, the total number of infected agents, and the geographic spread of outbreaks.<bold>Results: </bold>Our results show that closing down the schools in the town where an outbreak begins and the town with the highest in degree centrality provides the largest reduction in percent of runs leading to an outbreak as well as a reduction in the geographic spread of the outbreak compared to only closing down the town where the outbreak begins. Although closing down schools in the town with the closest proximity to the town where the outbreak begins also provides a reduction in the chance of an outbreak, we do not find the reduction to be as large as when the schools in the high in degree centrality town are closed.<bold>Conclusions: </bold>Thus we believe that focusing on high in degree centrality towns during an outbreak is important in reducing the overall size of an outbreak. [ABSTRACT FROM AUTHOR]