Introduction

What is Acute Viral Respiratory Infection (AVRI)?

Acute respiratory tract infections are defined as infections that appear suddenly in the sinuses, throat, airways, or lungs, among other breathing-related body parts.. Several types of viruses can cause viral respiratory tract infections, which impact the airways, throat, and nose. The common cold and influenza are typical respiratory infections that often present with similar symptoms, such as nasal congestion, runny nose, sore throat, coughing, and irritability On average, children experience around six episodes of viral respiratory tract infections each year.^1,2

Importance of school attendance in children's development

Attending school plays a crucial role in our child's academic success, overall well-being, and their personal development. It is evident that regular school attendance is a key factor to support children and young people’s educational, economic and social outcomes. On the other hand, school can help to facilitate positive peer relationships, which contribute to better mental health and well-being. Research conducted in 2019 showed that 84% of key stage 2 students with 100% attendance met the expected academic standard, compared to only 40% of students who were frequently absent throughout the key stage.^3,4 In this article, we explore how acute viral respiratory infections contribute to school absenteeism among children.

Common Acute Viral Respiratory Infections in Children

Viral infections of the respiratory tract are generally classified into two types:²

• Upper respiratory tract infections: Symptoms occur particularly in the nose and throat and could happen at any age and include the common cold and influenza
• Lower respiratory tract infections: They are more frequently seen in children and may include conditions such as croup, bronchiolitis, and pneumonia.

Transmission in the school settings

Outbreaks of Acute Respiratory Infections (ARI) in schools are commonly caused by seasonal influenza and other respiratory viruses such as rhinovirus and Respiratory Syncytial Virus (RSV), particularly from autumn to spring. Since early 2020, the novel coronavirus SARS-CoV-2, responsible for COVID-19, has also been circulating in the UK, leading to cases and outbreaks in schools. Schools are high-occupancy environments; they are well-known for being high-risk locations for the spread of respiratory viruses. The risk of transmission is increased because students spend 6-8 hours a day in these environments, and respiratory infections have a major effect on students' academic performance and absenteeism.^2,5

In schools, transmission occurs primarily through respiratory droplets when an infected person coughs, sneezes, talks, or breathes. These viruses can spread directly through close contact or indirectly by touching contaminated surfaces and then touching the face, particularly the mouth, nose, or eyes. In crowded areas like classrooms and communal spaces, close contact increases the risk of virus transmission. Poor ventilation and inconsistent hygiene, such as inadequate hand washing or improper use of masks, also contribute to the spread of respiratory infections in schools.^2,5

How Acute Viral Respiratory Infections Influence School Absenteeism 

School absenteeism because of infections is one of the most important problems facing both public and private schools. Acute respiratory infections, including COVID-19 and seasonal influenza, are common among school-aged children and are highly likely to spread quickly. This often leads to localised outbreaks within schools where children spend one-third of their day. When the symptoms are mild, schools usually still allow their students to attend classes; they will need to stay at home when they have high temperatures (38°C or above). However, often parents choose for their children to stay at home, as they are concerned about their wellbeing and fear of the contagiousness of the infections.^4,5,6

 A letter from the Chief of Medical Officer explained the criteria for when children can stay at home, and the government has also provided guidelines for schools and nurseries on health protection and managing specific infectious diseases. These say when children should be kept off school and when they should not. The case will be different in the special school settings where there are significant numbers of children in the clinical risk group.^4,5,6

Short-term and Long-term Educational Impact of AVRI that leads to School Absenteeism

Regular school attendance is crucial for our child’s achievement, well-being, and overall development. Higher attendance rates are consistently associated with better GCSE and A Level grades, according to research shows that students with higher attendance rates consistently achieve better GCSE and A Level results. The data also indicate that pupils who excelled at the end of primary and secondary school missed fewer school days.^3,4,5,7

Key Stage 2 primary children who fell short of expectations in reading, writing and arithmetic lost an average of four more days annually in 2019 than those who performed better. Similarly, secondary students who did not achieve grades 9 to 4 in English and maths missed an average of 10 more days compared to those who attained grades 9 to 5 in both subjects. Students are more likely to learn and do better on tests and other formal evaluations if they attend class more frequently.^3,4,5,7

Acute viral respiratory infections (AVRIs), such as influenza, the common cold, and respiratory syncytial virus (RSV), are common causes of school absenteeism in children. These infections can have both short-term and long-term educational impacts.^3,4,5,7

Short-term Impacts 

• Gaps in learning and difficulties of catching up as they missed instructional times
• Increased stress and anxiety when they return due to fear that they missed a lot of  learning
• Decrease in academic performance
• Disruption of peers' relationships, which can lead to demotivation or classroom engagement^3,4,5,7

Long-term Impacts 

• Continuous absenteeism if AVRI frequently occurs
• Skill development is delayed, especially in early childhood or primary school
• Reduced engagement, as they feel disconnected from the school environment
• May impact cognitive development, as they will have limited interaction with their peer group and teachers
• Risk of dropout of school in the future, which might cause failure to transition to their adulthood and also their long-term participation in society^3,4,5,7

Strategies to Mitigate School Absenteeism due to AVRI⁸

In order to be able to mitigate school absenteeism due to AVRI, a combination of strategies can be implemented, such as health prevention or education. The strategies should focus on reducing illness transmission, supporting students during absences, and helping them reintegrate back into school smoothly.^8,9,10  

Health prevention and awareness

• Hand hygiene : ensure liquid soap, warm water, and paper towels are available and easily accesible, especially at schools. The UK Health Security Agency (UKHSA), in collaboration with teachers, provides free resources to promote positive behaviour change among children and young people to support prevention and control of infections and also respond to the threat of antimicrobial resistance that is available on e-bug
• Encourage students to follow respiratory hygiene and cough etiquette, and also discourage spitting
• Educate students and staff about symptoms of the AVRI and when they should stay home^8,9,10  

School Health Policies and Support

• Schools must have guidelines on when students and staff can return once they are fully recovered to prevent further transmission and keep parents informed about the school policies
• Schools should offer support for students who are staying home due to sickness to be able to join and participate in classroom learning through virtual classes and also provide digital tools or resources for them to be able to stay on track with homework while they recover
• Provide support or counselling for pupils who have anxiety to return back to school after illness
• Regular cleaning and disinfection of the settings, including equipment, also areas with particular attention to hand touch surfaces that can be easily contaminated, such as door handles, toilet flushes, taps and communal touch areas
• Ensure all rooms are well ventilated. Open windows, and use an air purifier if possible^8,9,10

Promote vaccination 

• Vaccination can prevent viral infections like influenza and Covid-19. The NHS offered flu vaccines yearly during autumn or early winter to those with high risks of getting serious illness from flu. Covid vaccine is also provided by the NHS for those with an increased risk of getting serious ill from Covid-19
• Collaboration with Health Authorities for keeping up to date with guidelines, policy adjustments, and promoting health campaigns^8,9,10

Nutritional and Physical Health Support 

Chatting with students about healthy eating and encouraging regular physical activities to stay active and healthy.^8,9,10

Summary

Acute Viral Respiratory Infections (AVRI), such as the common cold, flu, and COVID-19, are one of the leading causes of school absenteeism in children. These infections are easily spreading in the school environments due to close contact, inadequate ventilation, and limited hygiene practices. Symptoms like fever, cough, and fatigue often enforce children to stay home, while school policies and parental concerns about transmission further extend absences. Prolonged absenteeism can negatively affect our children's academic performance and social development. Schools, parents and health authorities should work together to implement effective strategies to reduce absenteeism such as promoting vaccination, improving hygiene, enhancing ventilation, and offering remote learning options.