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Arizona’s Near Real Time School-based Syndromic Surveillance Program

Arizona’s Near Real Time School-based Syndromic Surveillance Program. Sixth Annual International Society for Disease Surveillance Conference October 10-12, 2007. Lea Trujillo PhD, Yue Qiu, MPH, Kenneth Komatsu, MPH, Laura Erhart, MPH Arizona Department of Health Services. Objectives.

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Arizona’s Near Real Time School-based Syndromic Surveillance Program

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  1. Arizona’s Near Real Time School-based Syndromic Surveillance Program Sixth Annual International Society for Disease Surveillance ConferenceOctober 10-12, 2007 Lea Trujillo PhD, Yue Qiu, MPH, Kenneth Komatsu, MPH, Laura Erhart, MPH Arizona Department of Health Services

  2. Objectives • Describe a near real-time school-based syndromic surveillance program • Demonstrate the potential of this program for early detection of communicable disease outbreaks among school children

  3. Outline • Background • Methods • Results • Conclusion • Data Limitations

  4. Background Origin of the SSSP • Child Health Indicator Program (CHIP) • Nurse codes: chronic, acute, immunization, injury New Functions and Features • Added new acute illness codes (now ~270) • New developed functions, electronic submission • Upgraded software implemented May ‘07

  5. Current Status • 344 schools at all levels (from 10 of 15 counties) throughout Arizona use CHIP software • Weekly upload of all the most updated data • Two-way alert system • Daily upload of data on high priority conditions e.g. communicable rash, ILI, GI (referred) • Reverse health alert message for public health intervention

  6. Methods • Describe program functions with data flow charts and screenshots • Comparison of Influenza-Like Illness “cases” from SSSP vs. sentinel providers / lab-confirmed Influenza cases

  7. School: Student-Nurse Encounter Software Program School: Upload data to AZSNC host server (Each Friday) Email reminder to schools not uploading weekly data Database on AZSNC Server Upload latest database to FolderShare (Monday by 2pm) Copy latest database to local and state epidemiologists 1. Weekly Data Upload 2 1 3 5 4

  8. School: Student-Nurse Encounter Software Program School: Upload data to AZSNC host server ( End of the day) Database on AZSNC Server Upload latest database to FolderShare ( End of the day) Send the critical code line list to local and state epidemiologists (Second day morning) 2. Near-Real Time Data Upload Critical codes 2 1 4 3

  9. Data Entry: Nurse Activity Code for the Student

  10. Upload: Early Surveillance Program (ESP)

  11. Reverse Alert Mechanism

  12. Results • 242 schools included in the analyses • not all schools upgraded software/reported year-end data • 2006-2007 school year - ~1.6 million school nurse visit records

  13. Graph 1: ILI Encounters by Month

  14. Graph 2: ILI Encounters by Week School break

  15. Data Limitation • Not a state-wide representation • Self-report bias • Only have one year of data • However…

  16. Conclusion • The SSSP uses existing school health information and burden on health offices is minimal so program is sustainable • Analysis of ILI data shows that the data from this program appear to be comparable and complementary to other ILI sources

  17. This is an efficient public health surveillance tool for monitoring communicable conditions among school students and has potential for early outbreak detection • Two-way alert system enhances communication between epidemiologists and school nurses

  18. Future Direction • Recruit more schools • Enhance training for school nurses • Enhance the application functions • Start sending monthly surveillance reports to participating schools • Data quality evaluation

  19. Acknowledgements • Mary Hallet, Arizona School Nurse Consortium • Steve Goetze, GLS Technology • Daniel Bronson-Lowe, Epidemiologist, ADHS • Rebecca Sunenshine, CDC Career Epidemiology Field Officer at ADHS

  20. Thank you!

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