Public Health Preparedness

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

Lea Trujillo PhD, Yue Qiu, MPH, Kenneth Komatsu, MPH, Laura Erhart, MPH

Arizona Department of Health Services

Sixth Annual International Society for Disease Surveillance ConferenceSixth Annual International Society for Disease Surveillance Conference

October 10-12, 2007October 10-12, 2007

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ObjectivesObjectives

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

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OutlineOutline

Background Methods Results Conclusion Data Limitations

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BackgroundBackground

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

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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

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MethodsMethods

Describe program functions with data flow charts and screenshots

Comparison of Influenza-Like Illness “cases” from SSSP vs. sentinel providers / lab-confirmed Influenza cases

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Software Program

School: Student-Nurse

Encounter

School:Upload data to

AZSNC host server (Each

Friday)

Upload latest database to

FolderShare (Monday by 2pm)

Copy latest database to local and state epidemiologists

Email reminder to schools not uploading

weekly dataDatabase

on AZSNC Server

1. Weekly Data Upload1. Weekly Data Upload

1 2

3

45

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2. Near-Real Time Data Upload2. Near-Real Time Data Upload

Software Program

School: Student-Nurse

Encounter

School:Upload data to

AZSNC host server( End of the day)

Upload latest database to

FolderShare ( End of the day)

Send the critical code line list to local and state

epidemiologists (Second day morning)

Databaseon AZSNC

Server

1 2

34

Critical codes

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Data Entry: Nurse Activity Code for the StudentData Entry: Nurse Activity Code for the Student

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Upload: Early Surveillance Program (ESP)Upload: Early Surveillance Program (ESP)

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Reverse Alert Mechanism Reverse Alert Mechanism

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ResultsResults

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

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Graph 1: ILI Encounters by MonthGraph 1: ILI Encounters by Month

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Graph 2: ILI Encounters by WeekGraph 2: ILI Encounters by Week

School break

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Data Data LimitationLimitation

Not a state-wide representation Self-report bias Only have one year of data However…

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ConclusionConclusion

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

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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

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Future DirectionFuture Direction

Recruit more schools Enhance training for school nurses Enhance the application functions Start sending monthly surveillance reports to

participating schools Data quality evaluation

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AcknowledgementsAcknowledgements

• Mary Hallet, Arizona School Nurse Consortium• Steve Goetze, GLS Technology• Daniel Bronson-Lowe, Epidemiologist, ADHS• Rebecca Sunenshine, CDC Career

Epidemiology Field Officer at ADHS

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Thank you!