Public Health Preparedness Arizona’s Near Real Time Arizona’s Near Real Time School-based Syndromic School-based Syndromic Surveillance Program 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 Sixth Annual International Society for Disease Surveillance Conference Surveillance Conference October 10-12, 2007 October 10-12, 2007
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Public Health Preparedness Arizona’s Near Real Time School-based Syndromic Surveillance Program Lea Trujillo PhD, Yue Qiu, MPH, Kenneth Komatsu, MPH, Laura.
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Public Health Preparedness
Arizona’s Near Real Time School-based Arizona’s Near Real Time School-based Syndromic Surveillance ProgramSyndromic Surveillance Program
Sixth Annual International Society for Disease Surveillance ConferenceSixth Annual International Society for Disease Surveillance Conference
October 10-12, 2007October 10-12, 2007
Public Health Preparedness
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
Public Health Preparedness
OutlineOutline
Background Methods Results Conclusion Data Limitations
Public Health Preparedness
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
Public Health Preparedness
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
Public Health Preparedness
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
Public Health Preparedness
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
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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
Public Health Preparedness
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
Public Health Preparedness
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
Public Health Preparedness
AcknowledgementsAcknowledgements
• Mary Hallet, Arizona School Nurse Consortium• Steve Goetze, GLS Technology• Daniel Bronson-Lowe, Epidemiologist, ADHS• Rebecca Sunenshine, CDC Career