1. Public Health Preparedness Arizona’s Near Real Time School-based Syndromic 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 Conference October 10-12, 2007

2. Public Health Preparedness 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. Public Health Preparedness Outline  Background  Methods  Results  Conclusion  Data Limitations

4. Public Health Preparedness 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. 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

6. Public Health Preparedness 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. 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 data Database on AZSNC Server 1. Weekly Data Upload 1 2 3 45

8. Public Health Preparedness 2. 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) Database on AZSNC Server 1 2 34 Critical codes

9. Public Health Preparedness Data Entry: Nurse Activity Code for the Student

10. Public Health Preparedness Upload: Early Surveillance Program (ESP)

11. Public Health Preparedness Reverse Alert Mechanism

12. Public Health Preparedness 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. Public Health Preparedness Graph 1: ILI Encounters by Month

14. Public Health Preparedness Graph 2: ILI Encounters by Week School break

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

16. Public Health Preparedness 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. 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

18. Public Health Preparedness 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. Public Health Preparedness 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. Public Health Preparedness Thank you!