A Smart Card-Based Electronic School Absenteeism System for Influenza-Like Illness Surveillance in Hong Kong: Design, Implementation, and Feasibility Assessment.

Dennis Km Ip,Hau Chi So,Gabriel M Leung,Vicky J Fang,Chi Kin Lam,Jingyi Xiao,Benjamin J Cowling,Yat Hung Tam,Eric Hy Lau

doi:10.2196/publichealth.6810

Abstract

BackgroundSchool-aged children have the highest incidence of respiratory virus infections each year, and transmission of respiratory viruses such as influenza virus can be a major concern in school settings. School absenteeism data have been employed as a component of influenza surveillance systems in some locations. Data timeliness and system acceptance remain as key determinants affecting the usefulness of a prospective surveillance system.ObjectiveThe aim of this study was to assess the feasibility of implementing an electronic school absenteeism surveillance system using smart card–based technology for influenza-like illness (ILI) surveillance among a representative network of local primary and secondary schools in Hong Kong.MethodsWe designed and implemented a surveillance system according to the Protocol for a Standardized information infrastructure for Pandemic and Emerging infectious disease Response (PROSPER). We employed an existing smart card–based education and school administration platform for data capture, customized the user interface, and used additional back end systems built for other downstream surveillance steps. We invited local schools to participate and collected absenteeism data by the implemented system. We compared temporal trend of the absenteeism data with data from existing community sentinel and laboratory surveillance data.ResultsWe designed and implemented an ILI surveillance system utilizing smart card–based attendance tracking approach for data capture. We implemented the surveillance system in a total of 107 schools (including 66 primary schools and 41 secondary schools), covering a total of 75,052 children. The system successfully captured information on absences for 2 consecutive academic years (2012-2013 and 2013-2014). The absenteeism data we collected from the system reflected ILI activity in the community, with an upsurge in disease activity detected up to 1 to 2 weeks preceding other existing surveillance systems.ConclusionsWe designed and implemented a novel smart card technology–based school absenteeism surveillance system. Our study demonstrated the feasibility of building a large-scale surveillance system riding on a routinely adopted data collection approach and the use of simple system enhancement to minimize workload implication and enhance system acceptability. Data from this system have potential value in supplementing existing sentinel influenza surveillance for situational awareness of influenza activity in the community.

Highlights

MethodsSchool as a High-Risk Setting for Disease TransmissionTransmission of respiratory virus infections, including influenza virus infections, has always been a major concern in schools because of poorer personal hygiene practices, more frequent person-to-person close contacts, and relatively lower preexisting immunity among young children [1,2]
Our study demonstrated the feasibility of building a large-scale surveillance system riding on a routinely adopted data collection approach and the use of simple system enhancement to minimize workload implication and enhance system acceptability
We have demonstrated the feasibility of building and implementing a large-scale surveillance system by employing a routinely adopted smart card–based approach for automatic data capture in schools, supplemented by simple automation of later steps required for prospective surveillance

Summary

Introduction

MethodsSchool as a High-Risk Setting for Disease TransmissionTransmission of respiratory virus infections, including influenza virus infections, has always been a major concern in schools because of poorer personal hygiene practices, more frequent person-to-person close contacts, and relatively lower preexisting immunity among young children [1,2]. School absenteeism is increasingly being employed as a source of syndromic data for influenza surveillance to inform epidemic and pandemic preparedness in different locations [6,7,8]. Whereas previous studies generally suggested that school absenteeism data is useful for reflecting community influenza activity [9,10,11] and detecting outbreaks [12,13], data timeliness and system acceptance remain as key determinants affecting their usefulness for prospectively informing relevant public health actions and reducing disease transmission [14,15]. School absenteeism data have been employed as a component of influenza surveillance systems in some locations. Data timeliness and system acceptance remain as key determinants affecting the usefulness of a prospective surveillance system

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Conclusion