Abstract
School children may transmit pathogens with cluster cases occurring on campuses and in families. In response to the 2009 influenza A (H1N1) pandemic, Taipei City Government officials developed a School-based Infectious Disease Syndromic Surveillance System (SID-SSS). Teachers and nurses from preschools to universities in all 12 districts within Taipei are required to daily report cases of symptomatic children or sick leave requests through the SID-SSS. The pre-diagnosis at schools is submitted firstly as common pediatric disease syndrome-groups and re-submitted after confirmation by physicians. We retrieved these data from January 2010 to August 2011 for spatio-temporal analysis and evaluated the temporal trends with cases obtained from both the Emergency Department-based Syndromic Surveillance System (ED-SSS) and the Longitudinal Health Insurance Database 2005 (LHID2005). Through the SID-SSS, enterovirus-like illness (EVI) and influenza-like illness (ILI) were the two most reported syndrome groups (77.6% and 15.8% among a total of 19,334 cases, respectively). The pre-diagnosis judgments made by school teachers and nurses showed high consistency with physicians’ clinical diagnoses for EVI (97.8%) and ILI (98.9%). Most importantly, the SID-SSS had better timeliness with earlier peaks of EVI and ILI than those in the ED-SSS. Furthermore, both of the syndrome groups in these two surveillance systems had the best correlation reaching 0.98 and 0.95, respectively (p<0.01). Spatio-temporal analysis observed the patterns of EVI and ILI both diffuse from the northern suburban districts to central Taipei, with ILI spreading faster. This novel system can identify early suspected cases of two important pediatric infections occurring at schools, and clusters from schools/families. It was also cost-effective (95.5% of the operation cost reduced and 59.7% processing time saved). The timely surveillance of mild EVI and ILI cases integrated with spatial analysis may help public health decision-makers with where to target for enhancing surveillance and prevention measures to minimize severe cases.
Highlights
Adequate community-based infectious disease surveillance can provide advanced awareness of emerging threats and promote timely, evidence-based prevention and control strategies [1]
The specific aims of this study were: (1) to evaluate the timeliness and feasibility of the novel School-based Infectious Disease Syndromic Surveillance System (SID-SSS) routinely operating in schools, (2) to find ways to improve its application in public health, and (3) to share our valuable experiences in Taipei with public health professionals in other countries to promote better global surveillance networks in the future
The majority of data were submitted from preschools (42.70%, n = 8256) and primary schools (41.82%, n = 8085), followed by secondary schools (13.88%, n = 2684), and others combined contributing the lowest (1.60%, n = 309)
Summary
Adequate community-based infectious disease surveillance can provide advanced awareness of emerging threats and promote timely, evidence-based prevention and control strategies [1]. School children infected with influenza have higher viral loads, longer shedding of viruses, and higher attack rates, are more likely to amplify transmission and create clusters of influenza-like illness (ILI) cases in families and schools [8,9,10]. An effective early outbreak detection system for school children is, essential to public health [11, 12]. To identify cases or clusters of infectious diseases that require an immediate public health response, we developed a nationwide Emergency Department based Syndromic Surveillance System (ED-SSS) in Taiwan after the outbreak of severe acute respiratory syndrome (SARS) in 2003 [13]. The Department of Health in Taipei (Taipei-DOH) implemented the first daily School-based Infectious Disease Syndromic Surveillance System (SID-SSS) with a 100% coverage rate of registered educational institutions from preschools to colleges and universities beginning in January 2010
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