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Useful Practice for School Surveillance


December 1, 2009
School classThere are reports that the nationwide rate of H1N1 influenza infection is declining.

This past week, the Centers for Disease Control and Prevention (CDC) found that the number of doctor visits related to influenza-like illness was on the decline, as well as the geographic spread of the virus. But rates of hospitalization and deaths from pulmonary infections and pneumonia remain high for this time of year.

At critical times like this, the importance of biosurveillance is demonstrated as a tool measuring the effectiveness of countermeasures such as vaccination and school closures. Tarrant County Public Health Department (TCPH) in Fort Worth, TX, and the Southwest Center for Advanced Public Health Practice (APC)  have developed evidence-based practices for biosurveillance of schools, businesses, and medical facilities. The programs implement sophisticated technology and products, but aim for accuracy and ease-of-use.

The APC conducted research, reviews of existing programs, and communicated with school nurses to develop a School Health Surveillance System (SHSS). According Dean F. Lampman, Regional Surveillance Coordinator with the TCPH APC, public health staff and school nurses wanted to "overcome the limitations of prior school reporting systems." As a result, the APC created an expanded online portal to collect and present information.

Part of the solution is an online form that takes less than five minutes to fill out and can be replicated by other LHDs. Anyone entering information has the option of giving comments, which can help to define the reasons for school absenteeism rates and closures. For example, students during the H1N1 outbreak sometimes stayed home out of fear of getting sick.

Over the past three years, the response rate to the SHSS has grown enormously. In 2008, a total of 4,800 school health reports were received. This year, the same number of reports was received in the first few months of the school year.

“H1N1 came along and gave a renewed sense of importance to the program,” said Lampman. "In a state where this kind of reporting is not mandatory…the viability of the programs is shown and is testimony to the fact that’s an easy-to-use system that provides value to people.”

According to Lampman, the data alerted health officials to the rapid and early spread of H1N1. “September was almost triple [the rate of infection] we saw in the spring,” he said. “Everyone was expecting this to happen, but we were surprised by the intensity and the early date.”

The data collected is combined with data from other community facilities, such as universities and businesses, as well as medical facilities as part of the Tarrant County Influenza Surveillance Program. The Centers for Disease Control and Prevention (CDC) is currently evaluating the information for indicators useful in the detection of pandemic influenza, as well as Adenovirus, Human Metapneumovirus, Respiratory Syncytial virus (RSV), and Parainfluenza (types 1-3).

The APC has operated since 2004 as a grant-funded unit of TCPH developing resources for disease detection and investigation (biosurveilllance), emergency preparedness, and workforce development and training. Funders include NACCHO and the U.S. Department of Homeland Security. 

Several of the tools and resources the APC have developed are available in the NACCHO Toolbox for other local health departments to use:
 

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