Oregon Child Absenteeism due to Respiratory Disease Study

描述(申请人提供)：流感在学龄儿童中很常见，发病率很高，是旷课的主要原因。它与相当大的发病率、死亡率和经济成本有关。最近，我们发现，在学龄儿童和0-4岁儿童中，校历与全原因呼吸道感染的就医就诊率之间存在显著的关系。然而，尽管流感疫苗在这些年龄段具有合理的疗效，但只有三分之一的学龄儿童接种了疫苗。由于流感在学校中的传播效率很高，学校缺勤率已被用于流感监测项目，并被提议作为早期预警系统的一个组成部分。然而，缺乏特异性带来了很大的局限性。自从现代分子检测方法出现以来，还没有将旷工与直接鉴定病原体相结合的研究，以评估特定原因的旷工对流感早期检测的价值。计划目标：果园的目标是在三年的时间里迅速确定一个学区的缺课原因，并评估基于特定流感缺勤情况的监测与以该学区为中心的多层免费流感监测之间的可比性。方法：每三年，我们将从威斯康星州戴恩县俄勒冈学区积极招募500名因呼吸道感染而缺课的儿童。我们将使用Jackson标准来确认ARI，并在学生家中收集鼻腔和NP/OP样本进行病毒学测试。将在那次访问中收集详细的人口统计、流行病学和症状数据。鼻标本将在2小时内使用Sofia RIDT平台进行检测，并将结果即时无线传输到安全服务器。NP/OP样本将被运送到威斯康星州立卫生实验室，在Qiagen Multiplex聚合酶链式反应平台上使用RT-PCR对17种呼吸道病毒进行近实时的分子检测。具体原因缺勤的时间模式将与流感监测进行比较，其基础是(1)对周围四家诊所进行特定原因的就诊，(2)在周围两层初级保健中进行ILI的EHR监测 诊所，(3)威斯康星州ILI-Net，(4)基于威斯康星州PCR和RIDT站点网络的病毒学监测。意义：以学校为基础的流感监测提供了在社区中极早发现流感的机会。将特定原因的缺勤与高灵敏度、无线RIDT和聚合酶链式反应确认相结合，可以廉价、快速地识别季节性和大流行流感。

DESCRIPTION (provided by applicant): Influenza is common in school-aged children, has high attack rates, and is a leading cause of school absenteeism. It is associated with substantial morbidity, mortality and economic costs. Recently, we have shown significant relationships between school calendars and prevalence of medically-attended visits for all-cause respiratory infections in school-aged children and children 0-4 years. Despite reasonable efficacy of influenza vaccines at these ages, however, only one third of school-aged children are immunized. Because influenza is efficiently spread within school settings, rates of school absenteeism have been used in influenza surveillance programs and proposed as a component of early warning systems. The lack of specificity, however, presents significant limits. Since the advent of modern molecular detection methods, there have been no studies coupling absenteeism with direct identification of pathogens to assess the value of cause-specific absenteeism for early detection of influenza. Program Goal: The goal of ORCHARDS is to determine rapidly the causes of school absenteeism across a school district over a three-year period and to assess the comparability between surveillance based on influenza-specific absenteeism and a multiple layers of complimentary influenza surveillance centered on this school district. Methods: We will actively recruit up to 500 children on the first day of their schol absence due to respiratory infection from the Oregon School District, Dane County, Wisconsin, in each of three years. We will use the Jackson criteria to confirm ARI, and collect nasal and NP/OP specimens at the student's home for virological testing. Detailed demographic, epidemiologic and symptom data will be collected at that visit. Nasal specimens will be tested within 2 hours using a SOFIA RIDT platform with instantaneous wireless transmission of results to a secure server. NP/OP specimens will be transported to the Wisconsin State Laboratory of Hygiene for near real-time molecular testing for the presence of 17 respiratory viruses using rT-PCR on a Qiagen Multiplex PCR platform. The temporal patterns of cause-specific absenteeism will be compared to influenza surveillance based on (1) cause-specific medically attended visits to four surrounding clinics, (2) EHR surveillance for ILI in two layers of surrounding primary care clinics, (3) ILI-Net for Wisconsin, (4) virological surveillance based on a network of Wisconsin PCR and RIDT sites. Significance: School-based influenza surveillance provides an opportunity for extremely early detection of influenza in a community. Coupling cause-specific absenteeism with high sensitivity, wireless RIDT with PCR confirmation allows for inexpensive, rapid identification of seasonal and pandemic influenza.