Oregon Child Absenteeism due to Respiratory Disease Study

描述（由申请人提供）：流感常见于学龄儿童，发病率高，是学校缺课的主要原因。它与大量发病率、死亡率和经济成本有关。最近，我们显示了学校日历与学龄儿童和0-4岁儿童的全因呼吸道感染就诊率之间的显著关系。尽管流感疫苗在这些年龄段有一定的功效，但只有三分之一的学龄儿童接种了疫苗。由于流感在学校环境中有效地传播，学校缺勤率已被用于流感监测规划，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，存在显著的局限性。自现代分子检测方法出现以来，没有研究将缺勤与直接鉴定病原体联系起来，以评估病因特异性缺勤对早期发现流感的价值。项目目标：ORCHARDS的目标是在三年的时间内迅速确定一个学区的缺勤原因，并评估基于流感特异性缺勤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：我们将每三年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标准确诊ARI，并在学生家中收集鼻腔和NP/OP标本进行病毒学检测。届时将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平台进行测试，并将结果即时无线传输到安全服务器。NP/OP标本将被运送到威斯康星州卫生实验室，在Qiagen多重PCR平台上使用rT-PCR对17种呼吸道病毒进行近实时分子检测。病因特异性缺勤的时间模式将与流感监测进行比较(1)基于病因特异性就诊的4个周边诊所，(2)基于两层周边初级保健的ILI电子健康档案监测

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.