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Title: Teacher led school-based surveillance can allow accurate tracking of emerging infectious diseases - evidence from serial cross-sectional surveys of febrile respiratory illness during the H1N1 2009 influenza pandemic in Singapore
Authors: Soh, S.E. 
Cook, A.R. 
Chen, M.I.C. 
Lee, V.J. 
Cutter, J.L.
Chow, V.T.K.
Tee, N.W.S.
Lin, R.T.P.
Lim, W.-Y. 
Barr, I.G.
Lin, C.
Phoon, M.C.
Ang, L.W.
Sethi, S.K.
Chong, C.Y.
Goh, L.G.
Goh, D.L.M.
Tambyah, P.A.
Thoon, K.C.
Leo, Y.S.
Saw, S.M. 
Keywords: Respiratory tract infections
Issue Date: 4-Dec-2012
Citation: Soh, S.E., Cook, A.R., Chen, M.I.C., Lee, V.J., Cutter, J.L., Chow, V.T.K., Tee, N.W.S., Lin, R.T.P., Lim, W.-Y., Barr, I.G., Lin, C., Phoon, M.C., Ang, L.W., Sethi, S.K., Chong, C.Y., Goh, L.G., Goh, D.L.M., Tambyah, P.A., Thoon, K.C., Leo, Y.S., Saw, S.M. (2012-12-04). Teacher led school-based surveillance can allow accurate tracking of emerging infectious diseases - evidence from serial cross-sectional surveys of febrile respiratory illness during the H1N1 2009 influenza pandemic in Singapore. BMC Infectious Diseases 12 : -. ScholarBank@NUS Repository.
Abstract: Background: Schools are important foci of influenza transmission and potential targets for surveillance and interventions. We compared several school-based influenza monitoring systems with clinic-based influenza-like illness (ILI) surveillance, and assessed the variation in illness rates between and within schools.Methods: During the initial wave of pandemic H1N1 (pdmH1N1) infections from June to Sept 2009 in Singapore, we collected data on nation-wide laboratory confirmed cases (Sch-LCC) and daily temperature monitoring (Sch-DTM), and teacher-led febrile respiratory illness reporting in 6 sentinel schools (Sch-FRI). Comparisons were made against age-stratified clinic-based influenza-like illness (ILI) data from 23 primary care clinics (GP-ILI) and proportions of ILI testing positive for pdmH1N1 (Lab-ILI) by computing the fraction of cumulative incidence occurring by epidemiological week 30 (when GP-ILI incidence peaked); and cumulative incidence rates between school-based indicators and sero-epidemiological pdmH1N1 incidence (estimated from changes in prevalence of A/California/7/2009 H1N1 hemagglutination inhibition titers ≥ 40 between pre-epidemic and post-epidemic sera). Variation in Sch-FRI rates in the 6 schools was also investigated through a Bayesian hierarchical model.Results: By week 30, for primary and secondary school children respectively, 63% and 79% of incidence for Sch-LCC had occurred, compared with 50% and 52% for GP-ILI data, and 48% and 53% for Sch-FRI. There were 1,187 notified cases and 7,588 episodes in the Sch-LCC and Sch-DTM systems; given school enrollment of 485,723 children, this represented 0.24 cases and 1.6 episodes per 100 children respectively. Mean Sch-FRI rate was 28.8 per 100 children (95% CI: 27.7 to 29.9) in the 6 schools. We estimate from serology that 41.8% (95% CI: 30.2% to 55.9%) of primary and 43.2% (95% CI: 28.2% to 60.8%) of secondary school-aged children were infected. Sch-FRI rates were similar across the 6 schools (23 to 34 episodes per 100 children), but there was widespread variation by classrooms; in the hierarchical model, omitting age and school effects was inconsequential but neglecting classroom level effects led to highly significant reductions in goodness of fit.Conclusions: Epidemic curves from Sch-FRI were comparable to GP-ILI data, and Sch-FRI detected substantially more infections than Sch-LCC and Sch-DTM. Variability in classroom attack rates suggests localized class-room transmission. © 2012 Soh et al.; licensee BioMed Central Ltd.
Source Title: BMC Infectious Diseases
ISSN: 14712334
DOI: 10.1186/1471-2334-12-336
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