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The Oregon Child Absenteeism Due to Respiratory Disease Study (ORCHARDS):Rationale, Objectives, and Design

By Jonathan L Temte, Shari Barlow, Maureen Goss, Emily Temte, Amber Schemmel, Bradley Maerz, Cristalyne Bell, Lily Comp, Mitchell Arnold, Kimberly Breunig, Sarah Clifford, Erik Reisdorf, Pete Shult, Mary Wedig, Thomas Haupt, James Conway, Ronald Gangnon, Ashley Fowlkes, Amra Uzicanin

Posted 04 Feb 2021
medRxiv DOI: 10.1101/2021.02.01.21250878

Background: Influenza viruses pose significant disease burdens through annual seasonal outbreaks and unpredictable pandemics. Existing influenza surveillance programs have relied heavily on reporting of medically attended influenza (MAI). Continuously monitoring cause-specific school absenteeism may identify local activity acceleration of seasonal influenza. The Oregon Child Absenteeism Due to Respiratory Disease Study (ORCHARDS; Oregon, WI) implements daily school-based monitoring of influenza-like illness-specific student absenteeism (a-ILI) in pre-kindergarten through grade 12 schools and assesses this approach for early detection of accelerated influenza and other respiratory pathogen transmission in schools and surrounding communities. Methods: Starting in September 2014, ORCHARDS has combined reporting of daily absenteeism though automated processes within 6 schools and home visits to school children with acute respiratory infections (ARI). Demographic, epidemiological, and symptom data are collected along with respiratory specimens. Specimens are tested for influenza and other respiratory viruses. Household members may participate in a supplementary household transmission study. Community comparisons are made possible using a pre-existing, long-standing, and highly effective influenza surveillance program, based on MAI at 5 primary care clinics in the same geographical area. Results: Over the first 5 years, a-ILI occurred on 6,634 (0.20%) of 3,260,461 student school days. Viral pathogens were detected in 64.5% of 1,728 children visited at home with ARI. Influenza was the most commonly detected virus, noted in 23.3% of ill students. Influenza (p<0.001) and adenovirus (P=0.004) were significantly associated with a-ILI. Discussion: ORCHARDS uses a community-based design to detect and evaluate influenza trends over multiple seasons and to evaluate the utility of absenteeism for early detection of accelerated influenza and other respiratory pathogen transmission in schools and surrounding communities. Initial findings suggest the study design is succeeding in collecting appropriate data to achieve study objectives.

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