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Biosurveillance program provided earlier detection of disease outbreaks among preschoolers

SAN DIEGO — A web-based system could help preschools and child care centers report illness to public health centers more quickly, as well as allow for detection of disease outbreaks, according to research presented at the 2014 AAP National Conference and Exhibition.

“Our study involved looking at child care illness and biosurveillance in this [early child care] setting,” Andrew N. Hashikawa, MD, FAAP, assistant professor in the department of emergency medicine and pediatrics at the University of Michigan, told Infectious Diseases in Children. “Really child care is an area that has been largely ignored. Schools do a better job of reporting illness but we took this opportunity to create a web-based surveillance system for child care centers and early learning centers.”

Andrew N. Hashikawa

Hashikawa and colleagues implemented a web-based biosurveillance program in four preschool/child care centers from Dec. 10, 2013 to March 28, 2014, to determine its effectiveness in tracking illness trends and illness-related absences. Researchers evaluated seven symptom categories including: fever, influenza-like illness, conjunctivitis, gastroenteritis, cold symptoms, ear infections and rash. Age ranges were categorized as infant (0-12 months), toddler (13-35 months) or preschooler (36-59 months). Daily attendance at the center and action taken after symptoms also were evaluated. Public health departments received data weekly, or more often if spikes in illnesses were observed.

“Most illness reporting methods used by many public health departments are slow, paper-based and inefficient,” Hashikawa said.

During the study period, 188 episodes of illness were reported. Illnesses occurred most often among preschoolers (53.7%) followed by toddlers (31.9%) and infants (14.4%).

Gastroenteritis was the most commonly reported illness (37.2%), followed by fever (30.9%), cold (16.5%), other (95%), influenza (3.2%), rash (1.6%), ear infection (1.1%) and conjunctivitis (0.5%). Illness that included a fever with cough, body aches or sore throat were categorized as influenza-like (6.3%).

Forty-four percent of the cases required immediate absence from school, 3.7% required same-day medical service and none required emergency care.

“The bottom line is that we were able to reduce the lag time [in reporting illnesses] by about 3 weeks,” Hashikawa said. “So we saw a spike in a gastrointestinal outbreak in our county 3 weeks ahead of the reporting just because [paper-based reporting] took so much time. This is a real way of looking at illness in the community because often times it spreads from the child care population. They spread illness, they shed viruses longer and during flu season, often times they are the ones who spread it to the other people.”

For more information:

Schellpfeffer NR. Abstract #26086. Presented at: 2014 AAP National Conference and Exhibition; Oct. 11-14, 2014; San Diego.

Disclosure: Infectious Diseases in Children was unable to confirm any relevant financial disclosures.