CK21-003, Oregon Child Absenteeism due to Respiratory Disease Study - 3

SUMMARY/ABSTRACT Background: Influenza (Flu) is common in children and a leading cause of school absenteeism. SARS-CoV-2 (SARS) has emerged as a significant pathogen, but the role of children in post-peak and post-pandemic transmission needs to be defined. Both viruses cause substantial morbidity, mortality and economic costs. As Flu is efficiently spread within school settings, rates of absenteeism have been proposed as an early warning system. Accordingly, we created and tested a simple modification of an existing electronic school information system (ESIS) to automatically report cause-specific absenteeism. We found a significant association between cause-specific K-12 school absenteeism and prevalence of medically-attended Flu in our six-year study, allowing for Flu monitoring and early warning for acceleration in community activity. We have also documented substantial within-household Flu transmission. Similar studies- using our established and effective methods-are needed for the newly emerged coronavirus, SARS. Program Goal: The goals of ORCHARDS-3 are to expand the absenteeism system to evaluate the effectiveness for SARS monitoring and to describe the level of within-household transmission of Flu and SARS from index cases who are school-aged children. Methods: We will use parental reporting of symptoms into a telephonic absence reporting system and an algorithm within the ESIS for daily absenteeism assessment. We will actively recruit ≥300 children absent due to Flu-like illness (ILI) or COVID-like illness (CLI) from the Oregon School District, Dane County, WI, in each of three years. Home visits will be used to collect detailed demographic, household, epidemiologic and symptom data, and nasal and NP/OP specimens for testing. Nasal specimens will be tested for Flu/SARS using SOFIA-2 FIA rapid testing. NP/OP specimens will be transported to the Wisconsin State Laboratory of Hygiene for Flu/SARS rRT-PCR testing and for the presence of other respiratory viruses using a Luminex Multiplex PCR platform. We will recruit ≥240 households/yr with ill children for transmission assessment. All household members will self-collect nasal specimens on day 0, 7 and 14 for Flu/SARS rRT-PCR and provide detailed illness data. Temporal patterns of absenteeism due to ILI and CLI will be compared to virological surveillance within the surrounding community. Rates of within-home transmission of Flu and SARS will be calculated. Significance: Transmission and amplification within schools, followed by transmission from children to other household members likely expands outbreaks. Cause-specific absenteeism monitoring of Flu and SARS may provide early detection in a community allowing for use of countermeasures.