title: Using daily syndrome-specific absence data for early detection of school outbreaks: a pilot study in rural China.
abstract: OBJECTIVE
  This paper describes and preliminarily evaluates the usefulness of the daily syndrome-specific absenteeism surveillance system (DSSASS) as an early warning system of school outbreaks in rural China.
  
  
  METHODS
  We conducted an experimental study in rural areas of Hubei Province from September 19, 2011 to December 31, 2011.
  
  
  METHODS
  Nine public elementary schools from two counties were selected as pilot sentinel schools. Daily monitoring data of the absent date and reason, sex, age and class of each absent student was collected and entered into a web database. Reported data were checked daily and field investigation was carried out when there was abnormal absentee aggregation. Descriptive analysis and preliminary evaluation were then conducted after the pilot study.
  
  
  RESULTS
  The findings showed that the total average of daily absenteeism rate was 3%, and the absenteeism rate differed by county, school level and grade level. The daily absenteeism rate in illness absentees was highest (2.74%), followed by business absentees (0.13%) and injury absentees (0.09%). The total timeliness report rate was 64.84% and the total incident report rate was 29.22%. One varicella outbreak and one influenza B outbreak were identified, but neither of them was detected by China Information System for Diseases Control and Prevention (CISDCP). The study shows syndrome-specific absenteeism data would be useful for early detection of unusual public health events or outbreaks in school. However, more efforts are needed to enhance the quality of surveillance data, and longer follow-up and more analysis are required to evaluate the system comprehensively. Our study might provide useful experience and evidence for other developing regions or counties establishing similar systems.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: tanlidyx@126.com.
authors.forename: L
authors.initials: L
authors.lastname: Tan
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: L
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: W
authors.initials: W
authors.lastname: Yan
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
authors.forename: B
authors.initials: B
authors.lastname: Xu
authors.affiliation: Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: V K
authors.initials: VK
authors.lastname: Diwan
authors.affiliation: Institute of Public Health, Heidelberg University, Heidelberg, Germany; Centre for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
authors.forename: H
authors.initials: H
authors.lastname: Dong
authors.affiliation: Future Position X, Gävle, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Palm
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: L
authors.initials: L
authors.lastname: Long
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: sf_nie@mails.tjmu.edu.cn.
authors.forename: S
authors.initials: S
authors.lastname: Nie
mesh_terms: D000041:Absenteeism; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks / Q000517:prevention & control*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011159:Population Surveillance / Q000379:methods*; D012423:Rural Health; D012574:Schools; D013334:Students / Q000706:statistics & numerical data
keywords: Absence surveillance; Early detection; School outbreak