1. Syndrome-Specific School Absenteeism Data for Public Health Surveillance Shuying Shen, MStat University of Utah

2. Setting Davis County in Utah Smallest county in Utah, 3 rd largest in population. 22.6% of the population is between 5-18 years old (large families) School district includes 56 elementary, 14 junior high, 8 high schools, 3 alternative schools, and 8 year-round schools.

3. Surveillance System In place since fall 2004 Absences reported by homeroom teachers and parents/guardians with: Date, classroom, teacher name, student name Reason for absence (Sick, Other, Unknown) Entered into District Information System and available in real-time.

4. Enhancement Ten public elementary schools recruited to participate as sentinel schools in fall 2007. Reason for absence expanded into syndrome categories: Respiratory GI Rash Other Unknown

5. Results The most common reason for absence was unknown (59%), followed by sick (23%) and other (18%). Other sickness-related absences accounted for 38% of the sick absences, followed by unknown (26%), GI (18%), respiratory (16%), and rash (0.6%). Respiratory-related absences correlated well with influenza cases reported to UDOH. Decrease in GI beginning of fall, otherwise stable

6. Absence Rate by Reason for Absence

7. Absence Rate by Syndrome

8. Other Observations Numerous schools not recruited used the enhanced reporting voluntarily. Requires minimal resource for enhanced reporting Principals and school nurses very interested in feedback information How we compare to ourselves How we compare to other schools

9. Limitations Data quality needs to be improved Too many unknowns and others

10. Potential Solutions Improve data collection by Promotion of importance of surveillance to parents/guardians Implement proactive reporting system for parents/guardians Statistical modeling Missing data imputation because likely bias in unknowns Adjustment for misclassification errors using Bayesian approach