Evaluation of a school-based influenza surveillance system.

Previous studies have suggested using school-based surveillance to monitor epidemic influenza-like illness in a community. Since the late 1970s, no studies have sought to evaluate this public health measure. The Boulder County Health Department developed, piloted, and implemented a school-based surveillance system beginning with the 1988-89 school year. After five seasons of surveillance, the school-based system was evaluated for sensitivity by comparing the epidemic curves from the school-based system with those of a preexisting communicable disease sentinel surveillance system. Additional attributes evaluated included acceptability, simplicity, timeliness, and overall usefulness. Comparisons of the overall epidemic patterns suggest a close correlation between the two measures for the influenza seasons 1988-89 through 1992-93. The school-based system closely followed the general rise, peak, and fall of epidemic influenza-like illness as measured by the preexisting sentinel system. Three of five epidemic peaks matched on the week of occurrence between the two surveillance systems; for the remaining seasons, 1989-90 and 1991-92, the school-based system peaked 1 week earlier than the sentinel system. The use of school-based surveillance has several positive attributes which suggests schools are an ideal setting for detecting influenza outbreaks, including the epidemiology of influenza which has shown children play an important role in the acquisition and spread of influenza-like illness. Student populations were accessible and easily monitored by absenteeism rates that required no diagnosis or invasive testing. All 44 schools within the school district readily participated in the surveillance of influenza. Only minimal time and resources were needed for the system's maintenance. The school-based surveillance system allowed the local health department to track influenza-like illness activity and provide timely and important information concerning outbreaks to schools, public health officials, health care providers,and the public.

The epidemiology of school-related injuries: new perspectives.

Among school-aged children, unintentional injuries are the leading cause of morbidity and mortality. We began this prospective study in a sample of nine schools within the Boulder Valley School District (Colorado) during the 1988-1989 school year in an effort to explore the etiology of school-related injuries and to provide information relevant to their prevention. During the study period, 509 injuries were reported among a population of 5,518 students, yielding an incidence of 9.22 per 100 students. Boys were nearly one and one-half times more likely to have sustained a school-related injury than girls (risk ratio (RR) = 1.41; 95% confidence intervals [CIs] 1.18, 1.68). We found a significant difference among injury rates by school level (P less than .001). Middle/junior high students had the highest rate, followed closely by elementary students and distantly by high school students. Sports activities accounted for the largest percentage of school injuries (53%), and the percentage of sports-related injuries increased with increasing grade level. Analysis of injury rates by school location revealed that high school students were most frequently injured in the gym (1.52 per 100), middle/junior high students on the athletic field (4.26 per 100), and elementary students on the playground (6.12 per 100). Using injury location as the focal point, we examined relationships among the variables sport/activity, body site, and nature of injury. We found that a large percentage of injuries sustained on the athletic field or in the gym were similar and affected similar body sites, whereas playground injuries differed in their nature and in body site affected.(ABSTRACT TRUNCATED AT 250 WORDS)

An outbreak of an enterovirus-like illness at a community wading pool: implications for public health inspection programs.

In June 1987, following an outbreak of an illness among children participating in a swim class, investigation revealed that 26 children who had swum in the outdoor wading pool were more likely to be ill than those who had not (OR 12.1, 95% CI = 2.9, 74.2). The pool chlorination system was operating improperly prior to onset of illness and chlorine levels were at or very near zero. This report emphasizes the need for operators and inspectors to give special attention to disinfection of wading pools.