Analysis of factors influencing influenza outbreaks in schools in Taicang City, China.

Objective: This study aims to analyze the awareness of influenza prevention and control and the behavioral attitudes toward the work among parents and staff in schools in Taicang City and the impact of the vaccination rate among students on influenza outbreaks in schools. The findings can provide references for the development of effective control strategies for the spread of influenza. Methods: An anonymous questionnaire survey was conducted on 10,962 students from 20 schools in Taicang City, with class as the unit of analysis. The survey investigated their awareness of influenza prevention and control, their attitudes, and the vaccination coverage. Results: From January to June 2023, a total of 388 influenza outbreaks were reported in schools in Taicang City, involving 77 schools. There were 3,475 confirmed cases, with an average infection rate of 18.53%. In schools where influenza outbreaks had occurred, the incidence rate of those who received influenza vaccine was significantly lower than those who did not, and the vaccine protection rate was 28.22%. The knowledge awareness rates of "the main transmission routes of influenza" and "influenza vaccination can prevent influenza" among parents of students were 95.49 and 93.16%, respectively. The differences between schools involved in the epidemic and non-epidemic were statistically significant (p < 0.05). The correct attitudes of parents toward "actively reporting relevant symptoms to teachers when their children show symptoms" and "avoiding classes with diseases when their children are suspected to be sick" are 98.80 and 96.26%, respectively. The differences between schools with and without epidemic are statistically significant (p < 0.05). The correct attitudes of the class teacher toward "correct management and control of students with flu like symptoms in the class" and "taking correct prevention and control measures in the event of a flu epidemic in the class" were 89.36 and 92.55%, respectively. The differences between epidemic related and non-epidemic related classes were statistically significant (p < 0.05). Conclusion: Enhance the knowledge level of influenza prevention and control among parents of students, Strengthening the training for class teachers in emergency response to infectious diseases and increasing vaccination coverage among students can effectively reduce the incidence of influenza and thereby the occurrence of cluster outbreaks in schools.

COVID-19 Outbreak during Summer Courses at an Elementary School.

Due to the COVID-19 emergency, face-to-face classes were suspended. After the vaccination of teachers and to mitigate educational backwardness, the schools have begun to reopen with protocols established by the government. Here, we investigated the COVID-19 outbreak in summer courses during the reopening of a private elementary school in July 2021. We report confirmed cases of COVID-19 in staff members, students, and their families. A total community of 290 people was part of this study, and we built the contact network. The clinical features of all cases are described. We used the methodology of cases and contacts. The index case was identified by epidemiological tracking, and containment measures were activated, as well as further infection chains in the setting. We estimate the attack rate for staff members at 15.68% (95% CI 7.0-28.6), students at 12.24% (95% CI 4.6-24.8), and family members at 2.6% (95% CI 0.8-6.0). An incubation period of 48-72 h was determined. A student-teacher-student-family transmission sequence was identified. The area where the infection was identified was the school swimming pool, an area where face masks are not worn or, in some cases, inadequately used. Finally, we continue with intermittent staff testing and early detection actions, reinforcing prevention measures, environmental control, cleaning, and educational interventions with students regarding the implementation of preventive measures through classes led by school health staff.

Vaccine Coverage and Effectiveness in a School-Based Varicella Outbreak in Jinan Prefecture, Shandong Province.

BACKGROUND: Licheng District of Jinan Prefecture reported a school-based varicella outbreak. We conducted an investigation to analyze the epidemiology and scope of the outbreak, determine varicella vaccine coverage on the school campus, and estimate varicella vaccine effectiveness (VE). METHODS: In the epidemiological investigation, we determined the attack rate, the clinical manifestations of varicella cases, and histories of prior varicella disease and varicella vaccination. We tested students for presence of serum IgM antibodies, and we attempted to isolate the varicella virus from vesicular fluid samples. We used chi-square to compare incidences between classes and floors. VE was estimated using a retrospective cohort study. RESULTS: There were 13 varicella cases in the outbreak. All were among fourth grade students - twelve in Class 7 and one in Class 6. The attack rate in the two classrooms was 14.3% (13/91). Clinical symptoms were rash (100%) and fever (46.15%). All cases were reported within one average incubation period, and the epidemic curve suggested common exposure. Six of the 13 cases previously received one dose of varicella vaccine with a median time between vaccination and infection of 9 years; the other seven cases had not been vaccinated. Varicella vaccine coverage with one or more doses was 81.31%; 2-dose coverage was 38.15%. The median age of receipt of dose 1 was 1.18 years, and median age for receiving dose 2 was 5.12 years. One-dose varicella VE was 73.2% (95% confidence interval: 37.0%, 88.6%), and two-dose VE was 100%. CONCLUSIONS: Varicella vaccine coverage has been gradually increasing in recent years, as ≥1-dose and 2-dose coverage rates are higher in younger children than older children. High one-dose vaccination coverage limited the outbreak scope and led to the breakthrough cases being mild. Mild cases were difficult to detect in a timely manner. Varicella vaccine was highly effective, with 1-dose VE of 73% nine years after vaccination and 2-dose VE of 100%. We strongly recommended that all school students receive two doses of varicella vaccine.

Risk Perception and Behavioral Response of Teachers to COVID-19 in Southern Ethiopia, 2021.

Introduction: Coronavirus disease 2019 (COVID-19) is an infectious illness which was first identified in Wuhan China. The mode of transmission of COVID-19 is mainly from person-to-person by respiratory transmission and from contact with contaminated surfaces. Teachers may have a significant higher number of social interactions than other professions, putting them at greater risk of contracting the virus. Objective: The aim of this study was to assess the risk perception and behavioral response of teachers to COVID-19 in Gamo zone, Southern Ethiopia. Methods: The study was conducted in Gamo zone from February to march, 2021. An Institution-based-cross sectional study design was employed and multi stage sampling technique was utilized to select 634 study participants. The data were collected using Kobo collect survey tool through interviewer administered questionnaire. The data were analyzed by SPSS version 25. Both bivariable and multivariable logistic regression models were fitted to identify factor associated with risk perception and behavioral response. Odds ratio with 95% confidence interval was computed to determine the level of significance; in multivariable analysis, variables with a P value less than 0.05 with 95% confidence interval were considered as statistically significant. Results: About 79.1% and 75.1% of the teachers had high risk perception and good protective behavior, respectively. Having children ((AOR=1.84, 95% CI: 1.15-2.94), COVID-19 update (AOR=3.7, 95% CI: 1.66-8.59) and good protective behavior (AOR= 1.98, 95% CI: 1.18-3.34) were associated with high risk perception. On the other hand, educational status (AOR=9.42, 95% CI: 4.94-17.96) and availability of personal protective equipment (AOR=5.85, 95CI:2.27-15.02) were associated with good protective behavior. Conclusion: Although majority of the teachers had good protective behavior, some protective measures were not frequently adopted. There were few individuals who had low risk perception; this could be a potential cause for the occurrence of school outbreak. Therefore, the stakeholder should provide adequate resource and training on COVID-19 to enhance their risk perception and to promote adoption of protective methods.

Investigation of a Limited but Explosive COVID-19 Outbreak in a German Secondary School.

The role of schools as a source of infection and driver in the coronavirus-pandemic has been controversial and is still not completely clarified. To prevent harm and disadvantages for children and adolescents, but also adults, detailed data on school outbreaks is needed, especially when talking about open schools employing evidence-based safety concepts. Here, we investigated the first significant COVID-19 school outbreak in Hamburg, Germany, after the re-opening of schools in 2020. Using clinical, laboratory, and contact data and spatial measures for epidemiological and environmental studies combined with whole-genome sequencing (WGS) analysis, we examined the causes and the course of the secondary school outbreak. The potential index case was identified by epidemiological tracking and the lessons in classrooms with presumably high virus spreading rates and further infection chains in the setting. Sequence analysis of samples detected one sample of a different virus lineage and 25 virus genomes with almost identical sequences, of which 21 showed 100% similarity. Most infections occurred in connection with two lesson units of the primary case. Likely, 31 students (12-14 years old), two staff members, and three family members were infected in the school or the typical household. Sequence analysis revealed an outbreak cluster with a single source that was epidemiologically identified as a member of the educational staff. In lesson units, two superspreading events of varying degrees with airborne transmission took place. These were influenced by several parameters including the exposure times, the use of respiratory masks while speaking and spatial or structural conditions at that time.

Impact of Communication Measures Implemented During a School Tuberculosis Outbreak on Risk Perception among Parents and School Staff, Italy, 2019.

Risk perception has a significant impact on decisions people make when facing a threat: a mismatch between actual hazard and perceived risk can lead to inappropriate behaviours and suboptimal compliance to recommended public health measures. The present study was conducted in the aftermath of a tuberculosis (TB) outbreak that occurred in 2019 in a primary school in Italy. The aim was to evaluate the impact of communication measures implemented by local health authorities (including face-to-face meetings between LHAs and the local population, weekly press announcements, implementation of a telephone hotline and of an information desk, and social media communication), on risk perception among parents of schoolchildren and school staff, and to identify factors related to a change in risk perception before and after the said activities. An anonymous questionnaire was administered to parents of schoolchildren (n = 846) and to school staff (n = 70). Participants were asked about the level of risk they had perceived at two distinct times: when they first became aware of the outbreak and following implementation of communication activities. A significant reduction of perceived risk was found in both groups (p < 0.001) following the communication activities. The largest reduction was found among participants who reported having appreciated the meetings with the LHA healthcare staff. Our findings suggest that keeping an open approach, explaining the actual threat to the population and adapting communication to different listening skills, are essential for health authorities to successfully manage a public health emergency.

Brote de tiña por Trichophyton tonsurans en una escuela básica de Valparaíso, Chile / Ringworm of Trichophyton tonsurans outbreak in a basic school in Valparaíso, Chile

Resumen Introducción: Las tiñas son infecciones que afectan la piel y anexos. Trichophyton tonsurans es un hongo antropofílico emergente que puede provocar brotes. Objetivo: Describir un brote de tiña por T. tonsurans en una escuela de Valparaíso. Materiales y Método: Estudio descriptivo realizado entre junio-agosto de 2018. Se consideró caso a todo alumno de la escuela y a familiares directos en contacto con ellos, con diagnóstico clínico de tiña. El estudio micológico de las muestras tomadas se realizó a través de pruebas morfo-fisiológicas. Los datos se expresaron en números y porcentajes. Resultados: Hubo 18 casos, 16 niños (15 del kindergarten) y dos adultos. Tasa de ataque en kindergarten fue de 68%. Nueve casos fueron varones con promedio de edad de 6 años. Catorce de nacionalidad chilena y una haitiana. El caso índice fue un niño chileno y el primario el niño haitiano. La localización más frecuente fue en el rostro. Diez casos tuvieron cultivo con desarrollo de T. tonsurans. La mayoría requirió tratamiento con terbinafina por fracaso terapéutico con clotrimazol. Conclusiones: El brote por T. tonsurans ocurrió principalmente en varones del kindergarten. La principal localización fue en el rostro. La mayoría de los casos requirió terbinafina como tratamiento por fracaso terapéutico con clotrimazol.

Background: Ringworm are skin and its annexes infections. Trichophyton tonsurans is an emergent anthropophilic fungus that might cause outbreaks. Aim: To describe a ringworm outbreak by T tonsurans in an elementary school in Valparaíso, Chile. Methods: A descriptive study was run between June and August, 2018. Students and his closest relatives in contact with them who were clinically diagnosed with ringworm have been considered a case. Mycological studies of samples had been carried out through morphophysiology tests. Data are shown in numbers and percentages. Results: There were 18 cases, 16 kids (15 from kindergarten) and 2 adults. Attack rate was 68% in kindergarten. Nine cases were boys with average age of 6 years old. For 14 cases their nationality was Chilean and in 1 case Haitian. First case was a Chilean boy, and primary case was a Haitian boy. The most frequent location was face. Ten cases yielded positive cultures for T tonsurans. Most of the patients needed terbinafine treatment after a therapeutic failure performed with clotrimazole. Conclusion: T. tonsurans outbreak ocurred mainly in kindergarten male. The most frequent location was face. Most of the patients needed terbinafine treatment after a therapeutic failure with clotrimazole.

High rate of transmission in a pulmonary tuberculosis outbreak in a primary school, north-eastern Italy, 2019.

Italy is a low-incidence country for tuberculosis (TB). We describe a TB outbreak in a primary school in north-eastern Italy, involving 10 cases of active pulmonary disease and 42 cases of latent infection. The index case was detected in March 2019, while the primary case, an Italian-born schoolteacher, was likely infectious since January 2018. Administration of a pre-employment health questionnaire to school staff with sustained contact with children should be considered in low-incidence countries.

Using daily syndrome-specific absence data for early detection of school outbreaks: a pilot study in rural China.

OBJECTIVES: 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. STUDY DESIGN: 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.