1420. Medically Attended Influenza A Cases in Clinics, an Emergency Department, and a Hospital are Preceded by Influenza A Detections in Schools
Session: Poster Abstract Session: Public Health
Friday, October 28, 2016
Room: Poster Hall
  • ORCHARDS IDWeek 2016 Poster.pdf (2.1 MB)
  • Background:  Transmission and amplification of influenza A (Flu-A) within schools has been purported as a driving mechanism for subsequent outbreaks in surrounding communities.  We explored the timing and relationship between Flu-A detections at four levels: schools (s), primary care clinics (c), an emergency department (ed), and a hospital (h) within a common community.

    Methods:   We conducted prospective detection of influenza in children aged 4-19 within the Oregon School District in Wisconsin through school absenteeism monitoring and home visits to absent students to collect swabs for reverse transcription polymerase chain reaction (RT-PCR).  The Wisconsin Influenza Incidence Surveillance Project (WIISP) monitors medically attended influenza at five primary care clinics in and surrounding the school district using RT-PCR.  The Public Health Information Exchange (PHINEX) at the University of Wisconsin School of Medicine and Public Health provided de-identified Flu-A RT-PCR results from the UW Hospital Emergency Department and inpatient services.  We compared weekly counts of Flu-A from 1/04/2015 - 2/13/2016 across four datasets (within 12 miles of one another) using Spearman rank correlation and tested the a priori hypothesis that school detections precede those in clinics, EDs, and hospitals.

    Results:  During the assessment period, we identified the following Flu-A counts in each setting, respectively: school (s: 13), clinic (c: 84), ED (ed: 60), and hospital (h: 66) (Fig 1).  Weekly Flu-A counts from the schools were significantly correlated with other settings:  s-c (rs=0.450); s-ed (rs =0.402); s-h (rs=0.324).  A statistically significant increase in correlation between school and hospital was noted by comparing 0 weeks with a 3-week time lag (P=0.0384; Fisher r-to-z transformation; Fig 2).

    Conclusion:  Within a common source population, we demonstrated significant, positive correlation between Flu-A detections from non-healthcare-associated illnesses in school-aged children, medically attended clinic visits, and ED and hospitalized patients.  Moreover, detections of Flu-A from the school setting preceded hospital detections by 3 weeks.  Our analysis is compatible with the premise that Flu-A circulates and amplifies within schools.


    Jonathan Temte, MD, PhD1, Shari Barlow, BA1, Amber Schemmel, BS1, Emily Temte, BA1, Maureen Landsverk, BS1, Brad Maerz, MS1, Ashley Fowlkes, MPH2, Yenlik Zheteyeva, MD, MPH3 and Amra Uzicanin, MD, MPH3, (1)Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, (2)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (3)Centers for Disease Control and Prevention, Atlanta, GA


    J. Temte, Quidel corporation: Research Contractor , Research grant

    S. Barlow, None

    A. Schemmel, None

    E. Temte, None

    M. Landsverk, None

    B. Maerz, None

    A. Fowlkes, None

    Y. Zheteyeva, None

    A. Uzicanin, None

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