The Oregon Child Absenteeism Due to Respiratory Disease Study (ORCHARDS): Rationale, objectives, and design

Abstract

Background Influenza viruses pose significant disease burdens through seasonal outbreaks and unpredictable pandemics. Existing surveillance programs rely heavily on reporting of medically attended influenza (MAI). Continuously monitoring cause‐specific school absenteeism may identify local acceleration of seasonal influenza activity. The Oregon Child Absenteeism Due to Respiratory Disease Study (ORCHARDS; Oregon, WI) implements daily school‐based monitoring of influenza‐like illness‐specific student absenteeism (a‐ILI) in kindergarten through Grade 12 schools and assesses this approach for early detection of accelerated influenza and other respiratory pathogen transmission in schools and surrounding communities. Methods Starting in September 2014, ORCHARDS combines automated reporting of daily absenteeism within six schools and home visits to school children with acute respiratory infection (ARI). Demographic, epidemiological, and symptom data are collected along with respiratory specimens. Specimens are tested for influenza and other respiratory viruses. Household members can opt into a supplementary household transmission study. Community comparisons are possible using a pre‐existing and highly effective influenza surveillance program, based on MAI at five family medicine clinics in the same geographical area. Results Over the first 5 years, a‐ILI occurred on 6634 (0.20%) of 3,260,461 student school days. Viral pathogens were detected in 64.5% of 1728 children with ARI who received a home visit. Influenza was the most commonly detected virus, noted in 23.3% of ill students. Conclusion ORCHARDS uses a community‐based design to detect influenza trends over multiple seasons and to evaluate the utility of absenteeism for early detection of accelerated influenza and other respiratory pathogen transmission in schools and surrounding communities.

Cause-specific student absenteeism monitoring in K-12 schools for detection of increased influenza activity in the surrounding community—Dane County, Wisconsin, 2014–2020

“…In addition, school-aged children with ARI are recruited to participant in a home study which allows evaluation of demographic, clinical, and virological correlates of respiratory infections. The complete, detailed methodology for ORCHARDS has been published elsewhere [15]. Briefly, ORCHARDS is based in the Oregon School District (OSD: www.oregonsd.org), which includes the villages of Oregon and Brooklyn, located in a semirural area of Dane County, Wisconsin.…”

“…The full details pertaining to recruitment of students for data and specimen collection at home, including inclusion and exclusion criteria, are available in the ORCHARDS methods paper [15]. Inclusion criteria included: (1) student attends, or is eligible to attend (e.g., home schooled), a school within the OSD; (2) has an illness characterized by �2 of 6 acute respiratory infection/ILI symptoms (nasal discharge; nasal congestion; sneezing; sore throat; cough; fever); and (3) scores �2 points on the Jackson scale.…”

“…Laboratory-supported data to evaluate the role of influenza on a-ILI status were collected for the OSD students who opted to participate in ORCHARDS [15]. Briefly, 2,378 home visits were conducted during the study period for children who met criteria for ARI.…”

“…The goal of the ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS) is to develop and implement a replicable system for daily school-based monitoring of ILI-specific student absenteeism in kindergarten through grade 12 (K-12) schools, and to assess the system's usability for early detection of accelerated influenza and other respiratory pathogen transmission in schools and surrounding communities [15]. In this paper, we discuss the relationship between student absenteeism and MAI in surrounding communities.…”

SARS-CoV-2 and other respiratory pathogens are detected in continuous air samples from congregate settings

“…Such studies would require a partnership with a well-established, intensive surveillance testing program to compare air sampling data with case reports from asymptomatic and symptomatic individuals. For example, the Oregon Child Absenteeism Due to Respiratory Disease Study (ORCHARDS) enrolls students and families from a K-12 school district and the surrounding community to understand the causes of influenza-like illness 67 . Partnering with a study like ORCHARDS would provide an opportunity to explore the relationship between data collected by air surveillance and identified causes of respiratory infections in school settings.…”