Surveillance, Monitoring Absenteeism &

Respiratory Transmission in Schools

Surveillance, Monitoring Absenteeism & Respiratory Transmission in Schools (SMART2) will lead to improved understanding of how diseases such as influenza spread between school children and the community. This research will provide useful data for dealing with both seasonal and pandemic (like H1N1) flu.
UPDATE SEPTEMBER, 2016: SMART2 completed a very successful 2015-2016 school year with Washington, Canon-McMillan and Fox Chapel School Districts. Thank you to the students, parents, administration and faculty: we couldn't have done it without YOU! We have been very lucky to receive some additional funding for 2016-2017, and will be continuing the research on a limited basis.
Why are we doing this study?
You may think that we know everything that we need to know about the flu, but we don't. Predicting flu season is largely done by monitoring people who get sick from the flu, and is after the flu has already started. We can't accurately predict when flu will begin to circulate in the community.
We believe that we will be able to use school absenteeism to predict when flu will start in the community. Early warning of the timing and extent of an influenza epidemic can substantially improve the response and preparation of healthcare services. This could allow community education in advance of the flu, gearing up to accommodate patient surge, and postponing or rescheduling routine non-essential activities. Health authorities could begin to actively look for flu, and identify problems, like a new flu strain, before it would become widely circulating throughout the population.
Who is involved in this study?
Canon-McMillan, Fox Chapel Area and Washington School Districts have agreed to work with Johns Hopkins University (Bloomburg School of Public Health), the University of Pittsburgh (School of Medicine), and the University of Florida on the SMART2 project. The study is funded by the US Centers for Disease Control and Prevention (CDC). We are also working with Lancaster University Medical School and the Institute of Infection and Global Health at the University of Liverpool (UK).
Our research team previously worked on the Pittsburgh Influenza Prevention Project (PIPP), where we placed hand sanitizer in 5 Pittsburgh city schools, and taught children about hand washing, covering coughs and sneezes, and other ways to avoid the flu. See for more information. We also conducted Social Mixing and Respiratory Transmission (SMART), which explored the mechanisms by which school students can spread respiratory diseases. SMART found that:

  1. Students in grades 1-4 are at the highest risk for influenza,
  2. Contacts within a classroom are the most important for elementary grades and that as students progress in school contacts within grade increase. By the time a student reaches high school, grade contacts become irrelevant. High schools form a single cluster of interactions.
  3. Partial day school closures may be as effective as full day closures, and are vastly less disruptive in situations of a severe flu outbreak or pandemic, when school closure would be considered.
Reports and other archive material are found in
What are the aims of this study, and how will it be conducted?
The primary goal of SMART2 is to improve prediction and tracking of influenza activity in entire communities. This will be done by conducting surveillance in school-based populations and comparing this to surveillance conducted by public health authorities in the general community.
SMART2 will monitor absenteeism in target schools, covering all grades from Kindergarten to Grade 12. It will determine the reason for absence and look for a specific set of symptoms commonly associated with influenza. It will test students for flu and other respiratory illnesses.
SMART2 will compare measures of incidence of influenza and other pathogens in the schools with surveillance data available on laboratory confirmed influenza outcomes from the University of Pittsburgh Medical Center, Allegheny County Health Department, Pennsylvania Department of Health and US Centers for Disease Control. The comparison will determine which systems and what output of existing surveillance systems are most predictive of influenza incidence in our school-based cohort.
SMART2 will work with a limited number of families in our target schools to record information about flu and flu like symptoms in individuals in these households. See SMART2 cohort flier.
The desired outcome is to develop statistical methods to improve prediction of influenza activity in communities that could be generalized for wide use across the country.
All of this research will be done confidentially, meaning we are not collecting any information about who you/your child is, or any personal information about your specific family. Participating students will be assigned code numbers. In the end, we may have information about the student, but this information will not be linked to his or her name, so we will not know who he or she is.
At every step, we are listening to and incorporating the opinions of the school leaders, students, parents, and teachers. We believe this will be a very successful partnership between the schools, Johns Hopkins University, the University of Pittsburgh, and the University of Florida. We are excited to work with all involved parties!
Quandelacy TM, Zimmer S, Vukotich CJ Jr, Bieltz R, Grantz K, Galloway DD, Lessler J, Zheteyeva Y, Gao H, Uzicanin A, Cummings DAT, Predicting virologically-confirmed influenza using school absences during the 2007-2015 seasons in Allegheny County, PA, International Society for Disease Surveillance, Dec 6-8, Atlanta GA
Quandelacy TM, Zimmer S, Vukotich CJ, Bieltz R, Grantz K, Galloway DD, Zheteyeva Y, Uzicanin A, Cummings DAT, (2016) Predicting influenza using school absences in Allegheny County, PA during the 2010-2014 influenza seasons, Models of Infectious Disease Agent Study, May 21, 2016, Houston, TX