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School-based outbreaks often precede increased incidence of acute respiratory infections in the greater community. We conducted acute respiratory infection surveillance among children to elucidate commonly detected pathogens in school settings and their unique characteristics and epidemiological patterns. The ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS) is a longitudinal, laboratory-supported, school-based, acute respiratory illness (ARI) surveillance study designed to evaluate the utility of cause-specific student absenteeism monitoring for early detection of increased activity of influenza and other respiratory viruses in schools from kindergarten through 12th grade. Eligible participants with ARIs provided demographic, epidemiologic, and symptom data, along with a nasal swab or oropharyngeal specimen. Multipathogen testing using reverse-transcription polymerase chain reaction (RT-PCR) was performed on all specimens for 18 respiratory viruses and 2 atypical bacterial pathogens (Chlamydia pneumoniae and Mycoplasma pneumoniae). Between 5 January 2015 and 9 June 2023, 3498 children participated. Pathogens were detected in 2455 of 3498 (70%) specimens. Rhinovirus/enteroviruses (36%) and influenza viruses A/B (35%) were most commonly identified in positive specimens. Rhinovirus/enteroviruses and parainfluenza viruses occurred early in the academic year, followed by seasonal coronaviruses, RSV, influenza viruses A/B, and human metapneumovirus. Since its emergence in 2020, SARS-CoV-2 was detected year-round and had a higher median age than the other pathogens. A better understanding of the etiologies, presentations, and patterns of pediatric acute respiratory infections can help inform medical and public health system responses. [ABSTRACT FROM AUTHOR]

Rapid influenza diagnostic tests (RIDTs) have variable sensitivity. In a community‐based population of kindergarten through 12th‐grade (K‐12) students, we assessed factors that may influence RIDT performance using 2368 paired results from Sofia® influenza A + B fluorescent immunoassay and reverse transcription polymerase chain reaction (RT‐PCR). RIDT sensitivity and specificity were 76.1% (95% CI: 72.8–79.1) and 97.2% (96.2–97.9), respectively. Factors associated with sensitivity included runny nose (OR = 3.0, p < 0.001), nasal congestion (1.59, p = 0.045), days from symptom onset (per day; 0.75; p < 0.001), myalgia (0.61; p = 0.014), age (per 5 years; 0.55; p = 0.001), and detection of another virus (0.50; p = 0.043). Understanding these factors can aid in interpreting negative results. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Household transmission of SARS-CoV-2 is a driver of the ongoing COVID-19 pandemic. Understanding factors that contribute to secondary infection risks (SIRs) can define changing trends and inform public health policies., Methods: The ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS) prospectively monitors respiratory viruses within the Oregon School District (OSD) in southcentral Wisconsin. Households with students who had ≥ 2 respiratory symptoms were eligible and opted to participate in ORCHARDS. Between October 28, 2020, and May 16, 2022, all household members provided self-collected nasal specimens on days 0, 7, and 14 for SARS-CoV-2 detection using real-time reverse-transcription-polymerase chain reaction. We used logistic regression to investigate individual- and household-level characteristics associated with SARS-CoV-2 transmission., Results: Overall, 127 households comprising 572 individuals (48% female; 52% male; 0.4% nonbinary; 77% ≥ 18 years) had at least one detection of SARS-CoV-2. The overall SIR was 47% and decreased over time (pre-Delta = 72% [95% CI: 58%-83%]; Delta = 51% [40%-63%]; and Omicron = 41% [36%-47%]). Odds of household transmission were 63% lower during the Omicron period compared with the pre-Delta period (OR = 0.36 [95% CI: 0.13-0.94] p = 0.037). Greater household density (members/bedroom) was significantly associated with household transmission during the Omicron period (OR = 6.8, [2.19-21.37] p = 0.001). Index case age, illness severity, and individual symptoms were not significantly associated with odds of household transmission., Conclusions: Greater household density was associated with a higher risk of SARS-CoV-2 transmission, but the risk declined over time with subsequent variants. Interplay between variants, prior infection, and individual/household factors may identify modifiable factors (e.g., behavior and vaccination) to reduce future transmission risk., (© 2024 The Author(s). Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Introduction: The COVID-19 pandemic created unprecedented opportunities to introduce rapid SARS-CoV-2 antigen testing (RSAT) into kindergarten through 12th grade (K-12) school settings. We evaluated the feasibility and functionality of Sofia Fluorescent Immunoassay Flu + SARS in 1 school district across the 2021-2022 academic year., Methods: Seven schools in the Oregon School District (Oregon, Wisconsin) were supplied with RSAT analyzers and test kits, along with minimal training of health office staff. We assessed RSAT utilization among schools, rate of invalid results, and comparability to 952 190 reverse transcription-polymerase chain reaction tests performed countywide during the same time period. A feedback survey was distributed to all 13 health office staff to assess respondents' perceptions regarding the feasibility and acceptability of RSAT in the Oregon School District., Results: Over the school year, 1226 RSATs were performed; SARS-CoV-2 was detected in 103 specimens. Percent positivity was similar to the county level (8.4 vs 9.2%; chi-square = 0.74; P  = 0.39). Cross-correlation of weekly positive tests between the Oregon School District and Dane County was maximal with no lag (rs = 0.69; P  < 0.001). Health office staff indicated Sofia2 RSAT was easy to perform, and 92.3% reported interest in continuing to utilize RSAT in the upcoming school year., Conclusions: Implementing a RSAT protocol is feasible and acceptable for monitoring SARS-CoV-2 cases in K-12 school settings. High rates of compliance and confidence in results demonstrate program effectiveness. Continuing to use RSAT in school settings after the urgency of the pandemic subsides could help address future outbreaks of SARS-CoV-2 and other respiratory viruses within schools and in the larger community., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Introduction: Surveillance of SARS-CoV-2 among university employees is an important part of mitigation strategies to prevent asymptomatic transmission and ensure a safe learning and work environment. Here, we assess the feasibility and performance of a program that relies on monitored self-collected nasal swabs to detect SARS-CoV-2 among asymptomatic faculty and staff., Methods: We recruited 1,030 faculty and staff via rolling enrollment who completed the required University of Wisconsin-Madison employee COVID-19 training and reported working on campus. Asymptomatic participants visited a designated location during a specified timeframe each week where they self-collected nasal swabs supervised by study staff. Specimens were stored in a cooler between 2 °C and 8 °C, then transported to the Wisconsin Veterinary Diagnostic Laboratory for polymerase chain reaction testing. Symptomatic participants or participants with a known exposure were advised to test elsewhere and follow quarantine guidelines from the Centers for Disease Control and Prevention., Results: Over the course of 31 weeks, 1,030 participants self-collected 17,323 monitored nasal swabs resulting in high participation (90%). SARS-CoV-2 was detected in 16 specimens. Eight specimens were inconclusive but were treated as positive results because of the implied detection of 1 or more SARS-CoV-2 genes. There were no invalid tests. Weekly SARS-CoV-2 incidence among participants ranged from 0 to 1.54% (x̄ = 0.20%). The SARS-CoV-2 incidence among participants was similar to estimated incidence in the greater university employee population., Conclusion: Weekly SARS-CoV-2 surveillance of asymptomatic faculty and staff on campus allowed for estimation of weekly SARS-CoV-2 incidence among on-campus employees. This surveillance protocol presents a low-cost, effective, and scalable option to identify asymptomatic cases of SARS-CoV-2 among university employees., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)