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Plan for Electronic Submission of School Level Absentee and Child

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					    Plan for Electronic Submission of School Level
    Absentee and Child Level Immunization Status




        Allegheny County Health Department




                      June 30, 2010




                            1 

 
                            Table of Contents

Introduction…………………………………………………………………………………......3

Methods………………………………………………………………………………………....4

Regulations…….………………………………………………………………………..……...5

Current Ad-Hoc and Paper Based Systems……………………………………..…………..6

Allegheny County School Immunization Law Report, 2009-2010…………………..…….7

Assessment of Current ACHD Systems...……………………….………………………......8

CDC Immunization Status Surveillance Efforts…………………………………………...13

Absenteeism Monitoring Best Practices.……………………………..…………..………...15

Task Force Results……………..………………………………………………………….....17

Survey Results………………………………………………………………………………..19

Barriers to Implementation of New Electronic Systems..………………………………….32

Recommendations for Systems Implementation……………………………………..…....34

Sources……………………….………………………………………………………………..38

Task Force Volunteers…….………………………………………………………………….40

References.………………………………………………………………………………….…41

Appendix A……………………………………………………………………………………..42

Appendix B……………………………………………………………………………………..44

Appendix C……………………………………………………………………………………..47

Appendix D……………………………………………………………………………………..51

Appendix E……………………………………………………………………………………..61

Appendix F……………………………………………………………………………………..64

Appendix G……………………………………………………………………………………..72

The End…………………………………………………………………………………………82


                                    2 

 
                                          Introduction

The project purpose is to better understand the current electronic and paper based
systems in place and gather input into system features and data elements to facilitate
the timely and efficient electronic submission of school level absentee and child level
immunization status reporting data to ACHD.

This document is a plan to implement electronic submission of school level absentee
and child level immunization status reporting to the Allegheny County Health
Department (ACHD). This system once implemented will provide ACHD with improved
situational awareness of school health issues of potential public health importance
which can guide county and district level decisions regarding school closures and other
decisions to protect the health of students, faculty, and staff.

The scope of the plan includes the following:

       Assessment of the current ad-hoc and paper based systems which are in place for
        this reporting.

       Lessons learned from convening meetings and discussions with key school health
        authorities in Allegheny County to better understand the current electronic and
        paper based systems in place and gather input into system features and data
        elements to facilitate the timely and efficient electronic submission of data to ACHD.

       Identification of barriers to implementation of the system and recommendations of
        appropriate accommodations which can be made to minimize the barriers.

       Preliminary assessment of informatics and field testing needs for the informatics
        contractor yet to be specified.




                                                3 

 
                                           Methods

The methods for this project included conducting the following activities during the
project time period of March 15, 2010 to June 30, 2010.

       Convened meetings and discussions with key school health authorities and key
        health department program contacts in Allegheny County.

       Identified and described best practices for school-level absentee and child-level
        vaccination reporting by conducting literature reviews and convening emails and
        telephone calls with key authorities from four county health departments, the
        Pennsylvania Department of Health, and the Centers for Disease Control and
        Prevention.

       Developed a survey for school nurses and other school professionals in Allegheny
        County to provide input into this process.

       The survey was completed hard copy by school nurses at an Allegheny County
        School Nurse meeting on May 27, 2010. These data were then entered online at
        the SurveyMonkey website for ease of data analysis. The raw quantitative and
        qualitative data can be accessed at the ACHD SurveyMonkey account listed under
        the file name Amanda’s School Survey.

       The survey was completed by school nurses and other school professionals in
        Allegheny County online at SurveyMonkey during the first week of June 2010.

       The survey served as discussion questions for a teleconference with a task force
        from the Allegheny Intermediate Unit (AIU) on June 3, 2010. The task force
        members were volunteers who responded to a call for volunteers from the AIU
        Director.

       Survey results were analyzed online at SurveyMonkey and downloaded for analysis
        in a Microsoft Excel file.

       Pittsburgh school nurses provided additional input during a presentation of survey
        results at an in-service on June 21, 2010.

       Presentation of this plan and supporting documents to ACHD on June 30, 2010.

This plan documents the information learned during the above activities and
synthesizes this information to make recommendations for facilitating the timely and
efficient electronic submission of school level absentee and child level immunization
status data to ACHD.
                                               4 

 
                                       Regulations

Allegheny County’s School Health Immunization Regulations, Article X, requires that all
schools are to determine the immunization status of every student registered in their
district prior to admission to school. This includes home and cyber schooled students.
Students who are entering Allegheny County schools for the first time (kindergarten or
students transferring from out of county) may be provisionally enrolled if they can prove
administration of at least one dose of each required vaccine series. These students’
parents should be notified that their child is provisionally enrolled in school and must
complete the required immunizations within eight months. This applies to the second
varicella vaccine as well as the other immunizations required for kindergarten through
twelfth grade.

Because MCV and Tdap immunizations are not a series, there is no provisional
enrollment period. Students in grades 7-12 who were enrolled in Allegheny County
schools must have MCV, Tdap (if 5 years have elapsed since last tetanus
immunization) and second dose of varicella vaccines. No provisional enrollment was
extended to these students.

For the school year 2009-2010, required school immunizations for Allegheny County
School children are listed below.

All Grades K-12: 4 doses of tetanus (1 does on or after the 4th birthday); 3 doses if
series started after 7 years of age; 4 doses of diphtheria (1 does on or after the 4th
birthday); 3 doses if series started after 7 years of age; 3 doses of polio; 2 doses of
measles; 2 doses of mumps; 1 dose of rubella; 3 doses of hepatitis B; 2 doses of
varicella or written statement from physician/designee indicating month and year of
disease or serologic proof of immunity

Grades 7-12: 1 dose of tetanus/diphtheria/pertussis (Tdap); 1 dose of meningitis
vaccine (MCV4)




                                             5 

 
                     Current Ad-Hoc and Paper Based Systems

Every public, private, parochial school, and intermediate unit must report summary
immunization data to the Allegheny County Health Department (ACHD) by October 15
of each year. The most recent School Immunization Report Summaries were due on
October 15, 2009 and April 15, 2010. The most recent Immunization Report Worksheet
was due January 15, 2010. The previous school year, both the report summary and the
worksheet were due for all three dates. Persons submitting data were advised to
maintain a copy of the original worksheet for their files. The completed worksheets were
submitted to the ACHD via fax or mail. The persons submitting data to the ACHD were
informed that completion of these forms help to expedite the exchange of information
between the schools and the ACHD to help in monitoring the number of provisionally
enrolled students in Allegheny County more efficiently and accurately. All data
requested were determined to be necessary for statistical and disease prevention
purposes.

The School Immunization Report Summary form requests data for all grades (K-12) for
the following data elements: number with complete immunizations, number with medical
exemptions, number home/cyber schooled, number with religious/moral exemptions,
number provisionally enrolled, total students enrolled, and total students denied
admission/attendance. See Appendix A for the School Immunization Report Summary
template.

The Immunization Report Worksheet included the following data elements: grade, birth
date, name, zip code, medical exemption, religious/moral exemption, home schooled,
cyber schooled, DIPH/TET 1, DIPH/TET2, DIPH/TET3, DIPH/TET4, Polio1, Polio2,
Polio3, MMR1, MMR2, HEPB1, HEPB2, HEPB3, Varicella1, Varicella2, Tdap, Td,
Meningitis (MCV4), Comments/Remarks. See Appendix B for the Immunization Report
Worksheet template.

Tables 1-3 summarize the data collected from the School Immunization Report
Summaries and the Immunization Report Worksheets for the school year 2009-2010.




                                           6 

 
     Table 1. Allegheny County School Immunization Law Report, 2009-2010

October 2009 School Summary Data*

Number complete                               164,856                       95.2%

Medical exemption                                 956                        0.6%

Religious exemption                              3,420                       2.0%

Home/cyber                                        642                        0.4%

Provisional Status                               3,218                       1.9%

Total Students                                173,151

*Data provided by Allegheny County Health Department Infectious Diseases Program



Table 2. January 2010 Student Data for All Grades*

Medical Exemption                                 634                        0.4%

Religious Exemption                              1,937                       1.1%

Provisional Status                               1,652                       1.0%

Total Students                                173,151

*Data provided by Allegheny County Health Department Infectious Diseases Program



Table 3. January 2010 Student Data for Grades 7-12*

Need TdaP                                         426                        0.5%

Need MCV                                          273                        0.3%

Need Varicella #2                                 226                        0.3%

Total Students                                 80,167

*Data provided by Allegheny County Health Department Infectious Diseases Program



                                        7 

 
                        Assessment of Current ACHD Systems

Absenteeism

The current ACHD system for surveillance of absenteeism is based on school level
concerns. When a school is concerned about a potential health problem, the school
contacts the ACHD to discuss strategies such as school closure. These phone calls are
usually responded to by the ACHD expert on the selected health problem. There is no
systematic hard copy or electronic documentation of these phone calls. This system
does not provide indicators for situational awareness prior to the problem reaching an
emergency status or prior to a school being concerned enough to contact the ACHD.
This system does not provide baseline and trend information for decision-making at
ACHD and at the school district.

The Commonwealth of Pennsylvania requires schools to have plans for attendance
including monitoring of absenteeism. The Pittsburgh Schools provide an absenteeism
report to the Commonwealth of Pennsylvania once a year. The categories monitored
and reported are listed on the Pennsylvania Department of Health, Division of School
Health form provided in Appendix C.

Some parents of students attending Pittsburgh Schools describe why the student was
absent and other parents do not report any information about the student absence.
Parents are not required to provide a reason, but are required to provide the note. At the
Pittsburgh Schools, students bring notes to the homeroom teacher to document
excused absences. The homeroom teacher does not routinely document the reason for
the excused absence and does not routinely save the paper note. The school social
worker is contacted by the homeroom teacher when the teacher is concerned about a
pattern of absences. For Pittsburgh Schools, each school social worker monitors days
absent and excuses for absence. The nurse isn't involved in attendance monitoring. The
Pittsburgh Public Schools Office of Student Services is contacted on the phone by
schools when the school has a concern about absenteeism. It may be possible for
Pittsburgh Schools to report on the number of children absent for various reasons by
submitting the data to a secured web-based data entry system that is user friendly.

The Allegheny Intermediate Unit (AIU) reports that some schools have attendance
officers documenting absenteeism. McKee Elementary school runs daily reports, but
long term reports including weekly and monthly could not be run. McKee Elementary
School has the ability to export their reports into Microsoft Excel, to include, but not
limited to students who are: absent, tardy, or early dismissal.



                                             8 

 
Immunizations

The current ACHD system for surveillance of immunization status has many challenges.

    1. The data being submitted to the ACHD are often creating more work for schools
       that have collected their immunization status data in their own format and their
       own system either electronically or on hard copy. The schools then use their
       systems to complete the ACHD hard copy forms and to complete the
       Pennsylvania Department of Health’s web-based data entry.

    2. The Pittsburgh Schools have computer software to enter student immunization
       status for their own use. The immunization data are maintained in a RTI (real
       time information) database. For mandated services and episodic care and daily
       electronic health records, the school nurses use Health e-Tools via Highmark. It’s
       double work to submit required data on county paper forms and then triple work
       to submit required data on the Pennsylvania Department of Health website. The
       ACHD requires more detailed data than the Pennsylvania Department of Health
       requirements for data submission.

    3. McKee Elementary School suggests that ACHD use the Pennsylvania Statewide
       Immunization Information System (siis) that is already in place for reporting
       immunizations.

    4. West Allegheny School District uses ProSoft software.

        a. Currently, 22 of Allegheny county’s 42 school districts use ProSoft’s student
           records software suite. One component of this suite is typically the Student
           Health Records Software Module. The Student Health Records Software
           Module can be used to track district-wide immunizations, office visits,
           screenings, RX dispensing, etc.

        b. ProSoft is interested in participating in a preliminary discussion with the
           ACHD regarding ProSoft’s potential role in facilitating the flow of this
           information if it is something that is currently retained in their software files.

    5. The data being submitted to the ACHD are being sent hard copy, then requiring
       the ACHD Infectious Diseases Program to conduct time consuming data entry.

    6. The data are being entered into an Oracle database, but the ACHD Infectious
       Diseases Program lacks staff with a comfort level to use the database.




                                               9 

 
    7. The data are continually being updated, checked, and cleaned by separate
       offices at ACHD. Previous analyses and results can not be replicated because of
       these continually changing data.

    8. There is no standard format or set deadline for a surveillance summary report to
       be produced and disseminated to the stakeholders including the persons
       submitting the data to ACHD.

    9. When a report is requested as needed, a contractor is needed to extract the data
       from the Oracle database and to export the data to an excel file so the ACHD
       Infectious Diseases Program can analyze the data and produce a report.

    10. The ACHD Infectious Disease Program would like to be able to answer the
        following questions with the immunization status data collected to better target
        program efforts.

        a. Where are the pockets of need geographically?

        b. What is the breakdown by age and grade?

        c. What number of provisionals are medical exemptions that have not been
           documented as medical exemptions?

        d. Who reported and who did not in which schools/districts?

        e. Number of students needing each vaccine?

        f. Identify needs and gaps in the county.

        g. Identify and understand differences by private and public schools.

        h. Identify and understand difference by home and cyber schools.

        i. Evaluate the success rate of campaigns.

        j. Assess the benefits of the program’s efforts.

    11. The data in the database are not of high quality for the following reasons.

        a. There are no unique identifiers for schools being used by ACHD to avoid
           confusion about school name changes, school closings, and school
           openings. Thus, there are duplicate schools listed under school name
           variations and other schools are not listed at all. The ACHD Infectious
           Diseases Program does not know how to remove duplicate school listings
           from the Oracle database.
                                            10 

 
    b. Not all schools report data. The ACHD Infectious Diseases Program follows
       up with schools who send incomplete data, incorrect data, or who are not
       sending data. About two thirds of the schools submit their forms and
       worksheets on time. About 40% of schools did not send the January report.
       Some papers were lost or misplaced. There is a training gap because the
       school nurses submitting the data change schools or have more than one
       school and do not receive training on data submission. When school nurses
       are out sick, and a substitute comes or sometimes no substitute comes, then
       the data deadline is missed.

    c. The school nurses are not always receiving reminders to submit data before
       the deadline.

    d. Data are not entered by grade level in the Oracle database.

    e. Schools submit immunization status data to the Pennsylvania Department of
       Health on a web-based system for only two grades because kindergarten
       and seventh grade are the grades where vaccination status changes. ACHD
       collects data in more detail including all grades. There is confusion about
       submitting data to ACHD and to the Pennsylvania Department of Health in
       that sometimes the school nurses believe they already submitted the data to
       ACHD, but they only did submit data to the state.

    f. There is not a manual or electronic system to cue the school nurses to
       follow-up with data entry for students who were incomplete with their
       immunization status.

    g. Some schools do not submit data with addresses and names due to privacy
       and legal reasons.

    h. Prior to the Oracle database, the data were contained in an Access database
       that crashed a year ago. Thus ACHD has lost these previous data.

    i. Completion dates for immunizations given to the school children are not
       included.

    j.   Not all schools save copies of their data submitted making it difficult to seek
         clarification regarding data quality questions. There is a lack of training for
         school nurses to use the Commonwealth’s secure website features to save
         an electronic copy of their data submission or to print a hard copy of their
         data submission to save so that if there is a glitch in the data submission


                                          11 

 
    process, and the ACHD follows up with the schools to resubmit data to
    ACHD or the State, the schools will have their data saved to easily resubmit.




                                    12 

 
                   CDC Immunization Status Surveillance Efforts

The Centers for Disease Control and Prevention (CDC) established immunization
registries in 1999 including data element standards for data transmission from state
health departments to the CDC. The Pennsylvania Department of Health has two
registries sending data to the CDC (Philadelphia and Harrisburg).

Pennsylvania Department of Health requests that the ACHD Infectious Diseases
Program contact non-reporting schools in Allegheny County so that the Pennsylvania
Department of Health can obtain the required data to transmit to CDC. The
Commonwealth requests ACHD to complete a blank sheet called a “Law Report” for
each school not reporting data and return immediately to the Commonwealth. ACHD is
asked to check and correct the address listed for each school and show the schools
AUN number, name, and address on each sheet as it is listed on the Commonwealth
report. The Commonwealth’s system is out of date for many of the school names,
school closures, and school openings. However, the AUN number remains unchanged.
The AUN number assigned by the State may be a good school ID rather than using
school name for the ACHD database.

The Commonwealth of Pennsylvania School Immunization Law Report includes the
following data elements for kindergarten and 7th grade per CDC requirements. DT 3
doses or more, DT 4 doses or more, Polio 3 doses or more, HepB 3 doses or more,
Varicella had disease, Varicella 1 dose, Varicella 2 doses, Tdap 1 dose, Td 1 dose,
MCV 1 dose, # of students enrolled, # of students medical exempt, # of students
religious exempt, # of students enrolled provisionally, # of students denied admission or
attendance.

The Commonwealth of Pennsylvania has collected immunization status data since the
late 1980s, and these data have been manually entered into a database. In the last 5
years, the data collection has become electronic. The schools entering the data into the
secure website can print and save their data inputs, but they can’t edit their data. If the
school needs to edit the data after submission, the school needs to contact the
Pennsylvania Department of Health. Previously, the Pennsylvania Department of Health
collected immunization status data for all grades. Since the 2007-2008 school year, only
kindergarten and seventh grade were reported which is consistent with CDC
requirements. The Pennsylvania Department of Health believes they do not capture
additional gaps in immunization status by reporting on all grades since kindergarten and
seventh grade are the key years for capturing immunization status information among
school children. The secure website is an internal system developed by the Bureau of
Information Technology in the Pennsylvania Department of Health (phone 717-787-
5623).
                                            13 

 
The ACHD can request Pennsylvania Department of Health summary data reports
about Allegheny County immunization status data by contacting Christine Weltmer at
the phone number 717-787-5681. For the 2007-2008, 2008-2009, and 2009-2010
school years, Christine Weltmer provided ACHD with summary data tables organized by
vaccine, by private or public schools, and by kindergarten or seventh grade for
Allegheny County. The numbers of total students denied admission in the school year
2007-2008 was 5 with 447 schools reporting; in 2008-2009, 12 students were denied
admission with 439 schools reporting; and in 2009-2010, 15 students were denied
admission with 452 schools reporting. See Appendix D for the detailed tables.

In addition to the school-aged reporting, the Pennsylvania Department of Health also
has a registry of immunization status across the lifespan starting at birth for
approximately 30% of the population in Pennsylvania. The medical doctors giving the
immunizations volunteer to input the data for this registry.

CDC contracted with RTI International, a not-for-profit research firm, for a project titled
“Strengthening the Evidence Base: Monitoring Vaccination Coverage and Exemptions
among Kindergarteners.” This two-year project will include technical assistance to two
grantees (Colorado and Washington); a survey of immunization program grantees and
school coordinators; and the development of best practices and trainings and
workshops to share these best practices with grantees. RTI developed a survey
instrument to characterize facilitators and barriers to conducting school assessments for
kindergarteners’ immunization and exemption rates. The survey included questions
relevant to the needs of CDC and grantees. This project includes input from 50 state
grantees and six urban area grantees for school assessment. RTI partnered with the
Association of Immunization Managers (AIM) and has support from the American
School Health Association (ASHA) for this project. Karen Wooten at CDC plans to
request RTI to invite the ACHD to provide input for this project.




                                            14 

 
                      Absenteeism Monitoring Best Practices

The US Centers for Disease Control and Prevention (CDC) does not monitor individual
student absenteeism. However, the CDC collaborated with the US Department of
Education to monitor school closures during the H1N1 pandemic in 2009.

The Miami Dade County Health Department (MDCHD) receives automatically uploaded
electronic raw absenteeism data from the Miami-Dade Public Schools System. These
data contain student age, sex, race/ethnicity, school name, school zip code, home zip
code and absentee status. An alert is raised when absenteeism is 8% or higher. These
MDCHD data are limited because the reason for absence is unknown.

New York City (NYC) also monitors school absenteeism data that are limited because
the reason for absence is not recorded. Absences are recorded on a bubble sheet
during a designated homeroom class period. Bubble sheets are forwarded to the
school's administrative offices and scanned into a local database that automatically
transmits the data to a central database at the NYC Department of Education.
Preliminary data are available by noon each day. Data are corrected over the next few
days for students who, for example, arrive late. NYC observed that students are absent
from school on days related to holidays, vacations, teacher work days, half days, snow
days, state exam days, Mondays and Fridays (days around weekends) and other
reasons that are not related to illness. NYC observed increases in absences coinciding
with influenza-like illness (ILI) and gastrointestinal (GI) outbreaks. NYC found that
school-level absenteeism data are noisy and do not detect localized outbreaks. NYC
has found the absenteeism data useful to calculate attack rates.

In general, the New York City Department of Health and Mental Hygiene found that the
average absenteeism rate in a good school is 5%. During the H1N1 pandemic, the
Communicable Disease bureau of the New York City Department of Health and Mental
Hygiene, conducted a phone survey for one day. In this survey, parents were contacted
to determine the reason for student absenteeism. Approximately one third of the
absenteeism was unrelated to the pandemic, approximately one third of the
absenteeism was related to flu-like symptoms, and the other third were home because
the parents were worried although the child had no symptoms.

As a result of the noisy absenteeism data, starting in 2008, NYC began to phase in
electronic school nurse visit monitoring via the Office of School Health. Approximately
1000 schools received an Office of School Health computer terminal for school nurses
to submit data. The chief complaint is selected from a pick list provided by the
homegrown simple software. Other data elements include measured temperature, data
of birth, and other details. In NYC, the schools have a nurse on site every weekday

                                           15 

 
making this system a viable option. These data are limited by incompleteness when the
school nurse is too busy to enter the data.

In addition to the school nurse visit monitoring, NYC also maintains a city wide
immunization registry and an automated school health record (ASHR).

Monterey County Health Department (MCHD) in California reports daily average
absenteeism by reporting week for the following categories: ILI, Varicella, GI, other,
unknown, all causes. Thirteen schools serve as sentinel sites based on geographic
location, student demographics, and/or participation in the surveillance program. On
Fridays during weeks that school is in session, participating schools fax or email a
completed form to MCHD including weekly absenteeism data and total weekly student
enrollment. At MCHD, data are entered manually into a Microsoft ACCESS database.
MCHD provides weekly reminders to the schools and accepts late data on Monday thru
Tuesday. The total number of schools reporting each week varies. The data are
reported to the schools by parents calling the school clerk or secretary. The MCHD
Health Officer appreciates receiving these data, and the schools appreciate receiving a
summary report. See Appendix E for the data collection form and the most current
summary report prepared by MCHD.

Davis County, Utah also uses the sentinel school methodology and includes reasons for
absence. Ten public elementary schools in Davis County serve as sentinel schools to
collect timely syndrome-specific school absenteeism in addition to reason for absence.
Davis County reports the following reasons for absence: sick, other, and unknown. If the
absence is sickness-related, it is further categorized into one of the following groups:
respiratory, GI, rash, other, and unknown. Absenteeism clerks enter daily absences
through a web-based district information system. The county surveillance coordinator
has real-time access to this system on the web. Average daily absence is calculated per
100 enrolled students for total absences and for sick absences. Davis County observed
a temporal trend of decreases in GI related absences, and an increase in respiratory
absences going from fall to winter. Reasons for absence combined with syndrome-
specific information may make absenteeism data more useful for early outbreak
detection. These data could be useful for targeted surveillance.




                                            16 

 
                                   Task Force Results

A survey was developed to obtain input from the school nurses and other school
professionals. The survey questions were used to facilitate a focus group
teleconference discussion with the AIU Task Force on June 3, 2010. The survey
questions can be viewed in Appendix F.

The AIU Task Force Focus Group discussion points are listed below.

Immunization Status Monitoring Discussion Points

   Six school districts were represented by the AIU Task Force: Clairton City, Deer
    Lakes, Gateway, North Hills, West Jefferson Hills, and West Mifflin Area.

   The ACHD forms need to have separate columns for home school and cyber school.
    The cyber schools report their own information directly to ACHD. The school nurses
    do not have access to cyber school immunization records. If a school nurse does
    manage to track down cyber school information, then the cyber school information
    may get counted twice.

   ACHD should note that the schools are already submitting summary data for
    kindergarten and seventh grade to the Pennsylvania Department of Health secured
    website, and that it’d be easier if the more detailed ACHD data could be submitted at
    this same secured website.

   Deer Lakes uses ProSoft for electronic immunization record management and also
    has hard copies for backup.

   Clairton uses ProSoft for electronic immunization record management.

   West Jefferson Hills uses Power School for electronic immunization record
    management.

Absenteeism Monitoring Discussion Points

   At Deer Lakes, the teacher reports to the main office the following categories of
    absences: lawful or unlawful day, vacation day, tardy day, nurse excused day,
    doctor excused day. Deer Lakes uses ProSoft to electronically document
    absenteeism.

   Class Rule software is used by some schools to take attendance and grades and
    then the attendance information are entered into ProSoft software.


                                            17 

 
   Absence categories for other schools are: homebound day, school business day, out
    of school suspension day, in school suspension day, early release day.

   During the H1N1 pandemic, the Gateway School District used a comment section in
    ProSoft to document if the parents reported an absence related to H1N1. It may be
    possible for Gateway School District to mandate using this comment section in
    ProSoft for the documentation of other medical reasons reported by parents on
    excused absence notes such as strep throat.

   Other schools would need ACHD to talk directly with the principal or the
    superintendant to learn options for documenting a medical reason for an excused
    absence reported by parents.

   West Jefferson Hills uses Power School software to document absenteeism. Power
    School can tracking excused illness, not illness, injuries.

   Clairton has an attendance secretary who is responsible for monitoring absenteeism.
    Clairton uses ProSoft to electronically document absenteeism. ProSoft tracks illness
    or injury. Most parents of Clairton students don’t have transportation to take home
    an ill child and that impacts absenteeism rate.

   In general, schools do not have updated phone numbers for parents because
    parents change phone numbers frequently and the parents are not good at updating
    the schools with their new phone numbers. Thus, it’s difficult to contact parents on
    the phone for any reason; including that it’s difficult to track down parents regarding
    reasons for student absences.

   Students are allowed 10 lawful days of excused absences reported by parents. After
    crossing the threshold of the 10th lawful excuse, parents receive a letter from the
    magistrate for the 11 excused absence day which is unlawful. The parent is required
    to submit doctor excuses to make it legal for a child to miss more than 10 excused
    days of school during a school year. Therefore, it is typical for the schools to learn in
    the spring such as the month of April that an excused absence in the fall or winter
    such as November was a medical absence and to learn the reason as reported by a
    doctor.




                                             18 

 
                                                 Survey Results

A total of 61 school professionals responded to the survey. The survey questions can
be viewed in Appendix F. The survey was completed hard copy by a total of 37 school
nurses representing Pittsburgh Schools and the Allegheny Intermediate Unit (AIU) on
May 27, 2010 at a School Nurse meeting at the Sheraton, Station Square. An additional
24 school professionals completed the online version of the survey posted on the
SurveyMonkey Website. Of the 61 school professionals who responded to the survey,
37 indicated they worked for Pittsburgh Schools. The other respondents worked for AIU
school districts. See Appendix G for a complete list of schools who documented
participating in the survey. Also in Appendix G is a list of the responses to the open
ended questions regarding suggestions and comments.

The following results summarize the data collected from the surveys. The data are
presented quantitatively in Tables 4-17. When provided by respondents, the responses
to open ended questions regarding suggestions and comments are presented by
qualitative themes following the relevant tables. When respondents selected don’t know,
they frequently wrote in that another school professional such as an information
technologist, a social worker, or an administrator would know the answer. The open
ended responses were double checked and clarified during the interactive discussion
with the Pittsburgh school nurses at an in-service on June 21, 2010.



Table 4 shows that the majority of our survey respondents were school nurses.

    Table 4. What is your role at your school district?

                                                                Response       Response
    Answer Options
                                                                 Percent        Count
    Administrator                                                  1.6%           1
    Attendance Officer                                             0.0%           0
    Clerk                                                          0.0%           0
    Computer Teacher                                               0.0%           0
    Information Technologist                                       1.6%           1
    School Nurse                                                  96.7%           59
    Other                                                          0.0%           0
                                                          answered question            61
                                                            skipped question            0




                                                          19 

 
Table 5 shows that the majority of schools/districts represented in this survey have
existing electronic systems to collect student immunization status data.



    Table 5. Does your school or district have an existing electronic system collecting
    student immunization status data?
                                                              Response         Response
    Answer Options
                                                               Percent          Count
    Yes                                                         79.7%             47
    No                                                          13.6%             8
    Don't Know                                                   6.8%             4
                                                       answered question                  59
                                                         skipped question                  2


The following software is currently used in schools for monitoring student immunization
status.

     RTI (16 responses)

     ProSoft (13 responses)

     Health e-tools by Highmark (5 responses)

     District/state website link (1 response)

     Webstars (2 responses)

     SNAP (2 responses)

     ADM at Board (1 response)

     Don’t know (7 responses)

     AIU Task Force data identified ProSoft and Power School software being used by
      some schools to document immunization status.




                                                       20 

 
Table 6 shows that the majority of schools/districts represented in this survey have
existing electronic systems to collect student absenteeism data.



    Table 6. Does your school or district have an existing electronic system collecting
    student absenteeism data?
                                                              Response         Response
    Answer Options
                                                               Percent          Count
    Yes                                                         70.7%             41
    No                                                           5.2%             3
    Don't Know                                                  24.1%             14
                                                       answered question                  58
                                                         skipped question                  3


The following software is currently used in schools for monitoring student absenteeism
status.

     Sasi (6 responses)

     RTI (8 responses)

     Webstars (1 response)

     STARS (1 response)

     ProSoft (16 responses)

     Don’t know name (12 responses)

     AIU Task Force data identified ProSoft, Class Rule, and Power School software
      being used by some schools to document attendance.




                                                       21 

 
Table 7 shows that the majority of survey respondents did not make suggestions for
changing the Immunization Report Summary. However, 35.6% of survey respondents
did provide suggested changes. The suggested changes are listed by qualitative
themes following Table 7.
    Table 7. Please review the 2009-2010 School Year School Immunization Report
    Summary. Are there any changes that you suggest to make the data collection more
    accurate, easier, or useful for your school and your school district?
                                                              Response    Response
    Answer Options
                                                               Percent      Count
    Yes                                                     35.6%            21
    No                                                      52.5%            31
    Don't Know                                              11.9%            7
                                                   answered question              59
                                                     skipped question              2


Suggested changes and comments for the 2009-2010 School Year School
Immunization Report Summary

       Form
            Change provisionally enrolled column-- either complete or not complete.
            Do not require update if students are complete.
            Cyber schools have their own follow-up that student nurses do not access.
            Home schooled and cyber schooled each need their own column.
            Size form to be more user friendly.
            Eliminate addresses—burden to access and not useful.
            Zip code is sufficient.
       Electronic Form
            Make form electronic
            Computer program for reporting with data entry into central database.
            Pennsylvania Department of Health electronic reporting is easy.
            Keep it brief and everything online--replicating requirements.
            Once electronic system functions have address, phone, and fax pop up.
       Deadlines
            Send a reminder email two weeks before the completed form due.
            Email to school twice a year instead of three times a year.
       Process
            Hire a nurse with research background to coordinate.
            Do not allow school enrollment without complete immunizations.
            Do not allow exceptions for private schools.
            Not all school nurses have access to health data compiled by the school’s
               office.
            If blood work shows the student already had the varicella disease, then
               allow a varicella vaccine exemption.

                                                    22 

 
Table 8 shows that the majority of survey respondents did not make suggestions for
changing the Immunization Report Worksheet. However, 28.8% of survey respondents
did provide suggested changes. The suggested changes are listed by qualitative
themes following Table 8.
        Table 8. Please review the 2009-2010 Immunization Report Worksheet. Are there
        any changes that you suggest to make the data collection more accurate, easier,
        useful for your school or your school district?
                                                                Response       Response
        Answer Options
                                                                 Percent         Count
        Yes                                                    28.8%            17
        No                                                     52.5%            31
        Don't Know                                             18.6%            11
                                                       answered question              59
                                                         skipped question              2
     
     
    Suggested changes and comments for the 2009-2010 School Year School
    Immunization Report Worksheet

           Form
                School nurses do not have good information about the immunization numbers
                   of home schooled and cyber schooled students.
                If hard copy reporting, make the paper size 8 1/2 x 11--easy to photocopy.
                If hard copy, reformat to create more space to write in comments box and to
                   have less data per page.
                Has the Allegheny County Health Department (ACHD) been using the student
                   address provided by the student nurses? If no, then exclude the address
                   because the address is difficult to access and time consuming. Suggest
                   reporting zip code.
                If the student's address/ contact information is desired, provide enough space
                   to accommodate this information.
           Electronic Form
                Make form electronic with data entry into central database.
                Make ACHD electronic system similar to the Pennsylvania Department of
                   Health’s reporting system.
                If school address, phone, and fax are needed, automate details to to pop up.
                Keep the electronic reporting brief and online--replicating requirements.
           Process
                Do not allow school enrollment without complete immunizations.
                Do not allow exceptions for private schools.
                If blood work shows the student already had the varicella disease, then allow a
                   varicella vaccine exemption.



                                                      23 

 
    Table 9 shows that the majority of school professionals completing the forms referred to in
    Table 7 and Table 8 are school nurses.


     Table 9. Who completes these forms at your school or district? You may select one
     or more of the below categories.
                                                            Response        Response
     Answer Options
                                                             Percent         Count
     Administrator                                             1.7%             1
     Clerk                                                     1.7%             1
     School Nurse                                             98.3%             58
     Teacher                                                   0.0%             0
     Other                                                     0.0%             0
     Don't Know                                                0.0%             0
                                                     answered question                59
                                                       skipped question                2




    Tables 10 shows that 22.0% of survey respondents identified barriers to their participation
    reporting data to an ACHD secure web-based data entry system. Identified barriers are
    listed by qualitative themes following Table 10.
      Table 10. ACHD is exploring options for developing a secure web-based data entry
      system to replace the existing School Year School Immunization Report Summary
      and the Immunization Report Worksheet paper system. Are there any barriers to your
      school or district participating in such a system?
                                                              Response       Response
      Answer Options
                                                               Percent        Count
      Yes                                                      22.0%             13
      No                                                       50.8%             30
      Don't Know                                               27.1%             16
                                                       answered question                 59
                                                         skipped question                 2




                                                     24 

 
Identified Barriers to an Electronic Immunization Surveillance System

     Computers
          Computers are old, slow, and need updating—not compatible to many
            programs.
          Computer access is not available to school nurses at every school—
            especially small schools and Catholic schools.
     Process
          Data access and data entry takes time that schools nurses do not have.
          Providing student details such as address takes time--provide only student
            name is easier. If the school nurse knows the reason for needing to submit
            the student address and knows the student address is being used by
            ACHD, then the school nurse is more likely to take the time to collect and
            report the student address.
          Student immunization status is often listed as complete in one document
            and incomplete in another document.
          Pediatricians need more education about immunization requirements and
            the value of their voluntary effort to document administering childhood
            vaccinations in the state registry. Some school nurses use this registry to
            double check student immunization status.
          If going electronic this school year, then send a letter notifying schools
            (especially private schools) to allow computer access and immunization
            status documentation access to school nurses.
          Continue to include school nurse input for developing a user friendly
            system.
          Would be helpful if ACHD does public service announcements on the
            radio and television regarding student immunization requirements and
            deadlines.


Table 11 shows that only 10.2% of survey respondents received training or guidance for
completing the forms referred to in Table 7 and Table 8. Training suggestions and
changes are summarized following Table 11.

Table 11. Did your school or district receive training or guidance for completing these
forms?
                                                           Response        Response
Answer Options
                                                            Percent         Count
Yes                                                         10.2%              6
No                                                          74.6%              44
Don't Know                                                  15.3%              9
                                                   answered question                 59
                                                     skipped question                 2


                                                     25 

 
Training Suggestions/Comments

 Instructions in the mailing for the hard copy reporting are clear.
 Will need training if reporting becomes electronic.
 Training is needed to educate persons who are documenting Tdap and Td as the
  same rather than as different.
 For new hires, forms should be reviewed for how to correctly complete prior to
  deadlines.
 Add instructions to the district employee orientation manual or procedure book.
 Need adequate on-site training/in-service in classroom and for individuals in schools.
 Information technology staff should be trained in immunization requirements as they
  are the ones who enter data some schools.
 Continue to receive urban school nurse input for development of a user friendly
  system.
 

Table 12 shows that the majority of schools or districts represented by the survey
respondents do monitor absenteeism.


    Table 12. Does your school or district monitor absenteeism?
                                                             Response         Response
    Answer Options
                                                              Percent          Count
    Yes                                                        96.6%                 57
    No                                                          0.0%                 0
    Don't Know                                                  3.4%                 2
                                                      answered question                   59
                                                        skipped question                   2


    Table 13 shows that 39.3% of respondents report their school or district documents
    the reason for the absence. Several respondents noted that in many schools, the
    social worker monitors absences--not the school nurse. Absenteeism categories
    monitored by schools represented by respondents are summarized following Table 13.

    Table 13. If you responded yes to the previous question, is the reason for the
    absence documented?
                                                             Response         Response
    Answer Options
                                                              Percent          Count
    Yes                                                        39.3%                 22
    No                                                         26.8%                 15
    Don't Know                                                 33.9%                 19
                                                      answered question                   56
                                                        skipped question                   5

                                                      26 

 
    Absenteeism Categories Monitored by Schools

        Not Medical
             Legal/Excused/approved absence
             Illegal/unexcused/unverified/un-approved/unauthorized absence
             Educational trip/fieldtrip/school activity
             Family trip
             Funeral/death
             Tardy
             Snow day
             Religious holiday
             Court hearing
             Homelessness
             Transfer awaiting transportation arrangements
             Cutting school
             Expelled (EUE)
             No reason given
        Episodic care provided by school nurses is reported to the Pennsylvania Department
         of Health once a year. The required reporting form is provided in Appendix C.
        Medical
             Excused medical absence
             Medical doctor/dentist appointment
             No specific medical reason given
             Injury
             Illness
             Fever
             Virus
             Flu
             Asthma
             Diarrhea
             Vomiting

    Tables 14 shows that 16.9% of respondents identified barriers to reporting absenteeism
    data to an ACHD secure web-based data entry system. Identified barriers
    are listed by qualitative themes following Table 14.

      Table 14. ACHD is exploring options for developing a secure web-based data entry
      system to monitor absenteeism. Are there any barriers to your school or district
      participating in such a system?
                                                              Response         Response
      Answer Options
                                                                Percent          Count
      Yes                                                      16.9%            10
      No                                                       30.5%            18
      Don't Know                                               52.5%            31
                                                      answered question               59
                                                        skipped question               2

                                                    27 

 
    Identified Barriers to an Electronic Absenteeism Surveillance System

        Computers
              Computers are old, slow, and need updating—not compatible to
                many programs.
              Computer access is not available to school nurses at every
                school—especially small schools and Catholic schools.
        Staffing
              Who would be responsible to collect the data and enter the
                data? Each school only has a nurse on site for one or two days
                per week.
              It's often difficult to contact parents and takes a lot of time. The
                school nurse does not have time for more work on top of the
                mandated screenings, episodic care, and other responsibilities.
              Need consistent and qualified personnel monitoring
                absenteeism who can properly identify and categorize the
                reason for absence.
        Information collection
              Need to understand how the data will be used because it takes
                a lot of time to collect these data, if possible to collect at all.
              There are confidentiality and legal concerns associated with
                absenteeism with lawful and unlawful excuses.
              The school does not usually receive a reason for absence from
                the parents or the medical doctors.
              Most medical excuses just have the medical doctor letterhead
                and the dates with no reason for the medical absence.
              There are inconsistencies within the district for how to monitor
                and document absenteeism.
              For many schools in Pittsburgh, the school nurse does not have
                access to the absenteeism information--only the counselor or
                social worker has access after the classroom teachers take
                attendance and enter into the computer.




                                             28 

 
 

    Table 15 shows that gastrointestinal illness and influenza-like illness are the most likely
    medical absence categories that schools/districts can monitor and report to the ACHD.

     
        Table 15. Please select the one or more absence categories that you believe your
        school or district could identify when collecting absenteeism data.
                                                                  Response        Response
        Answer Options
                                                                   Percent         Count
        Gastrointestinal illness                                    44.1%            26
        Influenza-like illness                                      44.1%            26
        Rash                                                        30.5%            18
        Respiratory                                                 35.6%            21
        Varicella                                                   22.0%            13
        Other                                                       16.9%            10
        Unknown                                                     23.7%            14
        None                                                        28.8%            17
                                                           answered question               59
                                                             skipped question               2
     
     
     
     
    Table 16 shows that 21 respondents provided suggested absence categories for
    monitoring and reporting to ACHD. The suggestions/comments for absenteeism
    monitoring are listed following Table 16.

     
     
        Table 16. If your school or district would find value in monitoring
        absence categories not listed in the previous question, please list the
        proposed categories here.
                                                                    Response
        Answer Options
                                                                      Count
                                                                      21
                                          answered question                 21
                                            skipped question                40




                                                          29 

 
    Suggestions/Comments for Absenteeism Monitoring

       Suggested Categories
             Suspension
             Homebound
             School refusal
             Excused medical absence
             Medical doctor/dental appointments
             Homelessness
             Hospitalization
             Fever
             Wound
             Headaches
             Vomiting, diarrhea
             Eye infection
             Strep throat
             Diabetes, endocrinology
             Epilepsy, neurology
       Information Collection
             See Appendix C for data collected by the Pennsylvania Department of heatlh
              once a year.
             Suggest sentinel school monitoring.
             There are privacy concerns with “Excused” or “Unexcused” absences
              because of consequences for court proceedings—especially with reasons for
              absence such as fractures, etc.
             Have a drop box for absence reasons.
             Absenteeism monitoring of the categories listed in Table 15 may be valuable
              to school nurses.
             The diagnosis is only documented if provided by the parent when the parent
              contacts the school. The medical doctor diagnosis is not listed on the school
              excuse.
             If absenteeism reasons are reported to ACHD, need to clarify if diagnosis if
              reported by parent or medical doctor.
             Most school nurses do not have time or access to contact parents of absent
              students, but some school nurses are interested to make an effort to do this
              contacting.
             Target social worker, not school nurse for absenteeism monitoring, but the
              school nurse may need to explain the diagnosis to the social worker.
             Be aware that children pretend to be their parents and lie about a medical
              absence. In this situation, need to monitor the pattern of absences.




                                           30 

 
    Table 17 shows that the majority of survey respondents report value in receiving a
    Summary immunization and absenteeism report from ACHD after the data collection and
    analyses are complete.

    Table 17. Would your school or district find value in receiving a summary
    immunization and absenteeism report from ACHD after the data collection and
    analyses are complete?
                                                               Response       Response
    Answer Options
                                                                 Percent       Count
    Yes                                                      59.3%             35
    No                                                       10.2%             6
    Don't Know                                               30.5%             18
                                                     answered question               59
                                                       skipped question               2




                                                    31 

 
                 Barriers to Implementation of New Electronic Systems

The results of the activities conducted within the scope of this plan were synthesized to
produce the following list of barriers to implementation of new electronic systems for the
Allegheny County Health Department.

Electronic Immunization Status Monitoring Barriers

   Not all schools have access to computers or access to adequate computers,
    especially private schools.

   Not all school nurses have a comfort level with submitting data electronically on
    computers.

   Not all school nurses are convinced that electronic data submission will save them
    time, and some school nurses are concerned a new electronic data system will take
    more time that they do not have since most schools only have a school nurse on site
    once a week.

   Some schools have concerns about privacy issues.

   Individual student level data such as student address is of concern to school nurses
    because of the time to locate and submit this detail, because of privacy issues, and
    because of question about relevance—will ACHD use the child’s address?

   School nurses do not have access to cyber school student immunization information.

   ACHD does not currently provide the schools with unique identifiers.

   Confusion exists about the differences and similarities between ACHD immunization
    surveillance activities and the Pennsylvania Department of Health secured website
    for immunization status data submission.

   Schools use a variety of software and hard copy systems to monitor immunization
    status among their students, and developing a system that is compatible with all the
    existing school systems may be difficult.




                                            32 

 
Electronic Absenteeism Status Monitoring Barriers

   Not all schools have access to computers or access to adequate computers,
    especially private schools.

   The school professional documenting the absenteeism varies by school such as:
    social worker, school nurse, attendance officer, clerk, and other.

   Not all school professionals have a comfort level with submitting data electronically
    on computers.

   Some school nurses are concerned a new electronic data system for monitoring
    absenteeism would be their responsibility and that this activity will be a time burden
    requiring time that they do not have since most schools only have a school nurse on
    site once a week.

   Schools have concerns about privacy issues.

   Schools use a variety of software and hard copy systems to monitor absenteeism
    status among their students, and developing a system that is compatible with all the
    existing school systems may be difficult.

   The current categories of absenteeism being monitored by schools vary, and the
    medical reason for an excused medical absence is not commonly reported at most
    schools.

   The timing of when a school knows about an excused medical absence can be
    weeks or months after the date of the absence due to the current system of for
    documenting lawful and unlawful absences.

   Parents are not currently required to report a reason for absence unless the absence
    is unlawful.




                                            33 

 
                   Recommendations for Systems Implementation

                          Including Minimization of Barriers

The results of the activities conducted within the scope of this plan were synthesized to
produce the following list of recommendations for systems implementation including
minimization of barriers for the Allegheny County Health Department.

Electronic Immunization Status Monitoring Recommendations

In summary, the Pittsburgh Public Schools and the Allegheny Intermediate Unit have
responded positively to the concept of the ACHD converting the current hard copy
immunization status monitoring system into an electronic system. The school
representatives believe this change will make their jobs easier. Below are
recommendations developed based on results of the activities conducted within the
scope of this plan.

   When developing the electronic data submission system, take into consideration
    options for efficiency of data collection and data entry by the school nurses as well
    as the understanding that most Allegheny County schools only have a school nurse
    on site once a week.

   When building the electronic system, consider including the same data elements as
    the current hard copy forms, except for the following suggested changes.

     Consider separating the home school column from the cyber school column, and
       providing clear instructions that the cyber schools are responsible to report for
       the cyber schools.

     Consider removing individual student address as a data element, and only
       submitting student zip code for residence.

     Consider using unique identifiers for the schools such as those identifiers
       currently used for the Pennsylvania Department of Health secure web-based
       system.

     When requesting open ended information, ensure enough space is available to
      type in the response.

     Consider pick lists for the electronic system whenever possible to standardize the
       responses.




                                            34 

 
     Consider only requiring and requesting data for kindergarten and seventh
       graders as these are the critical years for obtaining vaccinations, and little or no
       changes are seen among the other grades.

   Consider that the information technologist selected to build the ACHD electronic
    system should collaborate with the Pennsylvania Department of Health Bureau of
    Information Technology (phone 717-787-5623) to determine how to minimize
    confusion and build compatibilities between the Commonwealth’s existing internal
    electronic system and the county’s new system yet to be developed.

   The information technologist selected to build the ACHD electronic system should
    consider assessing the technical details of the various software the schools are
    using to electronically document immunization status. The results of this assessment
    may be used to build an electronic system for ACHD that is compatible with the
    majority of the software packages already being used by the schools. Or perhaps
    ACHD will decide to use one of the existing software packages being used in many
    of the schools

   Ensure that appropriate technology such as computers and software are available to
    the school professionals assigned responsibility to conduct electronic immunization
    status monitoring for ACHD.

   Consider conducting a school nurse in-service regarding use of the new electronic
    data system prior to requiring their electronic data submission. Consider including
    clarification regarding the distinctions between the ACHD system and the
    Pennsylvania Department of Health system such as data requirements, deadlines,
    and data access.

   Consider conducting a school nurse and school administrator (such as principals
    and superintendants) in-service to address privacy concerns.




                                            35 

 
Electronic Absenteeism Status Monitoring Recommendations

In summary, the majority of the Pittsburgh Public Schools and the Allegheny
Intermediate Unit representatives report that absenteeism data are not currently being
routinely collected and the effort to begin to collect such data would have many
logistical and privacy challenges. This being said, there are a few schools that may be
interested in collaborating with ACHD to develop a sentinel system for monitoring
absenteeism among students. Below are the recommendations developed from
discussions and survey responses from the school representatives as well as results of
assessing existing efforts to conduct student absenteeism surveillance at other local
health departments in the United States.

   Consider meeting with school administrators such as principals and superintendants
    to determine which schools are willing to authorize participating in a sentinel system
    for monitoring absenteeism among students including a discussion regarding privacy
    concerns and logistical concerns.

   A call for volunteers to be sentinel schools should be considered.

     Potential sentinel schools/school districts include (but are not limited to)
       Pittsburgh Public Schools, Gateway School District, ACLD Tillotson School,
       Carrick High, Keystone Oaks School District, Moon Area School District,
       Friendship Academy, and Pace School.

     Consider explaining to potential volunteers that the submission of data is
       voluntary and that the ACHD is not requesting schools to track down parents to
       receive reasons for absence, but rather to routinely request reasons for absence
       when parents call or send notes to excuse absences.

     Consider explaining to potential volunteers that the parents’ report of the reason
       for absence is adequate, but the medical doctor’s report may be documented if
       received.

   Proposed categories to consider for the sentinel schools to document are: illness or
    not illness related.

     If illness related then the suggested sub-categories are: medical doctor/dentist
       appointment, influenza like illness, varicella, gastrointestinal illness, injury, strep
       throat, respiratory, rash, eye infection, other, and unknown.

   Consider developing a data element to document if the reason for illness sub-
    category was a parent’s report or a medical doctor’s report.

                                              36 

 
   Consider building the electronic system to include the following:

     Consider using unique identifiers for the schools such as those identifiers
       currently used for the Pennsylvania Department of Health secure web-based
       system.

     Consider pick lists for the electronic system whenever possible to standardize the
       responses and save time in data entry.

   The information technologist selected to build the ACHD electronic system may
    consider assessing the technical details of the various software the schools are
    currently using to electronically document absenteeism status. The results of this
    assessment may be used to build an electronic system for ACHD that is compatible
    with the majority of the software packages already being used by the schools. Or
    perhaps ACHD will decide to use one of the existing software packages being used
    in many of the schools.

   Consider building the absenteeism system and the immunization system for
    electronically submitting the data to ACHD as one system, perhaps with different
    filing tabs on the user interface.

   Consider weekly reporting on Fridays with data submitted by a school clerk,
    attendance officer, school nurse, or social worker depending on the school.

   Ensure that appropriate technology such as computers and software are available to
    the school professionals assigned responsibility to conduct electronic immunization
    status monitoring for ACHD.

   Consider providing an in-service for school professionals prior to requiring their
    electronic data submission including an explanation of the utility of these data.




                                             37 

 
                                      Sources

Scott A. Anderson, President, ProSoft Technologies, Inc., phone 412-854-5622

Oxiris Barbot, New York City, Office of School Health, Automated School Health
Record, phone 212-442-1554

Susie Barnes, Monterey County Health Department, California, phone 831-755-4698

Lisa C. Barrios, NCCDPHP, ONDIEH, CDC, email lic8@cdc.gov

Frank Caniglia, IIS Manager, RHIA, Pennsylvania Department of Health, phone 717-
783-2548

Megan Casey, RN, BSN, MPH, Nurse Epidemiologist, ACHD

Tarisha Cockrell, CTR, OID, CDC, phone 404-639-1861

Wynona Cox, McKee Elementary, email Wynona_Cox@fcasd.edu

Kim Dawson, Computer Teacher, McKee Elementary, email
kdawson@westallegheny.k12.pa.us

Bruce W. Dixon, MD, Director, ACHD

Nancy Fenton, Clerical Supervisor, Infectious Diseases Program, ACHD

Lyn Finelli, NCIRD, OID, CDC, phone 404-639-2554

Ayaan A. Gedi, New York City, Bureau of Immunization, Citywide Immunization Registry
(CIR), phone 212-676-8986

Brian Hatch, Davis County Health Department, Utah, phone 801-451-3325

Laura Kann, Surveillance Branch Chief, Division of Adolescent and School Health,
CDC, phone 770-488-6181

John Kokenda, Epidemiologist, ACHD

Jim Lando, MD, MPH, Public Health Physician, ACHD

Christine Layton, PhD, MPH, Project Director, RTI, phone 410-467-2907

Bruce Y. Lee, MD, MBA, Assistant Professor of Medicine, Epidemiology, and
Biomedical Informatics, University of Pittsburgh
                                         38 

 
Amy E. Metroka, Director, New York City, Bureau of Immunization, Citywide
Immunization Registry (CIR), phone 212-676-2319

Erin O’Connell, Miami-Dade County Health Department, phone 305-470-5660

Bobby Rasulnia, LT USPHS, PhD, MPA, MPH, CHES, Senior Research Scientist,
Immunization Information Systems Support Branch, National Center for Immunization
and Respiratory Diseases, CDC, phone 404-639-6246

Abigail Shefer, NCIRD, OID, CDC, email ams7@cdc.gov

Sharon A. Silvestri, RN, Chief, Infectious Diseases Program, ACHD

Shirley J. Slagy, RN, Public Health Nurse Supervisor, Infectious Diseases Program,
ACHD

Heather Stafford, Immunization Program Manager, Pennsylvania Department of Health,
phone 717-787-5681

Carol A. Stanwyck, NCIRD, OID, CDC, phone 404-639-8308

Susanne Thomas, RN, M.ED., Public Health Administrator, Immunization Project,
ACHD

Ronald E. Voorhees, MD, MPH, Chief, Office of Epidemiology and Biostatistics, ACHD

Don Weiss, MD. MPH, Director of Surveillance, Bureau of Communicable Disease, New
York City Department of Health and Mental Hygiene, New York, phone 212-227-5333

Christine Weltmer, Administrative Assistant, Division of Immunizations, Pennsylvania
Department of Health, phone 717-787-5681

Karen Wooten, MA, Project Officer, CDC, phone 404-639-8343

Rose Yakopcic, Director, Allegheny Intermediate Unit

Janet Yuhasz, M.ED., Office of Student Services, Student Assistance Program,
Pittsburgh Public Schools

 
 




                                          39 

 
Thank you to the school professionals at Pittsburgh Public Schools and the Allegheny
Intermediate Unit (AIU) for participating in completing a survey either hard copy or
online. In addition thank you to the AIU for forming a task force to discuss the survey via
teleconference.

                              AIU Task Force Volunteers

Clairton City School District
CherylAnn Blosl
phone 412 233-9200 ext. 1124; email bloslc@clairton.k12.pa.us

Deer Lakes School District
Angelo Furiga, Director of Technology
Karen Meinert, MSN, RN
Phone 724-265-5300 ex: 2656 (Angelo); phone 724-265-5300 x3681 (Karen)
Email afuriga@dlsd.k12.pa.us; kmeinert@dlsd.k12.pa.us

Gateway School District, Monroeville
Fran Stewart, Manager, Student Information
Phone 412-858-1068; email fstewart@gatewayk12.org

North Hills School District
Mischelle Grubbs, Instructional Technology Coordinator
Phone: 412.318.1011; email GrubbsM@nhsd.net

West Jefferson Hills School District
Joanne DiMattia, School Nurse, elementary school
Email jdimatti@wjhsd.net
Pleasant Hills Middle School
Joan Perry RN
Phone 412-655-8680 ext 7229; email jsperry@wjhsd.net

West Mifflin Area School District
Joel Tachoir, Director of Technology
Email tachoirj@wmasd.org




                                            40 

 
                                     References

Besculides M, Heffernan R, Mostashari F, Weiss D. Evaluation of school absenteeism
data for early outbreak detection, New York City. BMC Public Health. 2005;5:105.

Centers for Disease Control and Prevention. Immunization Information Systems (IIS).
http://www.cdc.gov/vaccines/programs/iis/default.htm accessed 24May2010.

Monterey County Health Department. Student Absenteeism Surveillance 2009-2010
School Year. Public Health Bureau Surveillance and Preparedness Branch. May 28,
2010.

Pennsylvania Department of Health. PA Statewide Immunization Information System.
http://www.portal.state.pa.us/portal/server.pt/community/pa_statewide_immunization_inf
ormation_system_%2528pa-siis%2529/14281 accessed 24May2010

Rodriguez D, Zhang G, Leguen F, O'Connell E, Bustamante M. Using Public School
Absentee Data to Enhance Syndromic Surveillance in Miami-Dade County, 2007.
Advances in Disease Surveillance. 2007;4:188.

Shen S , Stone N, Hatch B, Rolfs R, South B, Gundlapalli A, Staes C, Samore M. Pilot
Evaluation of Syndrome-Specific School Absenteeism Data for Public Health
Surveillance. Advances in Disease Surveillance 2008;5:61.




                                          41 

 
APPENDIX A
                                        ALLEGHENY COUNTY HEALTH DEPARTMENT
                                        SCHOOL IMMUNIZATION REPORT SUMMARY


         School District                                                    Circle if:     New address    New school

                                                                                           School is closed
         School Name

         School Address

         Report Prepared by                                                       Date
                                      (First and Last Name)
         Telephone                                                                Fax:

         Days available                                                           Email:

         ENTER THE NUMBER OF STUDENTS BY GRADE FOR EACH CATEGORY


             GRADE         A.             *B.               *C.             *D.           *E.             F.            G.
             LEVEL     NUMBER WITH    NUMBER WITH         NUMBER      NUMBER WITH       NUMBER          TOTAL    TOTAL STUDENTS
                        COMPLETE        MEDICAL         HOME/CYBER   RELIGIOUS/MORAL PROVISIONALLY    STUDENTS        DENIED
                      IMMUNIZATIONS   EXEMPTIONS         SCHOOLED      EXEMPTIONS      ENROLLED       ENROLLED      ADMISSION/
                                                                                                                   ATTENDANCE


               K

               1

               2

               3

               4

               5

               6

               7

               8

               9

              10

              11

              12




             Totals

         Report Summary due: October 15, 2009                                       Mail or fax to:
                             April 15, 2010                                         Allegheny County Health Department:
                                                                                    Infectious Diseases Program
                                                                                    3441 Forbes Avenue
                                                                                    Pittsburgh PA 15213
                                                                                    Fax: (412) 578-8300
                                                                                    Phone: (412) 578-8060 (option 3)
         *Information requested on the Immunization Report
          Worksheet must be included for each student in these
          categories.
                                                                                                                                                                                                                                                            APPENDIX B
                              IMMUNIZATION REPORT WORKSHEET

School District                              School Name:                                                                                                   Address:

Report Prepared By:                                                                             Date:                                                                       Phone:

Fax:                                           Email:
                                                                                                                                                                            Worksheets Due:                                    January 15, 2010
Days available at School:

                                                   Missing Immunizations- Check all that apply
        BIRTH   NAME        ZIP    EXEMPTIONS                                                                                                                                                                                COMMENTS/REMARKS
                                   CHECK ONE
        DATE                CODE




                                                                                                                                                                            1

                                                                                                                                                                                        2
                                                                                                                                                                                                                             Examples:




                                                                    1

                                                                               2

                                                                                          3

                                                                                                     4




                                                                                                                                                                                                                MENINGITIS
                                                                                                                                                                            VARICELLA

                                                                                                                                                                                        VARICELLA
                                             SCHOOLED

                                                         SCHOOLED
                                             RELIGIOUS
                                                                                                                                                                                                                                                    st
                                                                                                                                                                                                                             MMR or Varicella before 1 BD




                                                                                                                1

                                                                                                                        2

                                                                                                                                3




                                                                                                                                                    1

                                                                                                                                                            2

                                                                                                                                                                    3
                                                                    DIPH/TET

                                                                               DIPH/TET

                                                                                          DIPH/TET

                                                                                                     DIPH/TET
                                   MEDICAL
GRADE




                                                                                                                                        1

                                                                                                                                              2
                                             MORAL



                                                         CYBER




                                                                                                                                                                                                                (MCV4)
                                                                                                                                                                                                                             Intervals too short




                                                                                                                POLIO

                                                                                                                        POLIO

                                                                                                                                POLIO




                                                                                                                                                    HEP B

                                                                                                                                                            HEP B

                                                                                                                                                                    HEP B
                                             HOME




                                                                                                                                        MMR

                                                                                                                                              MMR




                                                                                                                                                                                                    Tdap
                                                                                                                                                                                                                                              th
                                                                                                                                                                                                                             Needs D/T after 4 BD




                                                                                                                                                                                                           Td
  GRADE




                                                                                  DATE
                                                                                  BIRTH
                                                                                  ZIP       NAME
                                                                                  CODE




  MEDICAL

  RELIGIOUS
                                                                                        CHECK ONE
                                                                                        EXEMPTIONS




  MORAL
  HOME
  SCHOOLED
  CYBER
  SCHOOLED
  DIPH/TET                                                                  1

  DIPH/TET                                                                  2

  DIPH/TET                                                                  3

  DIPH/TET                                                                  4

  POLIO                                                 1

  POLIO                                                 2

  POLIO                                                 3

  MMR                                        1

  MMR                                        2

  HEP B                                               1

  HEP B                                               2

  HEP B                                               3

  VARICELLA                                                                             1

  VARICELLA                                                                             2

  Tdap

  Td

  MENINGITIS
  (MCV4)
                                                                            Examples:



            th
                       Intervals too short
Needs D/T after 4 BD
                                                                                            COMMENTS/REMARKS


                                                              st
                                             MMR or Varicella before 1 BD
APPENDIX C
                                                                                                                                                                                                 5/25/2010
                                                                                                                                                                                                             APPENDIX D




                                                                            Pennsylvania Department of Health
                                                                            School Immunization Report System
                                                                 Immunization Summary by County both Public and Private Schools
                                                                                  School Year : 2007 - 2008
 County:        02 - Allegheny

                          Total       DT        DT      Polio      MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                        Students   3 doses   4 doses   3 doses    2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
Grade Section           Enrolled   or more   or more   or more    or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

Kindergarten              14,513        0    12,515    12,892     12,144    12,834                 8,739       6,320          0        0        0        67       156        1,207           5
    Percent:                         0.00%    86.23%    88.83%     83.68%    88.43%                60.21%      43.55%      0.00%    0.00%    0.00%     0.46%     1.07%        8.32%

7th Grade                 15,444   14,480         0    14,604     14,573    14,576                12,960       1,156      4,326    3,604    1,826        53       106          334           0
     Percent:                       93.76%     0.00%    94.56%     94.36%    94.38%                83.92%       7.49%     28.01%   23.34%   11.82%     0.34%     0.69%        2.16%


    Totals:          29,957 14,480       12,515        27,496     26,717    27,410                21,699       7,476      4,326    3,604    1,826       120       262        1,541           5
    Percent:                    48.34%    41.78%        91.78%     89.18%    91.50%                72.43%      24.96%     14.44%   12.03%    6.10%     0.40%     0.87%        5.14%
     Number of schools reporting:    447
                                                                                                                                                                                                5/25/2010

                                                                           Pennsylvania Department of Health
                                                                           School Immunization Report System
                                                                       Immunization Summary by County - Private Schools
                                                                                   School Year : 2007 - 2008
 County:        02 - Allegheny

                          Total       DT        DT      Polio     MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                        Students   3 doses   4 doses   3 doses   2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
Grade Section           Enrolled   or more   or more   or more   or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

Kindergarten               2,842        0    2,656     2,726     2,450      2,695                 1,685       1,307          0        0        0        15        40          364           2
    Percent:                         0.00%    93.46%    95.92%    86.21%    94.83%                59.29%      45.99%     0.00%    0.00%    0.00%      0.53%     1.41%       12.81%

7th Grade                  2,195   2,111          0    2,161     2,151      2,151                 1,815         261       711      419      356         10        27           47           0
     Percent:                       96.17%     0.00%    98.45%    98.00%    98.00%                82.69%      11.89%     32.39%   19.09%   16.22%     0.46%     1.23%        2.14%


    Totals:            5,037    2,111     2,656        4,887     4,601      4,846                 3,500       1,568       711      419      356         25        67          411           2
    Percent:                    41.91%    52.73%        97.02%    91.34%    96.21%                69.49%      31.13%     14.12%   8.32%    7.07%      0.50%     1.33%        8.16%
     Number of schools reporting:     191
                                                                                                                                                                                                   5/25/2010

                                                                              Pennsylvania Department of Health
                                                                              School Immunization Report System
                                                                           Immunization Summary by County - Public Schools
                                                                                      School Year : 2007 - 2008
 County:        02 - Allegheny

                          Total       DT        DT      Polio     MMR          Hep B    Varicella                                                      Number    Number        Number       Number
                        Students   3 doses   4 doses   3 doses   2 doses      3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
Grade Section           Enrolled   or more   or more   or more   or more      or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

Kindergarten              11,671        0    9,859     10,166     9,694       10,139                 7,054       5,013          0        0        0        52       116          843           3
    Percent:                         0.00%    84.47%    87.10%    83.06%       86.87%                60.44%      42.95%      0.00%    0.00%    0.00%     0.45%     0.99%        7.22%

7th Grade                 13,249   12,369         0    12,443    12,422       12,425                11,145         895      3,615    3,185    1,470        43        79          287           0
     Percent:                       93.36%     0.00%    93.92%    93.76%       93.78%                84.12%       6.76%     27.29%   24.04%   11.10%     0.32%     0.60%        2.17%


    Totals:          24,920 12,369       9,859         22,609    22,116       22,564                18,199       5,908      3,615    3,185    1,470        95       195        1,130           3
    Percent:                    49.63%   39.56%         90.73%    88.75%       90.55%                73.03%      23.71%     14.51%   12.78%    5.90%     0.38%     0.78%        4.53%
     Number of schools reporting:    256
                                                                                                                                                                                                 5/25/2010

                                                                            Pennsylvania Department of Health
                                                                            School Immunization Report System
                                                                 Immunization Summary by County both Public and Private Schools
                                                                                  School Year : 2008 - 2009
 County:        02 - Allegheny

                          Total       DT        DT      Polio      MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                        Students   3 doses   4 doses   3 doses    2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
Grade Section           Enrolled   or more   or more   or more    or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

Kindergarten              13,210        0    12,048    12,712     11,706    12,608                 6,304      11,106          0        0        0        55       197        1,968           8
    Percent:                         0.00%    91.20%    96.23%     88.61%    95.44%                47.72%      84.07%      0.00%    0.00%    0.00%     0.42%     1.49%       14.90%

7th Grade                 13,950   13,478         0    13,489     13,444    13,265                 8,733       7,962      8,046    2,046    7,957        46       135        2,919           4
     Percent:                       96.62%     0.00%    96.70%     96.37%    95.09%                62.60%      57.08%     57.68%   14.67%   57.04%     0.33%     0.97%       20.92%


    Totals:          27,160 13,478       12,048        26,201     25,150    25,873                15,037      19,068      8,046    2,046    7,957       101       332        4,887          12
    Percent:                    49.62%    44.36%        96.47%     92.60%    95.26%                55.36%      70.21%     29.62%    7.53%   29.30%     0.37%     1.22%       17.99%
     Number of schools reporting:    439
                                                                                                                                                                                                5/25/2010

                                                                           Pennsylvania Department of Health
                                                                           School Immunization Report System
                                                                       Immunization Summary by County - Private Schools
                                                                                   School Year : 2008 - 2009
 County:        02 - Allegheny

                          Total       DT        DT      Polio     MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                        Students   3 doses   4 doses   3 doses   2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
Grade Section           Enrolled   or more   or more   or more   or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

Kindergarten               2,698        0    2,408     2,507     2,223      2,490                   987       2,087          0        0        0        15        55          459           2
    Percent:                         0.00%    89.25%    92.92%    82.39%    92.29%                36.58%      77.35%      0.00%   0.00%     0.00%     0.56%     2.04%       17.01%

7th Grade                  2,103   2,039          0    2,043     2,034      2,037                 1,021       1,296      1,320     267     1,257         5        27          399           2
     Percent:                       96.96%     0.00%    97.15%    96.72%    96.86%                48.55%      61.63%     62.77%   12.70%   59.77%     0.24%     1.28%       18.97%


    Totals:            4,801    2,039     2,408        4,550     4,257      4,527                 2,008       3,383      1,320     267     1,257        20        82          858           4
    Percent:                    42.47%    50.16%        94.77%    88.67%    94.29%                41.82%      70.46%     27.49%   5.56%    26.18%     0.42%     1.71%       17.87%
     Number of schools reporting:     180
                                                                                                                                                                                                   5/25/2010

                                                                              Pennsylvania Department of Health
                                                                              School Immunization Report System
                                                                           Immunization Summary by County - Public Schools
                                                                                      School Year : 2008 - 2009
 County:        02 - Allegheny

                          Total       DT        DT      Polio     MMR          Hep B    Varicella                                                      Number    Number        Number       Number
                        Students   3 doses   4 doses   3 doses   2 doses      3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
Grade Section           Enrolled   or more   or more   or more   or more      or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

Kindergarten              10,512        0    9,640     10,205     9,483       10,118                 5,317       9,019          0        0        0        40       142        1,509           6
    Percent:                         0.00%    91.70%    97.08%    90.21%       96.25%                50.58%      85.80%      0.00%    0.00%    0.00%     0.38%     1.35%       14.36%

7th Grade                 11,847   11,439         0    11,446    11,410       11,228                 7,712       6,666      6,726    1,779    6,700        41       108        2,520           2
     Percent:                       96.56%     0.00%    96.62%    96.31%       94.78%                65.10%      56.27%     56.77%   15.02%   56.55%     0.35%     0.91%       21.27%


    Totals:          22,359 11,439       9,640         21,651    20,893       21,346                13,029      15,685      6,726    1,779    6,700        81       250        4,029           8
    Percent:                    51.16%   43.11%         96.83%    93.44%       95.47%                58.27%      70.15%     30.08%    7.96%   29.97%     0.36%     1.12%       18.02%
     Number of schools reporting:    259
                                                                                                                                                                                                   5/25/2010

                                                                            Pennsylvania Department of Health
                                                                            School Immunization Report System
                                                                 Immunization Summary by County both Public and Private Schools
                                                                                  School Year : 2009 - 2010
 County:        02 - Allegheny

                          Total       DT        DT      Polio      MMR       Hep B    Varicella                                                        Number    Number        Number       Number
                        Students   3 doses   4 doses   3 doses    2 doses   3 doses     Had       Varicella   Varicella     Tdap      Td      MCV      Medical   Religious     Enrolled     Denied
Grade Section           Enrolled   or more   or more   or more    or more   or more   Disease      1 dose      2 doses     1 dose   1 dose    1 dose   Exempt     Exempt     Provisionally Admission

Kindergarten              13,602        0    12,712    13,004     12,403    12,950      235        5,971      12,234           0        0         0        88       220        1,301           2
    Percent:                         0.00%    93.46%    95.60%     91.19%    95.21%    1.73%       43.90%      89.94%       0.00%    0.00%     0.00%     0.65%     1.62%        9.56%

7th Grade                 13,541   13,414         0    13,417     13,373    13,377    1,678        4,508      11,877      12,244    2,046    12,528        82       212          559          13
     Percent:                       99.06%     0.00%    99.08%     98.76%    98.79%   12.39%       33.29%      87.71%      90.42%   15.11%    92.52%     0.61%     1.57%        4.13%


    Totals:          27,143 13,414       12,712        26,421     25,776    26,327    1,913       10,479      24,111      12,244    2,046    12,528       170       432        1,860          15
    Percent:                    49.42%    46.83%        97.34%     94.96%    96.99%    7.05%       38.61%      88.83%      45.11%    7.54%    46.16%     0.63%     1.59%        6.85%
     Number of schools reporting:    452
                                                                                                                                                                                                5/25/2010

                                                                           Pennsylvania Department of Health
                                                                           School Immunization Report System
                                                                       Immunization Summary by County - Private Schools
                                                                                   School Year : 2009 - 2010
 County:        02 - Allegheny

                          Total       DT        DT      Polio     MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                        Students   3 doses   4 doses   3 doses   2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
Grade Section           Enrolled   or more   or more   or more   or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

Kindergarten               2,696        0    2,441     2,500     2,305      2,499        95         909       2,222          0        0        0        19        67          360           0
    Percent:                         0.00%    90.54%    92.73%    85.50%    92.69%    3.52%       33.72%      82.42%      0.00%   0.00%     0.00%     0.70%     2.49%       13.35%

7th Grade                  2,142   2,092          0    2,093     2,080      2,087      168          523       1,843      1,793     244     1,857        20        55           74           0
     Percent:                       97.67%     0.00%    97.71%    97.11%    97.43%    7.84%       24.42%      86.04%     83.71%   11.39%   86.69%     0.93%     2.57%        3.45%


    Totals:            4,838    2,092     2,441        4,593     4,385      4,586      263        1,432       4,065      1,793     244     1,857        39       122          434           0
    Percent:                    43.24%    50.45%        94.94%    90.64%    94.79%    5.44%       29.60%      84.02%     37.06%   5.04%    38.38%     0.81%     2.52%        8.97%
     Number of schools reporting:     185
                                                                                                                                                                                                     5/25/2010

                                                                              Pennsylvania Department of Health
                                                                              School Immunization Report System
                                                                           Immunization Summary by County - Public Schools
                                                                                      School Year : 2009 - 2010
 County:        02 - Allegheny

                          Total       DT        DT      Polio     MMR          Hep B    Varicella                                                        Number    Number        Number       Number
                        Students   3 doses   4 doses   3 doses   2 doses      3 doses     Had       Varicella   Varicella     Tdap      Td      MCV      Medical   Religious     Enrolled     Denied
Grade Section           Enrolled   or more   or more   or more   or more      or more   Disease      1 dose      2 doses     1 dose   1 dose    1 dose   Exempt     Exempt     Provisionally Admission

Kindergarten              10,906        0    10,271    10,504    10,098       10,451      140        5,062      10,012           0        0         0        69       153          941           2
    Percent:                         0.00%    94.18%    96.31%    92.59%       95.83%    1.28%       46.41%      91.80%       0.00%    0.00%     0.00%     0.63%     1.40%        8.63%

7th Grade                 11,399   11,322         0    11,324    11,293       11,290    1,510        3,985      10,034      10,451    1,802    10,671        62       157          485          13
     Percent:                       99.32%     0.00%    99.34%    99.07%       99.04%   13.25%       34.96%      88.03%      91.68%   15.81%    93.61%     0.54%     1.38%        4.25%


    Totals:          22,305 11,322       10,271        21,828    21,391       21,741    1,650        9,047      20,046      10,451    1,802    10,671       131       310        1,426          15
    Percent:                    50.76%    46.05%        97.86%    95.90%       97.47%    7.40%       40.56%      89.87%      46.85%    8.08%    47.84%     0.59%     1.39%        6.39%
     Number of schools reporting:    267
APPENDIX E




                                                               Monterey County Health Department
                                                                       Public Health Bureau
                                                               Surveillance and Preparedness Branch
      1270 Natividad Road                                                                                        831.755.4521
      Salinas, CA 93906                                                                                     Fax: 831.754.6682


                                                                Student Absenteeism Surveillance
                                                                     2009-2010 School Year
      Report Date: May 28, 2010

      Beginning this school year, the Health Department enhanced its school surveillance efforts by
      collecting more detailed information from a few key, or sentinel, schools. Thirteen schools were
      selected as sentinel sites based on geographic location, student demographics, and/or
      participation in last year’s surveillance program. These schools represent approximately 9% of
      the public schools in Monterey County.

      For the school week of May 17th, 23% of sentinel sites reported absenteeism information to the
      Health Department. Reported absences were due to:

                                                                             Percent of Total Student Population
                                             Symptoms
                                                                           (Daily Average for the Reporting Week)1
                                             Influenza-Like Illness                         0.3%
                                             Varicella (Chickenpox)                         0.0%
                                             Gastrointestinal Illness                       0.2%
                                             Other                                          1.6%
                                             Unknown                                        0.4%
                                             All Causes                                     2.5%


                                    14                                Proportion of Students Absent
                                                                    from Sentinel Schools Each Day:
                                    12
                                                                         2009-2010 School Year
          Percent of Students




                                    10
                                Absent




                                         8

                                         6

                                         4

                                         2

                                         0
                              09




                       12 9



                              09

                              09
                      11 09




                               0




                               0
                               9




                               9

                               9




                               0

                               0




                               0
                               9




                      12 09




                               0
                       9/ 9




                       2/ 0




                       3/ 0




                       4/ 0




                       5/ 0
                              0
                            /0

                            /0




                            /1




                            /1




                            /1
                            /0

                            /0




                            /1

                            /1




                            /1
                             0




                             1




                             1




                             1
                             1
                           7/
                           0/




                           5/

                           9/
                            /




                            /
                           8/




                           9/




                           9/




                           4/
                           6/
                         11

                         25




                         22




                          /3




                          /1




                         12




                         23




                         23




                         18
                          /6




                         26




                         20
                        /1




                        /1

                        /2
                        /2
                        9/




                        2/




                        3/




                        4/




                        5/
                       10




                       11
                       8/

                       8/




                       1/

                       1/
                      10




                      12




                                                                  Influenza-Like Illness              All Causes
      Note: Days without data are due to school closures during the holiday season.

      If you have questions about the student absenteeism surveillance program or this report, please
      contact the Communicable Disease Unit at 831-755-4521.

      1
       Average percentages are based on the total student population and not the absent student population. Average
      percentages for individual illnesses will not sum to the average percentage for all causes.
APPENDIX F


1. Responder General Information

The Allegheny County Health Department appreciates your time to provide input into the development of
a plan to implement electronic submission of school-level absentee and child-level vaccination reporting.

There are a total of 24 questions in this survey. The estimated average time to complete this survey is
15 minutes.

This first section of the survey is gathering general information about the survey responder.

For any questions or comments regarding this survey, please contact:
Amanda Niskar, BSN, MPH, DrPH
Project Coordinator
Allegheny County Health Department
asniskar@gmail.com
770-630-8350 (mobile)


 * 1. What school district do you work in?
                                          5
                                          6

 * 2. What is the name of the school where you work?
                                          5
                                          6

 * 3. What is your role at your school district?
     k
     l
     m
     n
     j   Administrator


     l
     m
     n
     j
     k   Attendance Officer


     l
     m
     n
     j
     k   Clerk


     k
     l
     m
     n
     j   Computer Teacher


     k
     l
     m
     n
     j   Information Technologist


     l
     m
     n
     j
     k   School Nurse


     k
     l
     m
     n
     j   Other




                                                                                                Page 1
2. Immunizations

Every school district in Allegheny County is required to report immunization data to the Allegheny County
Health Department (ACHD) three times a year. The current data submission process involves completing
hard copy forms. To improve timeliness and data quality, schools and the ACHD would benefit from
development of an electronic system.

This second section of the survey is seeking your input regarding immunization status monitoring
options.


* 4. Please review the 2009-2010 School Year School Immunization Report
   Summary. Are there any changes that you suggest to make the data
   collection more accurate, easier, or useful for your school and your school
   district?

     c
     d
     e
     f
     g   Yes


     d
     e
     f
     g
     c   No


     d
     e
     f
     g
     c   Don't Know



   5. If you answered yes to the previous question, please describe your
   suggested changes for the 2009-2010 School Year School Immunization
   Report Summary.
                                         5
                                         6

* 6. Please review the 2009-2010 Immunization Report Worksheet. Are there
   any changes that you suggest to make the data collection more accurate,
   easier, useful for your school or your school district?
     k
     l
     m
     n
     j   Yes


     j
     k
     l
     m
     n   No


     k
     l
     m
     n
     j   Don't Know



   7. If you answered yes to the previous question, please describe your
   suggested changes for the 2009-2010 School Year School Immunization
   Report Worksheet.
                                         5
                                         6




                                                                                              Page 2
* 8. Who completes these forms at your school or district? You may select one
  or more of the below categories.
   c
   d
   e
   f
   g   Administrator


   c
   d
   e
   f
   g   Clerk


   d
   e
   f
   g
   c   School Nurse


   d
   e
   f
   g
   c   Teacher


   c
   d
   e
   f
   g   Other


   c
   d
   e
   f
   g   Don't Know



* 9. Did your school or district receive training or guidance for completing
  these forms?

   j
   k
   l
   m
   n   Yes


   k
   l
   m
   n
   j   No


   j
   k
   l
   m
   n   Don't Know



  10. Please describe any training suggestions that you may have.
                                5
                                6

* 11. ACHD is exploring options for developing a secure web-based data
  entry system to replace the existing School Year School Immunization
  Report Summary and the Immunization Report Worksheet paper system.
  Are there any barriers to your school or district participating in such a
  system?
   j
   k
   l
   m
   n   Yes


   k
   l
   m
   n
   j   No


   j
   k
   l
   m
   n   Don't Know



  12. If you responded yes to previous question, please describe the barriers
  and provide suggestions to minimize the barriers.
                                5
                                6




                                                                         Page 3
* 13. Does your school or district have an existing electronic system collecting
  student immunization status data?
   j
   k
   l
   m
   n   Yes


   j
   k
   l
   m
   n   No


   j
   k
   l
   m
   n   Don't Know



  14. If you responded yes to the previous question, what software is your
  school or district using? Please write don't know if you don't know.
                                5
                                6




                                                                        Page 4
3. Absenteeism

During the H1N1 pandemic, Allegheny County Health Department and School officials found school-level
absentee reporting to be an important tool in identifying, monitoring and controlling outbreaks.
Developing a voluntary electronic reporting system for school-level absentee information would be an
important tool for protecting public health in Allegheny County. The information resulting from this
system would provide important information to officials considering mitigation measures.

This third section of the survey seeks your input regarding absenteeism monitoring options.


* 15. Does your school or district monitor absenteeism?
     k
     l
     m
     n
     j   Yes


     j
     k
     l
     m
     n   No


     k
     l
     m
     n
     j   Don't Know



   16. If you responded yes to the previous question, is the reason for the
   absence documented?
     k
     l
     m
     n
     j   Yes


     j
     k
     l
     m
     n   No


     k
     l
     m
     n
     j   Don't Know



   17. If you responded yes to the previous question, please list the categories
   for the reason of absence.
                                         5
                                         6

* 18. ACHD is exploring options for developing a secure web-based data
   entry system to monitor absenteeism. Are there any barriers to your school
   or district participating in such a system?

     j
     k
     l
     m
     n   Yes


     k
     l
     m
     n
     j   No


     j
     k
     l
     m
     n   Don't Know



   19. If you responded yes to the previous question, please describe the
   barriers and provide suggestions to minimize the barriers.
                                         5
                                         6




                                                                                              Page 5
  20. Does your school or district have an existing electronic system collecting
  student absenteeism data?
   j
   k
   l
   m
   n   Yes


   k
   l
   m
   n
   j   No


   j
   k
   l
   m
   n   Don't Know



  21. If you responded yes to the previous question, what software is your
  school or district using? Write don't know if you don't know.
                                  5
                                  6

* 22. Please select the one or more absence categories that you believe your
  school or district could identify when collecting absenteeism data.
   c
   d
   e
   f
   g   Gastrointestinal illness


   d
   e
   f
   g
   c   Influenza-like illness


   c
   d
   e
   f
   g   Rash


   d
   e
   f
   g
   c   Respiratory


   c
   d
   e
   f
   g   Varicella


   d
   e
   f
   g
   c   Other


   d
   e
   f
   g
   c   Unknown


   c
   d
   e
   f
   g   None



  23. If your school or district would find value in monitoring absence
  categories not listed in the previous question, please list the proposed
  categories here.
                                  5
                                  6




                                                                        Page 6
4. Dissemination

Allegheny County Health Department (ACHD) thanks you for your time to provide input into the
development of a plan to implement electronic submission of school-level absentee and child-level
vaccination reporting to ACHD.

This final section of the survey seeks your input regarding dissemination of data collected.


* 24. Would your school or district find value in receiving a summary
   immunization and absenteeism report from ACHD after the data collection
   and analyses are complete?

     j
     k
     l
     m
     n   Yes


     k
     l
     m
     n
     j   No


     k
     l
     m
     n
     j   Don't Know




                                                                                               Page 7
Page 8
 


           List of Schools Represented in Survey Responses

    *Note: Not all respondents documented the school(s) they represent.

    pgh.arsenal 6-8, pgh.arsenal k-5, pgh vann k-5
    Avonworth MS & HS
    Avonworth Elementary School
    Baldwin High School
    ACLD Tillotson School
    Minadeo -- Mifflin, Colfox
    Carrick High
    Peabody High School
    Grandview, et al.
    Brashfar High School
    Pioneer
    OBlock Jr High, Adlai Stevenson Elem
    Plum Senior High School
    Greenfield, Pglo, Mont., St Bede, Ammac. Conc.
    David F. Williams
    Dormont Elementary, Alken Elementary, St Margaret of Scotland
    Ingram
    Forest Grove
    High School
    Ft Pitt, ALA, Student Achievement Center
    South Brook Middle School
    Liberty, Fulton, Sacred Heart, Kentucky Ave School, Pittsburgh New Church
    School
    Sto-Rox Elementary
    Moon Area High School
    Moon Middle School
    Bon Meade Elementary, Allard Elementary
    Sto-Rox HS, MS, Icover, St John of God
    Morrow, Rooney, Northview Ht
    Friendship Academy
    West Mifflin Middle
    Friendship Academy
    Pace School
    Homeville Elementary
    Centennial
    White Oak Elementary
    George Washington, Founders Hall
    Clayton Academy
    Obama
                                             73 

 
    Pittsburgh CAPA
    Pittsburgh Carrick High
    Murray ALA
    Roosevelt
    Carlow Campus School
    rooney
    northview heights
    John morrow
    Westwood k-8, Pittsburgh Classical Academy 6-8,Canevin High School 9 - 12
    Oliver
    Pittsburgh Perry High School
    Allegheny Traditional Academy Elem School. Manchester School K-8
    Greater Allen Christian School
    St. Cyrils
    WESTINGHOUSE
    LINCOLN INTERMEDIATE
    LINCOLN PRIMARY
    Presently work at the admin bldg
    NORTH HILLS SR HIGH
    Carmalt
    Pittsburgh Science and Technology Academy
    Helen S. Faison Primary
    Helen S. Faison Intermediate
    University Prep Academy at Milliones
    sunnyside,linden, st. edmunds academy
    schiller/springhill/ north catholic/st benedict
    schiller/spring hill/north catholic/ st. benedict
    Sterrett
    South Hills, Concord, Brookline Reg Cath School
    Conroy Education Center
    Pittsburgh Public Schools




                                           74 

 
        Suggested Changes for the 2009-2010 School Year School Immunization
                                  Report Summary

       Do you really use the full address or would the zip code be sufficient?
       Eliminate addresses of students--burdensome and not useful.
       Computer program for reporting/county.
       Let information data collection inform nurse after admission.
       Put everything online.
       Change the provisionally enrolled column--they are either complete or not
        complete. We don't follow the cyber school students--they have their own
        school follow-up.
       Electronic--the state immunization PA Dept of health electronic report is
        easy to use.
       Should hire a nurse with research background to coordinate.
       Take out home schooled and cyber
       Sizeform
       Send an email when due and ask that it be filled out.
       Please send reminder email when due.
       Email to school 2x a year instead of 3x.
       No school enrollment without complete Immunizations.
       No exceptions for private schools.
       Hire someone to oversee it.
       Brief and online, replicating the requirements.
       Once electronic system is functioning have address and telephone, fax
        numbers in place.
       No access of data compiled from health/nurse's office.
       Most students are not denied admission/attend into school.
       We should receive some type of email alert from you a two weeks before
        reports are due.
       Entry of data into a central database.
       Survey exemption students for history of varicella disease.
       Do not require an update if students are complete.




                                              75 

 
     Suggested Changes for the 2009-2010 School Year School Immunization
                              Report Worksheet

   We do not have good information about # of home/cyber schooled students.
   Making worksheet 8 1/2 x 11 is easier to photocopy.
   Electronic report.
   More space.
   Electronic-similar to state immunization reporting.
   Exclude the address.
   Make it a rule that we can put students out -- they will get the shots.
   Electronic
   If addresses are needed hopefully we can copy and paste.
   Do you use the complete address or could it just be the zip code?
   Brief and online, replicating the requirements.
   Is there a better way to format it? So much data one page, not enough space to
    write in comments box.
   Our district should have a listing of all students, so that we can choose their name
    matched with BD/zip in order to expedite the reporting process. Once the school
    name is typed in, then the address, phone #, fax should come up automatically.
   If student's address/ contact information is desired there should be space to
    accommodate this information.
   Entry into central database.
   Survey exemption students for history of varicella disease.




                                            76 

 
                          Training Suggestions/Comments

   Review of forms and how to fill them out correctly.
   Need training.
   If you decide to make this data-base, we will need training.
   If data-based would like to receive training.
   Information technology staff should be trained in immunization requirements as they
    are the ones who enter data in our system.
   Instructions in the mailing from the ACHD are clear.
   Clear written instructions online or by mail would be enough.
   ProSoft.
   In-service.
   Classroom and individuals in schools.
   Email about it.
   Please have school nurse input (urban districts) make it user friendly and report
    friendly.
   Give adequate on site hands on training, be open to suggestions.
   None needed.
   Forms should be reviewed with new hires prior to their having to complete them.
   Should be a section in an employee orientation manual or procedure book with the
    district.




                                           77 

 
       Identified Barriers to an Electronic Immunization Surveillance System

   Computers are outdated and not compatible to a lot of programs.
   Non-public schools may not have computer access for nurses.
   Computers are out of date; time to put info in.
   No computer at my catholic school.
   Our computers are old, slow, and need to be updated.
   Time, skip the details—name the students and that will do.
   Computer shortage and very slow.
   Computers not at every school.
   Sometimes students who are current are listed as delinquent, and appear on the
    system as
    non-compliant.
   Lots of research available for buy in, if people using the program are a part the
    process.
   School nurse input to the system would be very helpful.
   Please make it user friendly not just report friendly.
   Adequate time and proper training to complete the report is extremely important.
   Lack of computer and what is available is antiquated.
   Private and parochial schools most often do not provide computer access for the
    nurse covering the school especially in the small schools.




                                           78 

 
                   Absenteeism Categories Monitored by Schools

   Illness
   Family outing
   Snow day
   Excused
   Unexcused, unverified
   Medical absence/excuse
   Virus, flu
   Appointment MD/dentist
   Expelled (EUE)
   Tardy
   No reason given
   No specific medical reason
   Cutting school
   Funeral
   Trip
   Approved or unapproved absence
   Educational trip/fieldtrip/school activity
   Illegal
   No specific medical reason
   Unauthorized
   In public school, social worker monitors absences--not school nurse
   Injury
   Homelessness
   Transfer awaiting transportation arrangements
   Asthma
   Diarrhea
   Vomiting
   Fever
   Death
   Religious holiday
   Court hearing




                                           79 

 
 


       Identified Barriers to an Electronic Absenteeism Surveillance System

   Computers outdated.
   No computer at Catholic school.
   ProSoft.
   Incapabilities between software.
   As school nurse, I would have this responsibility of contacting parents of absent
    children and I'm there 1 or 2 days per week. It's often difficult to contact parents and
    takes a lot of time! And I have mandated screenings to do (and episodic care).
   Who would input it? Do not always get information from the parents.
   Why not just use the states?
   Confidentiality.
   What is the purpose for monitoring this data?
   Consistent personnel tracking absenteeism.
   Qualified people doing tracking that could properly categorize.
   Lack of staff.
   Most are already maxed out with mundane responsibilities.
   Teachers enter data re: absenteeism into the data base. The nurse usually does not
    see this information. Most medical excuses just have the MD letterhead and the
    dates with no specifics indicated regarding type of illness.
   Inconsistencies in the district. Many schools in Pittsburgh unless it was able to
    merge with the attendance program that the nurse does not access only the
    counselor or social worker after the classroom teachers take attendance and enter
    into the computer




                                             80 

 
                Suggestions/Comments for Absenteeism Monitoring

   Are you aware the state collects this data? #s only. Sentinel school monoitoring?
   Privacy.
   Want documentation form MD.
   Data would be from the parent. Doctor almost never list a Dx on school excuse.
   Medical/dental appointment can be a category to monitor for excused absence.
   Medical absence only.
   “Excused” or “Unexcused” has consequences for court proceedings, fractures, etc.
   Possible I would find value.
   We could find out all of these by contacting parents of absent students.
   We only know if the parent shares the information.
   Only if parent calls the information to the school.
    Only if parent calls into school to supply this information
   No—put just immunization, then dropbox.
   Suspension, hospitalization, school refusal, schoman, eye infection, strep throat.
   Homelessness, headaches, epilepsy, diabetes, diarrhea, vomiting, fever.
   Wound, concussion/neuro/endocrinology/Hmbnd (specific)
   I would like to know the purpose of the data. Please share with us what the data will
    drive and who will be responsible to collect and follow up on the information
    collected?
   To my knowledge, there are no categories necessary for absentee notes…all of the
    listings would be helpful to the nurse for tracking illness and injuries.




                                            81 

 
                         The End




                       Prepared for
            Allegheny County Health Department


                   Agreement # 110868
    Agreement Time Period: March 15, 2010-June 30, 2010


                       Prepared by
             Amanda Niskar, BSN, MPH, DrPH
              Senior Public Health Consultant
                   asniskar@gmail.com




                           82 

 
                             ALLEGHENY COUNTY HEALTH DEPARTMENT
                             SCHOOL IMMUNIZATION REPORT SUMMARY


School District                                                  Circle if:     New address    New school

                                                                                School is closed
School Name

School Address

Report Prepared by                                                     Date
                           (First and Last Name)
Telephone                                                              Fax:

Days available                                                         Email:

ENTER THE NUMBER OF STUDENTS BY GRADE FOR EACH CATEGORY


 GRADE           A.            *B.               *C.             *D.           *E.             F.            G.
 LEVEL      NUMBER WITH    NUMBER WITH         NUMBER      NUMBER WITH       NUMBER          TOTAL    TOTAL STUDENTS
             COMPLETE        MEDICAL         HOME/CYBER   RELIGIOUS/MORAL PROVISIONALLY    STUDENTS        DENIED
           IMMUNIZATIONS   EXEMPTIONS         SCHOOLED      EXEMPTIONS      ENROLLED       ENROLLED      ADMISSION/
                                                                                                        ATTENDANCE


    K

    1

    2

    3

    4

    5

    6

    7

    8

    9

   10

   11

   12




  Totals

Report Summary due: October 15, 2009                                     Mail or fax to:
                    April 15, 2010                                       Allegheny County Health Department:
                                                                         Infectious Diseases Program
                                                                         3441 Forbes Avenue
                                                                         Pittsburgh PA 15213
                                                                         Fax: (412) 578-8300
                                                                         Phone: (412) 578-8060 (option 3)
*Information requested on the Immunization Report
 Worksheet must be included for each student in these
 categories.
                              IMMUNIZATION REPORT WORKSHEET

School District                              School Name:                                                                                                   Address:

Report Prepared By:                                                                             Date:                                                                       Phone:

Fax:                                           Email:
                                                                                                                                                                            Worksheets Due:                                    January 15, 2010
Days available at School:

                                                   Missing Immunizations- Check all that apply
        BIRTH   NAME Z       IP    EXEMPTIONS                                                                                                                                                                                COMMENTS/REMARKS
                                   CHECK ONE
        DATE                CODE




                                                                                                                                                                            1

                                                                                                                                                                                        2
                                                                                                                                                                                                                             Examples:




                                                                    1

                                                                               2

                                                                                          3

                                                                                                     4




                                                                                                                                                                                                                MENINGITIS
                                                                                                                                                                            VARICELLA

                                                                                                                                                                                        VARICELLA
                                             SCHOOLED

                                                         SCHOOLED
                                             RELIGIOUS
                                                                                                                                                                                                                                                    st
                                                                                                                                                                                                                             MMR or Varicella before 1 BD




                                                                                                                1

                                                                                                                        2

                                                                                                                                3




                                                                                                                                                    1

                                                                                                                                                            2

                                                                                                                                                                    3
                                                                    DIPH/TET

                                                                               DIPH/TET

                                                                                          DIPH/TET

                                                                                                     DIPH/TET
                                   MEDICAL
GRADE




                                                                                                                                        1

                                                                                                                                              2
                                             MORAL



                                                         CYBER




                                                                                                                                                                                                                (MCV4)
                                                                                                                                                                                                                             Intervals too short




                                                                                                                POLIO

                                                                                                                        POLIO

                                                                                                                                POLIO




                                                                                                                                                    HEP B

                                                                                                                                                            HEP B

                                                                                                                                                                    HEP B
                                             HOME




                                                                                                                                        MMR

                                                                                                                                              MMR




                                                                                                                                                                                                    Tdap
                                                                                                                                                                                                                                              th
                                                                                                                                                                                                                             Needs D/T after 4 BD




                                                                                                                                                                                                           Td
    GRADE




                                                                                DATE
                                                                                BIRTH
                                                                                 IP       NAME Z
                                                                                CODE




    MEDICAL

    RELIGIOUS
                                                                                        CHECK ONE
                                                                                        EXEMPTIONS




    MORAL
    HOME
    SCHOOLED
    CYBER
    SCHOOLED
    DIPH/TET                                                                1

    DIPH/TET                                                                2

    DIPH/TET                                                                3

    DIPH/TET                                                                4

    POLIO                                              1

    POLIO                                              2

    POLIO                                              3

    MMR                                      1

    MMR                                      2

    HEP B                                             1

    HEP B                                             2

    HEP B                                             3

    VARICELLA                                                                       1

    VARICELLA                                                                      2

    Tdap

    Td

    MENINGITIS
    (MCV4)
                                                                            Examples:



         th
                       Intervals too short
Needs D/T after 4 BD
                                                                                          COMMENTS/REMARKS


                                                          st
                                             MMR or Varicella before 1 BD
Reports                                                                                                       file:///C:/Documents%20and%20Settings/tforgrave/Desktop/LandoFiles/Absentee%20and%20...




                                                                                                                                                                                                           5/25/2010

                                                                                      Pennsylvania Department of Health
                                                                                      School Immunization Report System
                                                                           Immunization Summary by County both Public and Private Schools
                                                                                            School Year : 2007 - 2008
           County:        02 - Allegheny

                                    Total       DT        DT      Polio      MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                                  Students   3 doses   4 doses   3 doses    2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
          Grade Section           Enrolled   or more   or more   or more    or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

          Kindergarten              14,513        0    12,515    12,892     12,144    12,834                 8,739       6,320          0        0        0        67       156        1,207           5
              Percent:                         0.00%    86.23%    88.83%     83.68%    88.43%                60.21%      43.55%      0.00%    0.00%    0.00%     0.46%     1.07%        8.32%

          7th Grade                 15,444   14,480         0    14,604     14,573    14,576                12,960       1,156      4,326    3,604    1,826        53       106          334           0
               Percent:                       93.76%     0.00%    94.56%     94.36%    94.38%                83.92%       7.49%     28.01%   23.34%   11.82%     0.34%     0.69%        2.16%


              Totals:          29,957 14,480       12,515        27,496     26,717    27,410                21,699       7,476      4,326    3,604    1,826       120       262        1,541           5
              Percent:                    48.34%    41.78%        91.78%     89.18%    91.50%                72.43%      24.96%     14.44%   12.03%    6.10%     0.40%     0.87%        5.14%
               Number of schools reporting:    447




1 of 2                                                                                                                                                                                                  6/29/2010 12:54 PM
Reports                                                                                                      file:///C:/Documents%20and%20Settings/tforgrave/Desktop/LandoFiles/Absentee%20and%20...




                                                                                                                                                                                                          5/25/2010

                                                                                     Pennsylvania Department of Health
                                                                                     School Immunization Report System
                                                                                 Immunization Summary by County - Private Schools
                                                                                             School Year : 2007 - 2008
           County:        02 - Allegheny

                                    Total       DT        DT      Polio     MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                                  Students   3 doses   4 doses   3 doses   2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
          Grade Section           Enrolled   or more   or more   or more   or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

          Kindergarten               2,842        0    2,656     2,726     2,450      2,695                 1,685       1,307          0        0        0        15        40          364           2
              Percent:                         0.00%    93.46%    95.92%    86.21%    94.83%                59.29%      45.99%     0.00%    0.00%    0.00%      0.53%     1.41%       12.81%

          7th Grade                  2,195   2,111          0    2,161     2,151      2,151                 1,815         261       711      419      356         10        27           47           0
               Percent:                       96.17%     0.00%    98.45%    98.00%    98.00%                82.69%      11.89%     32.39%   19.09%   16.22%     0.46%     1.23%        2.14%


              Totals:            5,037    2,111     2,656        4,887     4,601      4,846                 3,500       1,568       711      419      356         25        67          411           2
              Percent:                    41.91%    52.73%        97.02%    91.34%    96.21%                69.49%      31.13%     14.12%   8.32%    7.07%      0.50%     1.33%        8.16%
               Number of schools reporting:     191




1 of 2                                                                                                                                                                                                 6/29/2010 12:56 PM
Reports                                                                                                         file:///C:/Documents%20and%20Settings/tforgrave/Desktop/LandoFiles/Absentee%20and%20...




                                                                                                                                                                                                             5/25/2010

                                                                                        Pennsylvania Department of Health
                                                                                        School Immunization Report System
                                                                                     Immunization Summary by County - Public Schools
                                                                                                 School Year : 2007 - 2008
           County:        02 - Allegheny

                                    Total       DT        DT      Polio     MMR          Hep B    Varicella                                                      Number    Number        Number       Number
                                  Students   3 doses   4 doses   3 doses   2 doses      3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
          Grade Section           Enrolled   or more   or more   or more   or more      or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

          Kindergarten              11,671        0    9,859     10,166     9,694       10,139                 7,054       5,013          0        0        0        52       116          843           3
              Percent:                         0.00%    84.47%    87.10%    83.06%       86.87%                60.44%      42.95%      0.00%    0.00%    0.00%     0.45%     0.99%        7.22%

          7th Grade                 13,249   12,369         0    12,443    12,422       12,425                11,145         895      3,615    3,185    1,470        43        79          287           0
               Percent:                       93.36%     0.00%    93.92%    93.76%       93.78%                84.12%       6.76%     27.29%   24.04%   11.10%     0.32%     0.60%        2.17%


              Totals:          24,920 12,369       9,859         22,609    22,116       22,564                18,199       5,908      3,615    3,185    1,470        95       195        1,130           3
              Percent:                    49.63%   39.56%         90.73%    88.75%       90.55%                73.03%      23.71%     14.51%   12.78%    5.90%     0.38%     0.78%        4.53%
               Number of schools reporting:    256




1 of 2                                                                                                                                                                                                       6/29/2010 1:09 PM
Reports                                                                                                       file:///C:/Documents%20and%20Settings/tforgrave/Desktop/LandoFiles/Absentee%20and%20...




                                                                                                                                                                                                           5/25/2010

                                                                                      Pennsylvania Department of Health
                                                                                      School Immunization Report System
                                                                           Immunization Summary by County both Public and Private Schools
                                                                                            School Year : 2008 - 2009
           County:        02 - Allegheny

                                    Total       DT        DT      Polio      MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                                  Students   3 doses   4 doses   3 doses    2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
          Grade Section           Enrolled   or more   or more   or more    or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

          Kindergarten              13,210        0    12,048    12,712     11,706    12,608                 6,304      11,106          0        0        0        55       197        1,968           8
              Percent:                         0.00%    91.20%    96.23%     88.61%    95.44%                47.72%      84.07%      0.00%    0.00%    0.00%     0.42%     1.49%       14.90%

          7th Grade                 13,950   13,478         0    13,489     13,444    13,265                 8,733       7,962      8,046    2,046    7,957        46       135        2,919           4
               Percent:                       96.62%     0.00%    96.70%     96.37%    95.09%                62.60%      57.08%     57.68%   14.67%   57.04%     0.33%     0.97%       20.92%


              Totals:          27,160 13,478       12,048        26,201     25,150    25,873                15,037      19,068      8,046    2,046    7,957       101       332        4,887          12
              Percent:                    49.62%    44.36%        96.47%     92.60%    95.26%                55.36%      70.21%     29.62%    7.53%   29.30%     0.37%     1.22%       17.99%
               Number of schools reporting:    439




1 of 2                                                                                                                                                                                                     6/29/2010 1:10 PM
Reports                                                                                                      file:///C:/Documents%20and%20Settings/tforgrave/Desktop/LandoFiles/Absentee%20and%20...




                                                                                                                                                                                                          5/25/2010

                                                                                     Pennsylvania Department of Health
                                                                                     School Immunization Report System
                                                                                 Immunization Summary by County - Private Schools
                                                                                             School Year : 2008 - 2009
           County:        02 - Allegheny

                                    Total       DT        DT      Polio     MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                                  Students   3 doses   4 doses   3 doses   2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
          Grade Section           Enrolled   or more   or more   or more   or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

          Kindergarten               2,698        0    2,408     2,507     2,223      2,490                   987       2,087          0        0        0        15        55          459           2
              Percent:                         0.00%    89.25%    92.92%    82.39%    92.29%                36.58%      77.35%      0.00%   0.00%     0.00%     0.56%     2.04%       17.01%

          7th Grade                  2,103   2,039          0    2,043     2,034      2,037                 1,021       1,296      1,320     267     1,257         5        27          399           2
               Percent:                       96.96%     0.00%    97.15%    96.72%    96.86%                48.55%      61.63%     62.77%   12.70%   59.77%     0.24%     1.28%       18.97%


              Totals:            4,801    2,039     2,408        4,550     4,257      4,527                 2,008       3,383      1,320     267     1,257        20        82          858           4
              Percent:                    42.47%    50.16%        94.77%    88.67%    94.29%                41.82%      70.46%     27.49%   5.56%    26.18%     0.42%     1.71%       17.87%
               Number of schools reporting:     180




1 of 2                                                                                                                                                                                                    6/29/2010 1:11 PM
Reports                                                                                                         file:///C:/Documents%20and%20Settings/tforgrave/Desktop/LandoFiles/Absentee%20and%20...




                                                                                                                                                                                                             5/25/2010

                                                                                        Pennsylvania Department of Health
                                                                                        School Immunization Report System
                                                                                     Immunization Summary by County - Public Schools
                                                                                                 School Year : 2008 - 2009
           County:        02 - Allegheny

                                    Total       DT        DT      Polio     MMR          Hep B    Varicella                                                      Number    Number        Number       Number
                                  Students   3 doses   4 doses   3 doses   2 doses      3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
          Grade Section           Enrolled   or more   or more   or more   or more      or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

          Kindergarten              10,512        0    9,640     10,205     9,483       10,118                 5,317       9,019          0        0        0        40       142        1,509           6
              Percent:                         0.00%    91.70%    97.08%    90.21%       96.25%                50.58%      85.80%      0.00%    0.00%    0.00%     0.38%     1.35%       14.36%

          7th Grade                 11,847   11,439         0    11,446    11,410       11,228                 7,712       6,666      6,726    1,779    6,700        41       108        2,520           2
               Percent:                       96.56%     0.00%    96.62%    96.31%       94.78%                65.10%      56.27%     56.77%   15.02%   56.55%     0.35%     0.91%       21.27%


              Totals:          22,359 11,439       9,640         21,651    20,893       21,346                13,029      15,685      6,726    1,779    6,700        81       250        4,029           8
              Percent:                    51.16%   43.11%         96.83%    93.44%       95.47%                58.27%      70.15%     30.08%    7.96%   29.97%     0.36%     1.12%       18.02%
               Number of schools reporting:    259




1 of 2                                                                                                                                                                                                       6/29/2010 1:11 PM
Reports                                                                                                       file:///C:/Documents%20and%20Settings/tforgrave/Desktop/LandoFiles/Absentee%20and%20...




                                                                                                                                                                                                             5/25/2010

                                                                                      Pennsylvania Department of Health
                                                                                      School Immunization Report System
                                                                           Immunization Summary by County both Public and Private Schools
                                                                                            School Year : 2009 - 2010
           County:        02 - Allegheny

                                    Total       DT        DT      Polio      MMR       Hep B    Varicella                                                        Number    Number        Number       Number
                                  Students   3 doses   4 doses   3 doses    2 doses   3 doses     Had       Varicella   Varicella     Tdap      Td      MCV      Medical   Religious     Enrolled     Denied
          Grade Section           Enrolled   or more   or more   or more    or more   or more   Disease      1 dose      2 doses     1 dose   1 dose    1 dose   Exempt     Exempt     Provisionally Admission

          Kindergarten              13,602        0    12,712    13,004     12,403    12,950      235        5,971      12,234           0        0         0        88       220        1,301           2
              Percent:                         0.00%    93.46%    95.60%     91.19%    95.21%    1.73%       43.90%      89.94%       0.00%    0.00%     0.00%     0.65%     1.62%        9.56%

          7th Grade                 13,541   13,414         0    13,417     13,373    13,377    1,678        4,508      11,877      12,244    2,046    12,528        82       212          559          13
               Percent:                       99.06%     0.00%    99.08%     98.76%    98.79%   12.39%       33.29%      87.71%      90.42%   15.11%    92.52%     0.61%     1.57%        4.13%


              Totals:          27,143 13,414       12,712        26,421     25,776    26,327    1,913       10,479      24,111      12,244    2,046    12,528       170       432        1,860          15
              Percent:                    49.42%    46.83%        97.34%     94.96%    96.99%    7.05%       38.61%      88.83%      45.11%    7.54%    46.16%     0.63%     1.59%        6.85%
               Number of schools reporting:    452




1 of 2                                                                                                                                                                                                       6/29/2010 1:12 PM
Reports                                                                                                      file:///C:/Documents%20and%20Settings/tforgrave/Desktop/LandoFiles/Absentee%20and%20...




                                                                                                                                                                                                          5/25/2010

                                                                                     Pennsylvania Department of Health
                                                                                     School Immunization Report System
                                                                                 Immunization Summary by County - Private Schools
                                                                                             School Year : 2009 - 2010
           County:        02 - Allegheny

                                    Total       DT        DT      Polio     MMR       Hep B    Varicella                                                      Number    Number        Number       Number
                                  Students   3 doses   4 doses   3 doses   2 doses   3 doses     Had       Varicella   Varicella    Tdap      Td     MCV      Medical   Religious     Enrolled     Denied
          Grade Section           Enrolled   or more   or more   or more   or more   or more   Disease      1 dose      2 doses    1 dose   1 dose   1 dose   Exempt     Exempt     Provisionally Admission

          Kindergarten               2,696        0    2,441     2,500     2,305      2,499        95         909       2,222          0        0        0        19        67          360           0
              Percent:                         0.00%    90.54%    92.73%    85.50%    92.69%    3.52%       33.72%      82.42%      0.00%   0.00%     0.00%     0.70%     2.49%       13.35%

          7th Grade                  2,142   2,092          0    2,093     2,080      2,087      168          523       1,843      1,793     244     1,857        20        55           74           0
               Percent:                       97.67%     0.00%    97.71%    97.11%    97.43%    7.84%       24.42%      86.04%     83.71%   11.39%   86.69%     0.93%     2.57%        3.45%


              Totals:            4,838    2,092     2,441        4,593     4,385      4,586      263        1,432       4,065      1,793     244     1,857        39       122          434           0
              Percent:                    43.24%    50.45%        94.94%    90.64%    94.79%    5.44%       29.60%      84.02%     37.06%   5.04%    38.38%     0.81%     2.52%        8.97%
               Number of schools reporting:     185




1 of 2                                                                                                                                                                                                    6/29/2010 1:12 PM
Reports                                                                                                         file:///C:/Documents%20and%20Settings/tforgrave/Desktop/LandoFiles/Absentee%20and%20...




                                                                                                                                                                                                               5/25/2010

                                                                                        Pennsylvania Department of Health
                                                                                        School Immunization Report System
                                                                                     Immunization Summary by County - Public Schools
                                                                                                 School Year : 2009 - 2010
           County:        02 - Allegheny

                                    Total       DT        DT      Polio     MMR          Hep B    Varicella                                                        Number    Number        Number       Number
                                  Students   3 doses   4 doses   3 doses   2 doses      3 doses     Had       Varicella   Varicella     Tdap      Td      MCV      Medical   Religious     Enrolled     Denied
          Grade Section           Enrolled   or more   or more   or more   or more      or more   Disease      1 dose      2 doses     1 dose   1 dose    1 dose   Exempt     Exempt     Provisionally Admission

          Kindergarten              10,906        0    10,271    10,504    10,098       10,451      140        5,062      10,012           0        0         0        69       153          941           2
              Percent:                         0.00%    94.18%    96.31%    92.59%       95.83%    1.28%       46.41%      91.80%       0.00%    0.00%     0.00%     0.63%     1.40%        8.63%

          7th Grade                 11,399   11,322         0    11,324    11,293       11,290    1,510        3,985      10,034      10,451    1,802    10,671        62       157          485          13
               Percent:                       99.32%     0.00%    99.34%    99.07%       99.04%   13.25%       34.96%      88.03%      91.68%   15.81%    93.61%     0.54%     1.38%        4.25%


              Totals:          22,305 11,322       10,271        21,828    21,391       21,741    1,650        9,047      20,046      10,451    1,802    10,671       131       310        1,426          15
              Percent:                    50.76%    46.05%        97.86%    95.90%       97.47%    7.40%       40.56%      89.87%      46.85%    8.08%    47.84%     0.59%     1.39%        6.39%
               Number of schools reporting:    267




1 of 2                                                                                                                                                                                                         6/29/2010 1:13 PM
                 Student Absenteeism Surveillance Form
                         2009-2010 School Year

              Please complete the form below and fax it to the Health Department
                        before 4:00 p.m. each Friday of the school year.


School Name: __________________________________________ Total Student Enrollment: ____________

Report for Week Beginning (date): ______________ Completed by: ________________________________


                                                     Number of Students Absent
             Symptoms
                                 Monday        Tuesday   Wednesday      Thursday     Friday
 Influenza-Like Illness
 (fever with cough and/or
 sore throat)
 Chickenpox
 (Varicella)
 Gastrointestinal Illness
 (vomiting and/or diarrhea)
 Other
 (List)
 Other
 (List)

 Unknown


 Total Absent



If 5 or more students/staff in the same classroom report being ill with the same symptoms
within 5 days, please immediately call the Health Department at 831-755-4521 to report a
possible outbreak.


          Please call 831-755-4503 if you have questions about completing this form
                          or about any communicable disease issues.

                      FAX TO: Monterey County Health Department
                       Communicable Disease Unit at 831-754-6682
                                      (no cover sheet required)               updated 7/17/2009
                                                         Monterey County Health Department
                                                                 Public Health Bureau
                                                         Surveillance and Preparedness Branch
1270 Natividad Road                                                                                        831.755.4521
Salinas, CA 93906                                                                                     Fax: 831.754.6682


                                                          Student Absenteeism Surveillance
                                                               2009-2010 School Year
Report Date: May 28, 2010

Beginning this school year, the Health Department enhanced its school surveillance efforts by
collecting more detailed information from a few key, or sentinel, schools. Thirteen schools were
selected as sentinel sites based on geographic location, student demographics, and/or
participation in last year’s surveillance program. These schools represent approximately 9% of
the public schools in Monterey County.

For the school week of May 17th, 23% of sentinel sites reported absenteeism information to the
Health Department. Reported absences were due to:

                                                                       Percent of Total Student Population
                                       Symptoms
                                                                     (Daily Average for the Reporting Week)1
                                       Influenza-Like Illness                         0.3%
                                       Varicella (Chickenpox)                         0.0%
                                       Gastrointestinal Illness                       0.2%
                                       Other                                          1.6%
                                       Unknown                                        0.4%
                                       All Causes                                     2.5%


                              14                                Proportion of Students Absent
                                                              from Sentinel Schools Each Day:
                              12
    Percent of Students




                                                                   2009-2010 School Year
                              10
                          Absent




                                   8

                                   6

                                   4

                                   2

                                   0
                              09




                       12 9



                              09

                              09
                               9

                               9




                               9

                               9




                      11 09




                      12 09




                               0

                               0




                               0




                               0




                               0




                               0
                       9/ 9




                       2/ 0




                       3/ 0




                       4/ 0




                       5/ 0
                              0
                            /0

                            /0




                            /0

                            /0




                            /1

                            /1




                            /1




                            /1




                            /1




                            /1
                             0




                             1




                             1




                             1




                             1
                           0/




                           7/




                           5/

                           9/
                            /




                            /
                           8/




                           9/




                           9/




                           6/




                           4/
                         11

                         25




                         22


                          /6




                          /3




                          /1




                         12

                         26




                         23




                         23




                         20




                         18
                        /2




                        /1




                        /1

                        /2
                        9/




                        2/




                        3/




                        4/




                        5/
                       10




                       11
                       8/

                       8/




                       1/

                       1/
                      10




                      12




                                                            Influenza-Like Illness              All Causes
Note: Days without data are due to school closures during the holiday season.

If you have questions about the student absenteeism surveillance program or this report, please
contact the Communicable Disease Unit at 831-755-4521.

1
 Average percentages are based on the total student population and not the absent student population. Average
percentages for individual illnesses will not sum to the average percentage for all causes.
1. Responder General Information

The Allegheny County Health Department appreciates your time to provide input into the development of
a plan to implement electronic submission of school-level absentee and child-level vaccination reporting.

There are a total of 24 questions in this survey. The estimated average time to complete this survey is
15 minutes.

This first section of the survey is gathering general information about the survey responder.

For any questions or comments regarding this survey, please contact:
Amanda Niskar, BSN, MPH, DrPH
Project Coordinator
Allegheny County Health Department
asniskar@gmail.com
770-630-8350 (mobile)


* 1. What school district do you work in?
                                          5
                                          6

* 2. What is the name of the school where you work?
                                          5
                                          6

* 3. What is your role at your school district?
     j
     k
     l
     m
     n   Administrator


     k
     l
     m
     n
     j   Attendance Officer


     k
     l
     m
     n
     j   Clerk


     j
     k
     l
     m
     n   Computer Teacher


     j
     k
     l
     m
     n   Information Technologist


     k
     l
     m
     n
     j   School Nurse


     k
     l
     m
     n
     j   Other




                                                                                                Page 1
2. Immunizations

Every school district in Allegheny County is required to report immunization data to the Allegheny County
Health Department (ACHD) three times a year. The current data submission process involves completing
hard copy forms. To improve timeliness and data quality, schools and the ACHD would benefit from
development of an electronic system.

This second section of the survey is seeking your input regarding immunization status monitoring
options.


* 4. Please review the 2009-2010 School Year School Immunization Report
   Summary. Are there any changes that you suggest to make the data
   collection more accurate, easier, or useful for your school and your school
   district?

     c
     d
     e
     f
     g   Yes


     d
     e
     f
     g
     c   No


     d
     e
     f
     g
     c   Don't Know



   5. If you answered yes to the previous question, please describe your
   suggested changes for the 2009-2010 School Year School Immunization
   Report Summary.
                                         5
                                         6

* 6. Please review the 2009-2010 Immunization Report Worksheet. Are there
   any changes that you suggest to make the data collection more accurate,
   easier, useful for your school or your school district?

     k
     l
     m
     n
     j   Yes


     j
     k
     l
     m
     n   No


     k
     l
     m
     n
     j   Don't Know



   7. If you answered yes to the previous question, please describe your
   suggested changes for the 2009-2010 School Year School Immunization
   Report Worksheet.
                                         5
                                         6




                                                                                              Page 2
* 8. Who completes these forms at your school or district? You may select one
  or more of the below categories.

   c
   d
   e
   f
   g   Administrator


   c
   d
   e
   f
   g   Clerk


   d
   e
   f
   g
   c   School Nurse


   d
   e
   f
   g
   c   Teacher


   c
   d
   e
   f
   g   Other


   c
   d
   e
   f
   g   Don't Know



* 9. Did your school or district receive training or guidance for completing
  these forms?

   j
   k
   l
   m
   n   Yes


   k
   l
   m
   n
   j   No


   j
   k
   l
   m
   n   Don't Know



  10. Please describe any training suggestions that you may have.
                                5
                                6

* 11. ACHD is exploring options for developing a secure web-based data
  entry system to replace the existing School Year School Immunization
  Report Summary and the Immunization Report Worksheet paper system.
  Are there any barriers to your school or district participating in such a
  system?

   j
   k
   l
   m
   n   Yes


   k
   l
   m
   n
   j   No


   j
   k
   l
   m
   n   Don't Know



  12. If you responded yes to previous question, please describe the barriers
  and provide suggestions to minimize the barriers.
                                5
                                6




                                                                          Page 3
* 13. Does your school or district have an existing electronic system collecting
  student immunization status data?

   j
   k
   l
   m
   n   Yes


   j
   k
   l
   m
   n   No


   j
   k
   l
   m
   n   Don't Know



  14. If you responded yes to the previous question, what software is your
  school or district using? Please write don't know if you don't know.
                                5
                                6




                                                                         Page 4
3. Absenteeism

During the H1N1 pandemic, Allegheny County Health Department and School officials found school-level
absentee reporting to be an important tool in identifying, monitoring and controlling outbreaks.
Developing a voluntary electronic reporting system for school-level absentee information would be an
important tool for protecting public health in Allegheny County. The information resulting from this
system would provide important information to officials considering mitigation measures.

This third section of the survey seeks your input regarding absenteeism monitoring options.


* 15. Does your school or district monitor absenteeism?
     k
     l
     m
     n
     j   Yes


     j
     k
     l
     m
     n   No


     k
     l
     m
     n
     j   Don't Know



   16. If you responded yes to the previous question, is the reason for the
   absence documented?

     k
     l
     m
     n
     j   Yes


     j
     k
     l
     m
     n   No


     k
     l
     m
     n
     j   Don't Know



   17. If you responded yes to the previous question, please list the categories
   for the reason of absence.
                                         5
                                         6

* 18. ACHD is exploring options for developing a secure web-based data
   entry system to monitor absenteeism. Are there any barriers to your school
   or district participating in such a system?

     j
     k
     l
     m
     n   Yes


     k
     l
     m
     n
     j   No


     j
     k
     l
     m
     n   Don't Know



   19. If you responded yes to the previous question, please describe the
   barriers and provide suggestions to minimize the barriers.
                                         5
                                         6




                                                                                              Page 5
  20. Does your school or district have an existing electronic system collecting
  student absenteeism data?

   j
   k
   l
   m
   n   Yes


   k
   l
   m
   n
   j   No


   j
   k
   l
   m
   n   Don't Know



  21. If you responded yes to the previous question, what software is your
  school or district using? Write don't know if you don't know.
                                  5
                                  6

* 22. Please select the one or more absence categories that you believe your
  school or district could identify when collecting absenteeism data.

   c
   d
   e
   f
   g   Gastrointestinal illness


   d
   e
   f
   g
   c   Influenza-like illness


   c
   d
   e
   f
   g   Rash


   d
   e
   f
   g
   c   Respiratory


   c
   d
   e
   f
   g   Varicella


   d
   e
   f
   g
   c   Other


   d
   e
   f
   g
   c   Unknown


   c
   d
   e
   f
   g   None



  23. If your school or district would find value in monitoring absence
  categories not listed in the previous question, please list the proposed
  categories here.
                                  5
                                  6




                                                                          Page 6
4. Dissemination

Allegheny County Health Department (ACHD) thanks you for your time to provide input into the
development of a plan to implement electronic submission of school-level absentee and child-level
vaccination reporting to ACHD.

This final section of the survey seeks your input regarding dissemination of data collected.


* 24. Would your school or district find value in receiving a summary
   immunization and absenteeism report from ACHD after the data collection
   and analyses are complete?

     j
     k
     l
     m
     n   Yes


     k
     l
     m
     n
     j   No


     k
     l
     m
     n
     j   Don't Know




                                                                                               Page 7
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