Syndromic surveillance as a predictive tool for health-related school absences in COVID-19 Sentinel Schools in Catalonia, Spain

Monitoring influenza-like illness through syndromic surveillance could be an important strategy in the COVID-19 emergence scenario. The study aims to implement syndromic surveillance for children aged 6-11 years in COVID-19 sentinel schools in Catalonia. Data collection was made by self-applied survey to collect daily health status and symptoms. We proceed logistic mixed models and a Latent Class Analysis to investigate associations with syndromes and school absence. Were enrolled 135 students (2163 person-days) that filled 1536 surveys and 60 participants reported illness (29.52 by 100 person/day) and registered 189 absence events, 62 of them (32.8%) related to health reasons. Subgroups of influenza-like illness were founded such as a significantly and positively association with school absences. The findings of this study can be applied to the detection of health events, and association with school absences, offering an opportunity for quick action, or simply for monitoring and understanding the students’ health situation. ARTICLE SUMMARY LINE This study confirms the relevance of syndromic surveillance in students from 6 to 11 years of age as a strategy to timely detect events that can cause school absence, either to support public health actions by applying analytical models that improve their potential in providing systematized information, or to monitor and understand the health situation of students, thus offering an opportunity for rapid action. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the Health Department of the Government of Catalonia with no grant number. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. FG, AB, LA and ACC received a salary from the abovementioned funder. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved on 17 December 2020 by the Ethical Committee of the Foundation University Institute for Research in Primary Health Care Jordi Gol i Gurina (IDIAPJGol) (code 20/192-PCV). Informed consent providing information about anonymity, confidentiality, use of the collected data, risks, and general information about the study, was signed for school staff, parents for those children under 16 years and student with 16 years or older. Participants were free to decline/withdraw consent at any time without providing a reason and without being subject to any resulting detriment. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript. Complementary anonymized databases and their corresponding codebooks can be available through formal proposal to the CEEISCAT via email ceeiscat{at}iconcologia.net. Due to legal restrictions in relation to the Personal Information Protection Act, personal or spatial data that allow identified any participant, including the name of the school, which was used as an adjustment factor in the analysis, cannot be made publicly available.