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ISDS 2012 Conference Abstracts

Incorporation of School Absenteeism Data into the
Maryland Electronic Surveillance System for the Early
Notification of Community-based Epidemics (ESSENCE)
Zachary Faigen*, Anikah Salim and Isaac Ajit

Office of Preparedness & Response, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA

Objective
The state of Maryland has incorporated 100% of its public school

systems into a statewide disease surveillance system. This session
will discuss the process, challenges, and best practices for expanding
the ESSENCE system to include school absenteeism data as part of
disease surveillance. It will also discuss the plans that Maryland has
for using this new data source, as well as the potential for further ex-
pansion.

Introduction
Syndromic surveillance offers the potential for earlier detection of

bioterrorism, outbreaks, and other public health emergencies than tra-
ditional disease surveillance. The Maryland Department of Health
and Mental Hygiene (DHMH) Office of Preparedness and Response
(OP&R) conducts syndromic surveillance using the Electronic Sur-
veillance System for the Early Notification of Community-based Epi-
demics (ESSENCE). Since its inception, ESSENCE has been a vital
tool for DHMH, providing continuous situational awareness for pub-
lic health policy decision makers. It has been established in the pub-
lic health community that syndromic surveillance data, including
school absenteeism data, has efficacy in monitoring disease, and
specifically, influenza activity. Schools have the potential to play a
major role in the spread of disease during an epidemic. Therefore,
having school absenteeism data in ESSENCE would provide the op-
portunity to monitor schools throughout the school year and take ap-
propriate actions to mitigate infections and the spread of disease.

Methods
DHMH partnered with the Maryland State Department of Educa-

tion (MSDE), local health departments, and local school systems to
incorporate school absenteeism data into the syndromic surveillance
program. There are 24 local public school systems and 24 local health
departments in the state of Maryland. OP&R contacted each local
school superintendent and each local health officer to arrange a joint
meeting to discuss the expansion of the ESSENCE program to in-
clude school absenteeism data. Once the meetings were arranged,
OP&R epidemiologists traveled to each local jurisdiction and pre-
sented their plan for the ESSENCE expansion. At each meeting were
representatives from the local health department, as well as school
health, school attendance, and school IT staff. This allowed all ques-
tions and concerns to be addressed from both sides. In addition to the
targeted meetings and presentations, the Secretary of Health issued an

executive order which required all local school systems to sign a
memorandum of understanding (MOU) with DHMH. This MOU de-
tailed the data elements to be shared with the ESSENCE program and
the process by which this would be shared. While this order made
data contribution mandatory, the site visits by the OP&R staff cre-
ated a working relationship and partnership with the local jurisdic-
tions. Data was collected from all public schools in the state including
elementary, middle, and high schools.

Results
As of June 30, 2012, Maryland became the first state in the United

States to incorporate 100% of its public school systems (1,424
schools) into ESSENCE. Each school system reports absenteeism
data daily via an automated secure FTP (sFTP) transfer to DHMH.
Due to its unique properties, Johns Hopkins Applied Physics Labo-
ratory (JHUAPL) designed a new detection algorithm in ESSENCE
specifically for this data source. OP&R epidemiologist review and
analyze this data for disease surveillance purposes in conjunction
with other data sources in ESSENCE (emergency department chief
complaints, poison control center data, thermometer sales data, and
over-the-counter medication sales data). Integrating school absen-
teeism data will provide a more complete analysis of potential pub-
lic health threats. The process by which Maryland incorporated their
public school systems’ data could potentially be used as a best prac-
tice for other jurisdictions. Not only was DHMH able to obtain data
from all public schools in the state, but the process also enhanced col-
laboration between local health departments and public school sys-
tems.

Keywords
ESSENCE; Surveillance; Absenteeism

Acknowledgments

The Office of Preparedness & Response at the Maryland Department of
Health and Mental Hygiene would like to acknowledge and thank the
Maryland State Department of Education and the 24 local health depart-
ments and public school systems for their support and collaboration to
successfully implement this project.

*Zachary Faigen
E-mail: zfaigen@dhmh.state.md.us

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e176, 2013