Ruello Marc

Since the terrorist attacks against the satirical newspaper Charlie Hebdo in January 2015, France has activated the highest level of its national anti-terrorist security plan. A new terrorist attack occurred the 26th of June at 9:50 AM in a gas production plant located in the industrial area of Saint Quentin Fallavier nearby Lyon (East -South-of France). The plant produces several different chemical products like gas and plastics and employed 40 people. The attack resulted in an explosion followed by fire. The French Institute for Public Health Surveillance (InVS) was alerted at 11 AM and decided to implement with its Rhône-Alpes regional office a protocol to timely assess the potential health impact on the population living or working around the attack area on emergency health care facilities (EHCF).

Objective

To timely assess the potential health impact on the population living or working in a terrorist attack area using syndromic surveillance

Since 2004, the French syndromic surveillance system Oscour® has been implemented by the national institute for public health surveillance (InVS) and is daily used to detect and follow-up various public health events all over the territory [1]. Beginning with 23 ED in 2004, the coverage and data quality have permanently been increasing until including about 650 ED in August 2015. Initially based on a voluntary participation of ED, a mandatory transmission has been decided in July 2013, with major modification on the structural organization of the data transmission in some regions and on coding practices of the new ED. Besides this juridical context, the system is based on automatically data collection by ED physicians without recording added information for public health surveillance. This represents the main theorical condition to ensure stability and quality, even in case of occurrence of major public health events susceptible to drastically increase the workload [2].

Objective

Identification of the main factors influencing the stability and the quality of the French Emergency departments (ED) syndromic surveillance system.

The French syndromic surveillance system SursaUD® has been set up by Santé publique France, the national public health agency (formerly French institute for public health - InVS) in 2004. In 2016, the system is based on three main data sources: the attendances in about 650 emergency departments (ED), the consultations to

 62 emergency general practitioners’ (GPs) associations SOS Médecins and the mortality data from 3,000 civil status offices [1]. Daily, about 60,000 attendances in ED (88% of the national attendances), 8,000 visits in SOS Médecins associations (95% of the national visits) and 1,200 deaths (80% of the national mortality) are recorded all over the territory and transmitted to Santé publique France. About 100 syndromic groupings of interest are constructed from the reported diagnostic codes, and monitored daily or weekly, for different age groups and geographical scales, to characterize trends, detect expected or unexpected events (outbreaks) and assess potential impact of both environmental and infectious events. All-causes mortality is also monitored in similar objectives. Two user-friendly interactive web applications have been developed using the R shiny package [2] to provide a homogeneous framework for all the epidemiologists involved in the syndromic surveillance at the national and the regional levels.

Objective

The presentation describes the design and the main functionalities of two user-friendly applications developed using R-shiny to support the statistical analysis of morbidity and mortality data from the French syndromic surveillance system SurSaUD.

France hosted 2016 UEFA European Football Championship between June 10 and July 10. In the particular context of several terrorist attacks occurring in France in 2015 [1], the French national public health agency « Santé publique France » (formerly French Institute for Public Health Surveillance-InVS) was mandated by the Ministry of Health to reinforce health population surveillance systems during the UEFA 2016 period. Six French regions and 10 main stadiums hosted 51 matches and several official and nonofficial dedicated Fan Zones were implemented in many cities across national territory. Three types of hazard have been identified in this context: outbreak of contagious infectious disease, environmental exposure and terrorist attack. The objectives of health surveillance of this major sporting event were the same as for an exceptional event including mass gathering [2] : 1/ timely detection of a health event (infectious cluster, environmental pollution, collective foodborne disease…) to investigate and timely implement counter measures (control and prevention), 2/ health impact assessment of an unexpected event. The French national syndromic surveillance system SurSaUD® was one of the main tools for timely health impact assessment in the context of this event.

Objective

To describe the surveillance indicators implemented for the health impact assessment of a potential health event occurring before, during or after the UEFA Euro 2016 football matches in order to timely implement control and prevention measures.

In France, the surveillance of GE is performed by several complementary systems including specific and syndromic surveillance systems.

The GP’s emergency associations “SOS Médecins” are part of the French syndromic surveillance system SurSaUD since 2006. SOS Médecins functions as a liberal medical regulation. In 9 years, the network has become almost exhaustive and contribute to the surveillance of seasonal and non-seasonal health events at different geographical scales, in the fields of infectious diseases and environmental health. GE is one of the 50 indicators daily followed by the by the French Institute for Public Health Surveillance (InVS) syndromic surveillance unit.

Objective

To illustrate the complementarity and added value of the GP’s emergency network “SOS Médecins” through an example of an epidemic of gastroenteritis (GE).

To describe the results of the new organization of influenza surveillance in France, based on a regional approach. This regional multi-source approach has been made possible by the sharing of data visualizations and statistical results through a web application. This application helped detecting early the epidemic start and allowed a reactive communication with the regional health authorities in charge of the organization of health care, the management and the setting up of the appropriate preventive measures.