Virtual surveillance of communicable diseases: a 20-year experience in France

Abstract

Inserm has developed, since 1984, an information system based on a computer network of physicians in France. It allows for constitution of large databases on diseases, with individual description of cases, and to explore some aspects of the mathematical theory of communicable diseases. We developed user-friendly interfaces for remote data entry and GIS tools providing real-time atlas of the epidemiologic situation in any location. The continuous and ongoing surveillance network is constituted of about 1200 sentinel voluntary and unpaid investigators. We studied their motivation, reasons for either withdrawal or compliance using survival analyses. We implemented early warning systems for outbreak detection and for time-space forecasting. We conducted epidemiological surveys for investigating outbreaks. Large available time and space series allowed us to calibrate and explore synchronism of influenza epidemics, to test the assumption of panmixing in susceptibles-infectious-removed type models and to study the role of closing school in influenza morbidity and mortality in elderly. More than 250 000 cases of influenza, 150 000 cases of acute diarrheas, 35 000 patients for whom HIV tests have been prescribed by general practitioners and 25 000 cases of chickenpox have been collected. Detection of regional influenza or acute diarrhea outbreaks and forecasting of epidemic trends three weeks ahead are currently broadcasted to the French media and published on Sentiweb© on a weekly basis. Age-cohort-period models assessed field effectiveness of mass immunization strategies against measles and influenza in the country. Case-control studies with more than 1200 sets of cases of acute diarrheas and their matched controls showed the role of calicivirus and rotavirus as probable major causes of gastroenteritis during recurrent widespread outbreaks in winter in France. An age-specific model for chickenpox showed the probable role of children in disease transmission to their susceptible parents or grandparents. High level of synchronism between influenza epidemics has been demonstrated, either at a regional level (in France) or between France and the USA. The designation of our lab as a WHO collaborating center for electronic disease surveillance stimulates the development of global monitoring of diseases. We developed operational systems that are now available for the global monitoring of influenza (FluNet©), and human and animal rabies (RABNET©). Extension of electronic syndromic surveillance is needed in the world for improving surveillance capacities and real-time response against emerging diseases.

Get full access to this article

View all access options for this article.

References

Valleron AJ , Bouvet E , Garnerin PH. , Menares J , Heard I , Letrait S , Lefaucheux J. A computer network for the surveillance of communicable diseases: the French experiment . American Journal of Public Health 1986; 76: 1289-1292 .

Fourquet F , Drucker J. Communicable disease surveillance: the Sentinel network . Lancet 1997; 349: 794-795 .

Parsons DF , Garnerin P , Flahault A , Gotham I. The status of electronic reporting of notifiable conditions in USA and France . Telemedecine Journal 1996; 2: 273-284 .

Halperin W , Baker EL , Monson RR. Public health surveillance. Van Nostrand Reinhold , 1992: 238-238 pp.

Van Loock F. Infectious disease surveillance: early warning systems and public health interventions in a Belgian and European perspective . Acta Clinica Belgica 1994; 49: 236-242 .

Szecsenyi J , Uphoff-H , Ley-S , Brede HD. Influenza surveillance: experiences from establishing a sentinel surveillance system in Germany . Journal of Epidemiology and Community Health 1995; 49S: 9-13 .

Ferguson T. Digital doctoring - Opportunities and challenges in electronic patient-physician communication . JAMA 1998; 280: 1361-1362 .

Boussard E , Flahault A , Vibert JF , Valleron AJ. Sentiweb: French communicable disease surveillance on the World Wide Web . BMJ 1996; 313: 1381-1382 .

Letrilliart L , Desenclos JC , Flahault A. Risk factors for winter outbreak of acute diarrhoea in France: case-control study . BMJ 1997; 315: 1645-1649 .

10.

Flahault A , Garnerin P , Chauvin P , Farran, N , Saidi Y , Diaz C , Toubiana L , Drucker J , Valleron AJ , Sentinelle traces of an epidemic of acute gastroenteritis in France . Lancet 1995; 346: 162-163 .

11.

Larkin M. Influenza information spreads across the web . Lancet 1999; 353: 6736-6736 .

12.

Morse SS , Rosenberg BH , Woodall J. ProMED global monitoring of emerging diseases: design for a demonstration program . Health Policy 1996; 38: 135-153 .

13.

Garshnek V , Burkle FM. Application of telemedecine and telecommunications to disaster medicine. Historical and future perspectives . JAMIA 1999; 6: 26-37 .

14.

Jernigan DB , Cetron MS , Breiman RF. Minimizing the impact of drug-resistant Streptococcus pneumoniae (DRSP). A strategy from the DRSP Working Group . JAMA 1996; 275: 206-209 .

15.

Flahault A , Dias Ferrao V , Chaberty P , Esteves K , Valleron AJ , Lavanchy D. FluNet as a tool for global monitoring of influenza on the Web . JAMA 1998; 280: 1330-1332 .

16.

Chauvin P and Vallerou AJ. Participation of French general Practitioners in public health surveillance: a multidisciplinary approach . J Epidemiol Community Health 1998; 52 Suppl. 1: 25-85 .