@article{Ruello_Pelat_Caserio-Schönemann_Fouillet_Bonmarin_Levy-Brühl_Le Strat_2017, title={A regional approach for the influenza surveillance in France}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7671}, DOI={10.5210/ojphi.v9i1.7671}, abstractNote={<div style="left: 78.2727px; top: 296.356px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.0823);" data-canvas-width="55.467823232323234">Objective</div><div style="left: 91.3182px; top: 309.359px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02121);" data-canvas-width="331.9260088383836">To describe the results of the new organization of influenza</div><div style="left: 78.2727px; top: 323.854px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00124);" data-canvas-width="261.74110101010103">surveillance in France, based on a regional approach.</div><div style="left: 78.2727px; top: 351.437px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.11884);" data-canvas-width="71.86668434343434">Introduction</div><div style="left: 91.3182px; top: 364.44px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.975002);" data-canvas-width="330.5744272727273">In France, until winter 2014-2015, management and preventive</div><div style="left: 78.2727px; top: 378.935px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03613);" data-canvas-width="343.1316919191919">actions for the control of the flu epidemic were implemented when</div><div style="left: 78.2727px; top: 393.43px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.984255);" data-canvas-width="343.81672323232306">the national incidence of influenza-like illness (ILI) consultations</div><div style="left: 78.2727px; top: 407.925px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02535);" data-canvas-width="343.04667904040366">in general practice was over an epidemic threshold. The 2014-2015</div><div style="left: 78.2727px; top: 422.42px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01832);" data-canvas-width="342.7842479797979">influenza epidemic had a major public health impact, particularly in</div><div style="left: 78.2727px; top: 436.915px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.980256);" data-canvas-width="341.5866752525251">the elderly, and caused a severe overloading of the health care system,</div><div style="left: 78.2727px; top: 451.41px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.969992);" data-canvas-width="343.603575">in particular emergency departments (ED) [1]. The epidemic alert</div><div style="left: 78.2727px; top: 465.905px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00484);" data-canvas-width="342.38382499999994">emitted by the French National Public Health Agency at the national</div><div style="left: 78.2727px; top: 480.4px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.949695);" data-canvas-width="343.48899242424255">level was too late for the hospitals to prepare themselves in many</div><div style="left: 78.2727px; top: 494.895px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00176);" data-canvas-width="39.35233838383838">regions.</div><div style="left: 91.3182px; top: 509.39px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03948);" data-canvas-width="332.37325050505046">After a national feedback organized in April 2015 with all</div><div style="left: 78.2727px; top: 523.884px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02655);" data-canvas-width="343.0898015151514">partners involved in influenza surveillance and management, it was</div><div style="left: 78.2727px; top: 538.379px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00594);" data-canvas-width="342.3899853535354">recommended to improve influenza surveillance in France following</div><div style="left: 78.2727px; top: 552.874px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03483);" data-canvas-width="343.04544696969714">3 axes: 1) regionalize surveillance so that healthcare structures can</div><div style="left: 78.2727px; top: 567.369px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.999379);" data-canvas-width="342.2372085858586">adapt to the particular situation of their region; 2) use a pre-epidemic</div><div style="left: 78.2727px; top: 581.864px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04041);" data-canvas-width="343.1267636363636">alert level for better anticipating the outbreak; 3) use multiple data</div><div style="left: 78.2727px; top: 596.359px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.961485);" data-canvas-width="343.10581843434335">sources and multiple outbreak detection methods to strengthen the</div><div style="left: 78.2727px; top: 610.854px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00503);" data-canvas-width="185.79626262626272">determination of influenza alert level.</div><div style="left: 78.2727px; top: 638.437px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.07424);" data-canvas-width="50.65042676767676">Methods</div><div style="left: 91.3182px; top: 651.44px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.980596);" data-canvas-width="328.49962020202014">A user-friendly web application was developed to provide common</div><div style="left: 78.2727px; top: 665.935px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03874);" data-canvas-width="345.10300505050503">data visualizations and statistical results of outbreak detection</div><div style="left: 78.2727px; top: 680.43px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00249);" data-canvas-width="342.24952929292925">methods to all the epidemiologists involved in influenza surveillance</div><div style="left: 78.2727px; top: 694.925px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.942668);" data-canvas-width="343.2253292929293">at the national level or in the 15 regional units of our agency [2].</div><div style="left: 78.2727px; top: 709.42px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0269);" data-canvas-width="342.8975984848484">It relies on 3 data sources, aggregated on a weekly time step: 1) the</div><div style="left: 78.2727px; top: 723.915px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.98389);" data-canvas-width="341.96738510101005">proportion of ILI among all coded attendances in the ED participating</div><div style="left: 78.2727px; top: 738.41px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.94261);" data-canvas-width="343.51856212121197">to the OSCOUR Network [3] ; 2) the proportion of ILI among all</div><div style="left: 78.2727px; top: 752.905px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.996613);" data-canvas-width="342.070879040404">coded visits made by emergency general practitioners (GPs) working</div><div style="left: 78.2727px; top: 767.4px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.945188);" data-canvas-width="343.16618989898996">in the SOS Médecins associations [3]; 3) the incidence rate of ILI</div><div style="left: 78.2727px; top: 781.895px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00132);" data-canvas-width="219.69052777777776">estimated from a sample of sentinel GPs [4].</div><div style="left: 91.3182px; top: 796.39px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.977908);" data-canvas-width="328.51194090909087">For each region each week, 3 statistical outbreak detection methods</div><div style="left: 78.2727px; top: 810.884px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.959721);" data-canvas-width="343.500081060606">were applied to the 3 data sources, generating 9 results that were</div><div style="left: 78.2727px; top: 825.379px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03626);" data-canvas-width="343.1587974747474">combined to obtain a weekly regional influenza alarm level. Based</div><div style="left: 78.2727px; top: 839.874px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03405);" data-canvas-width="231.83381666666665">on this alarm level and on other information (</div><div style="left: 310.239px; top: 839.874px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00787);" data-canvas-width="17.889666666666663">e.g.</div><div style="left: 328.146px; top: 839.874px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03232);" data-canvas-width="93.13222474747474">virological data),</div><div style="left: 78.2727px; top: 854.369px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.977966);" data-canvas-width="343.6245202020203">the epidemiologists then determined the epidemiological status of</div><div style="left: 78.2727px; top: 868.864px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02041);" data-canvas-width="342.80519318181814">each region as either 1) epidemic-free, 2) in pre/post epidemic or 3)</div><div style="left: 78.2727px; top: 883.359px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00169);" data-canvas-width="48.24788888888889">epidemic.</div><div style="left: 91.3182px; top: 897.854px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.980888);" data-canvas-width="328.515637121212">The R software was used for programming algorithms and building</div><div style="left: 78.2727px; top: 912.349px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00117);" data-canvas-width="169.34811868686873">the web interface (package shiny).</div><div style="left: 78.2727px; top: 939.932px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.08542);" data-canvas-width="44.50239393939395">Results</div><div style="left: 91.3182px; top: 952.935px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0322);" data-canvas-width="330.18509292929286">The epidemiological status of influenza at the regional level was</div><div style="left: 78.2727px; top: 967.43px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01704);" data-canvas-width="344.84303813131316">communicated through maps published in the weekly influenza</div><div style="left: 78.2727px; top: 981.925px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04069);" data-canvas-width="345.40486237373733">reports of the Agency throughout the surveillance season [5].</div><div style="left: 78.2727px; top: 996.42px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03884);" data-canvas-width="342.95673787878803">In week 2016-W03, Brittany was the first French region to declare</div><div style="left: 78.2727px; top: 1010.91px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.997058);" data-canvas-width="342.0905921717172">the influenza epidemic, with nine other regions in pre-epidemic alert.</div><div style="left: 78.2727px; top: 1025.41px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.979164);" data-canvas-width="341.87497979797973">The epidemic then spread over the whole mainland territory. The peak</div><div style="left: 78.2727px; top: 1039.9px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00265);" data-canvas-width="303.1509974747475">of the epidemic was declared in week 11, the end in week 16.</div><div style="left: 443.545px; top: 296.356px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.10408);" data-canvas-width="73.93656313131314">Conclusions</div><div style="left: 456.591px; top: 309.359px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.960503);" data-canvas-width="330.2848906565654">This regional multi-source approach has been made possible by</div><div style="left: 443.545px; top: 323.854px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.993769);" data-canvas-width="342.00557929292927">the sharing of data visualizations and statistical results through a web</div><div style="left: 443.545px; top: 338.349px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.994166);" data-canvas-width="344.2134499999998">application. This application helped detecting early the epidemic</div><div style="left: 443.545px; top: 352.844px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04216);" data-canvas-width="345.54655050504994">start and allowed a reactive communication with the regional</div><div style="left: 443.545px; top: 367.339px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.961391);" data-canvas-width="343.66517853535356">health authorities in charge of the organization of health care, the</div><div style="left: 443.545px; top: 381.834px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04959);" data-canvas-width="345.8558002525251">management and the setting up of the appropriate preventive</div><div style="left: 443.545px; top: 396.329px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00155);" data-canvas-width="48.92552777777778">measures.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Ruello, Marc and Pelat, Camille and Caserio-Schönemann, Céline and Fouillet, Anne and Bonmarin, Isabelle and Levy-Brühl, Daniel and Le Strat, Yann}, year={2017}, month={May} }