The French communicable diseases computer network: a technical view

Modeling the spatial spread of infectious diseases: the GLobal Epidemic and Mobility computational model

Here we present the Global Epidemic and Mobility (GLEaM) model that integrates sociodemographic and population mobility data in a spatially structured stochastic disease approach to simulate the spread of epidemics at the worldwide scale. We discuss the flexible structure of the model that is open to the inclusion of different disease structures and local intervention policies. This makes GLEaM suitable for the computational modeling and anticipation of the spatio-temporal patterns of global epidemic spreading, the understanding of historical epidemics, the assessment of the role of human mobility in shaping global epidemics, and the analysis of mitigation and containment scenarios.

Trends in voluntary HIV testing in general practices in France between 1987 and 2002

OBJECTIVES

To measure the level of voluntary HIV testing and to assess its changes in the French general population according to the evolution of HIV testing policies.

METHODS

When general practitioners belonging to the Sentinelles network (SGP) offer HIV testing to their patients, they send the network an anonymous description of the patient and a report of the test results.

RESULTS

The number of HIV tests peaked in 1993 at 1760 per 100,000 inhabitants. Since 1995 the rate has fallen slightly, from 1474 to 810 per 100,000 in 2002. Between 1987 and 2002 there was a significant fall in the proportion of persons with a history of STD (31.4-5.1%, p = 0.0001), clinical signs of HIV infection (9.1-4.5%, p = 0.0002) and a history of prior testing (19.3-13.6%, p = 0.0005).

CONCLUSIONS

Our results show that demand for HIV testing among the French general practice patient population has fallen since 1995, along with the frequency with which GPs offer HIV testing.

A recent increase in the incidence of male urethritis in France

BACKGROUND

At-risk sexual behaviors appear to have increased recently in France, possibly because of the reassuring efficacy of highly active antiretroviral treatments. The objective of this study was to assess the pattern of change.

GOAL

The goal was to analyze trends in the incidence of male urethritis, a marker of at-risk sexual behavior, between 1989 and 2000.

STUDY DESIGN

The general practitioners of the Sentinelles Network reported, through an online computer system, all cases of male urethritis they diagnosed, together with the patients' age, presence of discharge, sexual preference, history of sexually transmitted disease, prescriptions, and results of microbiologic findings.

RESULTS

After falling markedly between 1989 and 1995, the incidence of urethritis increased slightly in 1996 and then stabilized. The percentage of homosexual/bisexual men was higher among the cases than in the general population. Homosexual/bisexual men were younger than heterosexual men with urethritis; they were more likely to have a discharge and a history of sexually transmitted disease and had more sex partners. The main causative organisms were chlamydiae (18%) and Neisseria gonorrhoeae (13%).

CONCLUSION

The increasing incidence of urethritis in France calls for a readjustment of preventive strategies.

Status of electronic reporting of notifiable conditions in the United States and Europe

OBJECTIVE

To improve the computer connectivity and network strategies to connect U.S. county health departments (CHDs), state health departments (SHDs), and the Centers for Disease Control (CDC) for reporting notifiable conditions.

METHODS

HSPNET-L mailing list discussions and individual Internet communications were used to compare selected features of notifiable conditions networking in the United States, France, and the United Kingdom.

RESULTS

In the US, the CHD is the agency that first responds to an infectious disease outbreak on receiving notifications from physicians. Prompt recognition by the SHD that a widespread outbreak has occurred depends on the way in which county data are received, the "age" of the data, and the time taken to analyze them. Similarly, the recognition of the national scale of the outbreak depends on the promptness with which SHDs report to the CDC and the age of the data. An analysis of the French Communicable Disease Network suggests that an expansion of electronic links between US CHDs and SHDs will improve timeliness. Electronic data exchange allows CHDs to set up a local database and reduces transcription errors, mailing costs, and telephone costs.

CONCLUSION

A fuller use of e-mail or other electronic communication by US CHDs will allow them to use a local database as a tool for managing local disease outbreaks more effectively and independently. Federal and state agency access to the CHD databases will enable early reporting of epidemic outbreaks. Periodic posting of public health information on Internet servers is recommended for immediate access to the public health data by Internet users worldwide.

Communications--future needs and present solutions

The paper is linked with what was already stated at the 1993 working conference about the healthcare professional workstation. The present and future needs about sharing and communication facilities are reviewed: telemedicine and hence telematics. Then it appears that detailed computerized patient records (CPRs) are needed. Gathering and retrieving are network dependent. CPRs constitute the necessary basis for clinical epidemiology, quality assessment, multi-centre meta-analysis. A molecular biology server is described as well as the integrated PACS. For solutions, special emphasis is given to the explosive Internet culture and to the high-speed communication networks, and the 'open systems movement'. The final discussion attempts to match 'needs' with 'solutions'.

Surveillance of sexually transmitted diseases in France: recent trends and incidence

OBJECTIVE

To present recent trends in sexually transmitted diseases (STDs) in France and to estimate the gonorrhoea incidence in 1990.

METHODS

Trends were analysed from data of three surveillance systems: (1) STD clinics: number of diagnoses, (2) a sentinel voluntary General Practitioner (GP) network: mean number of acute male urethritis/week/GP, characteristics of the notified urethritis (age, presence of discharge, sexual orientation), (3) a sentinel voluntary laboratory network: mean number of gonorrhoea isolates/month/laboratory, characteristics of patients with positive isolates (sex, age, site of sampling) and of strains (PPNG and TRNG rates). To estimate the gonorrhoea incidence in France in 1990, results of a study held among a national sample of laboratories were used, combined with data from surveillance systems and specific studies.

RESULTS

Decreasing trends in gonorrhoea in STD clinics and in the laboratory network as well as in acute male urethritis in the GP network have been observed since implementation of the networks in 1985. The rate of PPNG strains has regularly increased in the laboratory network to reach 14% in 1991. Data suggest that the incidence in some acute non recurrent STDs could have increased among homo/bisexual men since 1988. Chlamydia trachomatis is now the most frequent diagnosis in STD clinics. Estimation of male gonorrhoea incidence rate in France in 1990 of 74/100,000 inhabitants (15-59 years) is consistent with figures observed in England and Wales, where the age distribution is very similar. On the other hand, the estimated female gonorrhoea incidence rate of 14/100,000, which concerns only microbiologically ascertained cases, is one third in France than that observed in England and Wales.

CONCLUSION

The consistency of the decreasing trends in gonorrhoea and acute male urethritis observed from the different networks reduces the possibility of a bias due to any change in notification or in prescription. Trends in Chlamydia trachomatis will be better appraised in the near future with the recent implementation of new systems. The French STD surveillance appears quite satisfactory for male infections and has been able to show a marked decrease in the incidence of some STDs in the last years. Surveillance of female STDs is to be improved, in terms of monitored diagnoses and selected health care facilities. Differences between the female gonorrhoea incidence rate observed in England and Wales and the one computed for France could be attributed to differences in contact tracing policies between the two countries or to differences in sexual lifestyles.