1
|
Sideroglou T, Chrysostomou A, Politi L, Georgalis L, Mellou K. Gastroenteritis Outbreaks after Contamination of Water Supply Systems: Public Health Response Gaps and Challenges, Greece, 2004-2023. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:701. [PMID: 38928947 PMCID: PMC11203888 DOI: 10.3390/ijerph21060701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND waterborne disease outbreaks (WGDOs) following the contamination of drinking water remain a public health concern. METHODS The current study aims to assess the occurrence and identify gaps in the notification and investigation of WGDOs in Greece. Data for 2004-2023 were retrieved and summarized. RESULTS Thirty-five outbreaks with 6128 recorded cases were identified. The median time from the date of onset in the first cases to reporting was 7 days (range: 1-26 days). Authorities were informed by health care services in thirty (85.7%) outbreaks and by the media in five (14.3%). The investigation methods used varied. An analytical study was conducted in nine (25.7%) outbreaks and the testing of clinical samples in twenty-seven (77.1%). In three (11.1%) outbreaks, clinical samples were simultaneously tested for multiple bacteria, viruses, and parasites. Water samples were collected in nineteen (54.3%) outbreaks (in three after chlorination) with a mean time lag of 5 days (range: 1-20 days) from the first cases. A pathogen in clinical samples was identified in 20 (57.1%) outbreaks and, in 1 (6.25%), the same microorganism was isolated in both clinical and water samples. CONCLUSIONS delays in reporting and the heterogeneity of investigations depict that the surveillance of WGDOs and response practices should be strengthened, and operational procedures should be standardised.
Collapse
Affiliation(s)
- Theologia Sideroglou
- Department of Foodborne and Waterborne Diseases, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece; (T.S.); (A.C.); (L.G.)
| | - Anthi Chrysostomou
- Department of Foodborne and Waterborne Diseases, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece; (T.S.); (A.C.); (L.G.)
| | - Lida Politi
- Department of Microbial Resistance and Infections in Health Care Settings, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece;
| | - Leonidas Georgalis
- Department of Foodborne and Waterborne Diseases, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece; (T.S.); (A.C.); (L.G.)
| | - Kassiani Mellou
- Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece
| |
Collapse
|
2
|
Politi L, Mellou K, Chrysostomou A, Mandilara G, Spiliopoulou I, Theofilou A, Polemis M, Tryfinopoulou K, Sideroglou T. A Community Waterborne Salmonella Bovismorbificans Outbreak in Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:167. [PMID: 38397659 PMCID: PMC10887688 DOI: 10.3390/ijerph21020167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND In August 2022, the Hellenic National Public Health Organisation was notified about a gastroenteritis outbreak in town A in Southern Greece. Investigations aimed to identify the source and implement control measures. METHODS Case definition categories were used in a 1:3 case-control study. Cases and controls were interviewed about various exposures. Cases' stool samples were cultured on agar plates and characterised by serotyping, antimicrobial susceptibility testing and Pulse Field Gel Electrophoresis (PFGE). Environmental investigations included tap water sampling for microbiological and chemical analysis in town A and inspection of the water supply system. RESULTS We identified 33 cases (median age: 17 years). Tap water consumption was the only significant risk factor for gastroenteritis (OR = 5.46, 95% CI = 1.02-53.95). Salmonella (S.) Bovismorbificans isolated from eight stool and one tap water samples had identical PFGE profiles. No resistant isolates were identified. Residual chlorine levels were lower than the acceptable limits before and during the outbreak. We advised consumption of bottled water and adherence to strict hand hygiene rules until tap water was declared suitable for drinking. CONCLUSIONS Epidemiological and molecular data revealed a waterborne S. Bovismorbificans outbreak in town A. We recommend local water safety authorities to ensure that residual chlorine levels comply with the legislation towards water safety planning, to mitigate risks.
Collapse
Affiliation(s)
- Lida Politi
- Department of Microbial Resistance and Infections in Health Care Settings, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece;
| | - Kassiani Mellou
- Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece
| | - Anthi Chrysostomou
- Department of Foodborne and Waterborne Diseases, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece; (A.C.); (T.S.)
| | - Georgia Mandilara
- National Reference Centre for Salmonella and Shigella, School of Public Health, University of West Attica, 11521 Athens, Greece;
| | - Ioanna Spiliopoulou
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (I.S.); (K.T.)
| | - Antonia Theofilou
- Water Microbiology Laboratory, Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece;
| | - Michalis Polemis
- National Electronic Antimicrobial Resistance Surveillance Network, Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece;
| | - Kyriaki Tryfinopoulou
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (I.S.); (K.T.)
| | - Theologia Sideroglou
- Department of Foodborne and Waterborne Diseases, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece; (A.C.); (T.S.)
| |
Collapse
|
3
|
Pouey J, Galey C, Chesneau J, Jones G, Franques N, Beaudeau P, Mouly D. Implementation of a national waterborne disease outbreak surveillance system: overview and preliminary results, France, 2010 to 2019. ACTA ACUST UNITED AC 2021; 26. [PMID: 34448447 PMCID: PMC8393890 DOI: 10.2807/1560-7917.es.2021.26.34.2001466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Waterborne disease outbreaks (WBDO) associated with tap water consumption are probably underestimated in France. Aim In order to improve their detection, Santé publique France launched a surveillance system in 2019, based on the periodical analysis of health insurance data for medicalised acute gastroenteritis (mAGE). Methods Spatio-temporal cluster detection methods were applied to mAGE cases to prioritise clusters for further investigation. These investigations determined the plausibility that infection is of waterborne origin and the strength of association. Results Between January 2010 and December 2019, 3,323 priority clusters were detected (53,878 excess mAGE cases). They involved 3,717 drinking water supply zones (WSZ), 15.4% of all French WSZ. One third of these WSZ (33.4%; n = 1,242 WSZ) were linked to repeated clusters. Moreover, our system detected 79% of WBDO voluntarily notified to health authorities. Conclusion Environmental investigations of detected clusters are necessary to determine the plausibility that infection is of waterborne origin. Consequently, they contribute to identifying which WSZ are linked to clusters and for which specific actions are needed to avoid future outbreaks. The surveillance system incorporates three priority elements: linking environmental investigations with water safety plan management, promoting the systematic use of rainfall data to assess waterborne origin, and focusing on repeat clusters. In the absence of an alternative clear hypothesis, the occurrence of a mAGE cluster in a territory completely matching a distribution zone indicates a high plausibility of water origin.
Collapse
Affiliation(s)
| | | | | | | | - Nathalie Franques
- Direction générale de la Santé, Ministère des solidarités et de la santé, Paris, France
| | | | -
- Santé publique France, Saint-Maurice, France
| | | |
Collapse
|
4
|
Hyllestad S, Amato E, Nygård K, Vold L, Aavitsland P. The effectiveness of syndromic surveillance for the early detection of waterborne outbreaks: a systematic review. BMC Infect Dis 2021; 21:696. [PMID: 34284731 PMCID: PMC8290622 DOI: 10.1186/s12879-021-06387-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background Waterborne outbreaks are still a risk in high-income countries, and their early detection is crucial to limit their societal consequences. Although syndromic surveillance is widely used for the purpose of detecting outbreaks days earlier than traditional surveillance systems, evidence of the effectiveness of such systems is lacking. Thus, our objective was to conduct a systematic review of the effectiveness of syndromic surveillance to detect waterborne outbreaks. Method We searched the Cochrane Library, Medline/PubMed, EMBASE, Scopus, and Web of Science for relevant published articles using a combination of the keywords ‘drinking water’, ‘surveillance’, and ‘waterborne disease’ for the period of 1990 to 2018. The references lists of the identified articles for full-text record assessment were screened, and searches in Google Scholar using the same key words were conducted. We assessed the risk of bias in the included articles using the ROBINS-I tool and PRECEPT for the cumulative body of evidence. Results From the 1959 articles identified, we reviewed 52 articles, of which 18 met the eligibility criteria. Twelve were descriptive/analytical studies, whereas six were simulation studies. There is no clear evidence for syndromic surveillance in terms of the ability to detect waterborne outbreaks (low sensitivity and high specificity). However, one simulation study implied that multiple sources of signals combined with spatial information may increase the timeliness in detecting a waterborne outbreak and reduce false alarms. Conclusion This review demonstrates that there is no conclusive evidence on the effectiveness of syndromic surveillance for the detection of waterborne outbreaks, thus suggesting the need to focus on primary prevention measures to reduce the risk of waterborne outbreaks. Future studies should investigate methods for combining health and environmental data with an assessment of needed financial and human resources for implementing such surveillance systems. In addition, a more critical thematic narrative synthesis on the most promising sources of data, and an assessment of the basis for arguments that joint analysis of different data or dimensions of data (e.g. spatial and temporal) might perform better, should be carried out. Trial registration PROSPERO: International prospective register of systematic reviews. 2019. CRD42019122332. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06387-y.
Collapse
Affiliation(s)
- Susanne Hyllestad
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Institute of Health and Society, Oslo, Norway.
| | - Ettore Amato
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Karin Nygård
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Line Vold
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Preben Aavitsland
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
5
|
Strakova N, Shagieva E, Ovesna P, Korena K, Michova H, Demnerova K, Kolackova I, Karpiskova R. The effect of environmental conditions on the occurrence of Campylobacter jejuni and Campylobacter coli in wastewater and surface waters. J Appl Microbiol 2021; 132:725-735. [PMID: 34192401 PMCID: PMC9290866 DOI: 10.1111/jam.15197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 12/19/2022]
Abstract
Aims The purpose of the study was to evaluate the occurrence of Campylobacter jejuni and Campylobacter coli in the aquatic environment based on the water origin, seasonality and physico‐chemical properties. Methods and Results The occurrence of C. jejuni and C. coli was determined in waste (29) or surface (56) waters in four different seasons. The air and water temperatures were measured during sampling and chemical analyses of water samples for ammonium, chloride, chlorine, nitrite, nitrate, phosphate and iron were performed. The thermotolerant Campylobacter spp. were more frequently detected in wastewater (59%; 17 positive samples) compared to surface water (38%; 21 positive samples), with the highest rate in autumn (67% of samples positive) and with a higher C. coli occurrence than C. jejuni (31% vs. 26%). Ammonium (above 0.2 mg/L) and chloride ion concentrations (above 60 mg/L) favour C. jejuni. Similarly, C. coli occurrence in water was supported by ammonium (above 0.2 mg/L), chloride (above 60 mg/L) and in addition by phosphate ion concentrations (below 0.7 mg/L). Conclusions Campylobacter presence in water is influenced by physico‐chemical parameters such as concentrations of ammonium and chloride ions. Significance and Impact of the Study Water environment is an alternative source of Campylobacter. The concentration of ammonium and chloride ions can be used as a basis for successful prediction of the potential occurrence of C. jejuni and C. coli in wastewater and surface water in future.
Collapse
Affiliation(s)
| | - Ekaterina Shagieva
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Czech Republic
| | - Petra Ovesna
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | | | - Hana Michova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Czech Republic
| | - Katerina Demnerova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Czech Republic
| | | | | |
Collapse
|
6
|
Hyllestad S, Iversen A, MacDonald E, Amato E, Borge BÅS, Bøe A, Sandvin A, Brandal LT, Lyngstad TM, Naseer U, Nygård K, Veneti L, Vold L. Large waterborne Campylobacter outbreak: use of multiple approaches to investigate contamination of the drinking water supply system, Norway, June 2019. ACTA ACUST UNITED AC 2020; 25. [PMID: 32885779 PMCID: PMC7472686 DOI: 10.2807/1560-7917.es.2020.25.35.2000011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
On 6 June 2019, the Norwegian Institute of Public Health was notified of more than 50 cases of gastroenteritis in Askøy. A reservoir in a water supply system was suspected as the source of the outbreak because of the acute onset and geographical distribution of cases. We investigated the outbreak to confirm the source, extent of the outbreak and effect of control measures. A case was defined as a person in a household served by Water Supply System A (WSS-A) who had gastroenteritis for more than 24 h between 1 and 19 June 2019. We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. System information of WSS-A was collected. Whole genome sequencing on human and environmental isolates was performed. Among 6,108 individuals, 1,573 fulfilled the case definition. Residents served by the reservoir had a 4.6× higher risk of illness than others. Campylobacter jejuni isolated from cases (n = 24) and water samples (n = 4) had identical core genome MLST profiles. Contamination through cracks in the reservoir most probably occurred during heavy rainfall. Water supply systems are susceptible to contamination, particularly to certain weather conditions. This highlights the importance of water safety planning and risk-based surveillance to mitigate risks.
Collapse
Affiliation(s)
- Susanne Hyllestad
- University of Oslo, Faculty of Medicine, Institute of Health and Society, Oslo, Norway.,Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Emily MacDonald
- Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Ettore Amato
- European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Control and Prevention (ECDC), Stockholm, Sweden.,Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | - Lin T Brandal
- Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Trude Marie Lyngstad
- Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Umaer Naseer
- Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Karin Nygård
- Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Lamprini Veneti
- Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Line Vold
- Department of Zoonoses, Food- and Waterborne Diseases, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
7
|
Bounoure F, Mouly D, Beaudeau P, Bentayeb M, Chesneau J, Jones G, Skiba M, Lahiani-Skiba M, Galey C. Syndromic Surveillance of Acute Gastroenteritis Using the French Health Insurance Database: Discriminatory Algorithm and Drug Prescription Practices Evaluations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124301. [PMID: 32560168 PMCID: PMC7345322 DOI: 10.3390/ijerph17124301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 01/26/2023]
Abstract
The French national public health agency (Santé publique France) has used data from the national health insurance reimbursement system (SNDS) to identify medicalised acute gastroenteritis (mAGE) for more than 10 years. This paper presents the method developed to evaluate this system: performance and characteristics of the discriminatory algorithm, portability in mainland and overseas French departments, and verification of the mAGE database updating process. Pharmacy surveys with certified mAGE from 2012 to 2015 were used to characterise mAGE and to estimate the sensitivity and predictive positive value (PPV) of the algorithm. Prescription characteristics from these pharmacy surveys and from 2014 SNDS prescriptions in six mainland and overseas departments were compared. The sensitivity (0.90) and PPV (0.82) did not vary according to the age of the population or year. Prescription characteristics were similar within all studied departments. This confirms that the algorithm can be used in all French departments, for both paediatric and adult populations, with stability and durability over time. The algorithm can identify mAGE cases at a municipal level. The validated system has been implemented in a national waterborne disease outbreaks surveillance system since 2019 with the aim of improving the prevention of infectious disease risk attributable to localised tap water systems.
Collapse
Affiliation(s)
- Frederic Bounoure
- Laboratory of Pharmaceutical & Biopharmaceutical Technology, UFR of Health, Normandy University, Unirouen, 22 Bd Gambetta, 76183 Rouen Cedex, France; (M.S.); (M.L.-S.)
- DC2N, INSERM U1239, Unirouen, Normandy University, 76128 Mont Saint Aignan, France
- Correspondence:
| | - Damien Mouly
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Pascal Beaudeau
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Malek Bentayeb
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Julie Chesneau
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Gabrielle Jones
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| | - Mohamed Skiba
- Laboratory of Pharmaceutical & Biopharmaceutical Technology, UFR of Health, Normandy University, Unirouen, 22 Bd Gambetta, 76183 Rouen Cedex, France; (M.S.); (M.L.-S.)
- DC2N, INSERM U1239, Unirouen, Normandy University, 76128 Mont Saint Aignan, France
| | - Malika Lahiani-Skiba
- Laboratory of Pharmaceutical & Biopharmaceutical Technology, UFR of Health, Normandy University, Unirouen, 22 Bd Gambetta, 76183 Rouen Cedex, France; (M.S.); (M.L.-S.)
- DC2N, INSERM U1239, Unirouen, Normandy University, 76128 Mont Saint Aignan, France
| | - Catherine Galey
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (D.M.); (P.B.); (M.B.); (J.C.); (G.J.); (C.G.)
| |
Collapse
|
8
|
Vilcu AM, Blanchon T, Sabatte L, Souty C, Maravic M, Hanslik T, Steichen O. Cross-validation of an algorithm detecting acute gastroenteritis episodes from prescribed drug dispensing data in France: comparison with clinical data reported in a primary care surveillance system, winter seasons 2014/15 to 2016/17. BMC Med Res Methodol 2019; 19:110. [PMID: 31151387 PMCID: PMC6545010 DOI: 10.1186/s12874-019-0745-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/29/2019] [Indexed: 12/15/2022] Open
Abstract
Background This study compares an algorithm to detect acute gastroenteritis (AG) episodes from drug dispensing data to the validated data reported in a primary care surveillance system in France. Methods We used drug dispensing data collected in a drugstore database and data collected by primary care physicians involved in a French surveillance network, from season 2014/15 to 2016/17. We used an adapted version of an AG discrimination algorithm to identify AG episodes from the drugstore database. We used Pearson’s correlation coefficient to evaluate the agreement between weekly AG signals obtained from the two data sources during winter months, in the overall population, by specific age-groups and by regions. Results Correlations between AG signals for all ages were 0.84 [95%CI 0.69; 0.92] for season 2014/15, 0.87 [95%CI 0.75; 0.93] for season 2015/16 and 0.94 [95%CI 0.88; 0.97] for season 2016/17. The association between AG signals estimated from two data sources varied significantly across age groups in season 2016/17 (p-value < 0.01), and across regions in all three seasons studied (p-value < 0.01). Conclusions There is a strong agreement between the dynamic of AG activity estimated from drug dispensing data and from validated primary care surveillance data collected during winter months in the overall population but the agreement is poorer in several age groups and in several regions. Once automated, the reuse of drug dispensing data, already collected for reimbursement purposes, could be a cost-efficient method to monitor AG activity at the national level. Electronic supplementary material The online version of this article (10.1186/s12874-019-0745-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France.
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Laure Sabatte
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Cécile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Milka Maravic
- Real World Insight, IQVIA, F-92099, La Défense Cedex, France.,Assistance Publique - Hôpitaux de Paris (APHP), hôpital Lariboisière, Service de Rhumatologie, F-75010, Paris, France
| | - Thomas Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France.,Université de Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR de Médecine, F-78000, Versailles, France.,Assistance Publique - Hôpitaux de Paris (APHP), hôpital Ambroise Paré, Service de Médecine Interne, F-92100, Boulogne Billancourt, France
| | - Olivier Steichen
- Sorbonne Université, Inserm, université Paris 13, Laboratoire d'informatique médicale et d'ingénierie des connaissances en e-santé, LIMICS, F-75006, Paris, France.,Assistance Publique - Hôpitaux de Paris (APHP), hôpital Tenon, Service de Médecine Interne, F-75020, Paris, France
| |
Collapse
|
9
|
Mouly D, Goria S, Mounié M, Beaudeau P, Galey C, Gallay A, Ducrot C, Le Strat Y. Waterborne Disease Outbreak Detection: A Simulation-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071505. [PMID: 30018195 PMCID: PMC6068474 DOI: 10.3390/ijerph15071505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 11/16/2022]
Abstract
Waterborne disease outbreaks (WBDOs) remain a public health issue in developed countries, but to date the surveillance of WBDOs in France, mainly based on the voluntary reporting of clusters of acute gastrointestinal infections (AGIs) by general practitioners to health authorities, is characterized by low sensitivity. In this context, a detection algorithm using health insurance data and based on a space–time method was developed to improve WBDO detection. The objective of the present simulation-based study was to evaluate the performance of this algorithm for WBDO detection using health insurance data. The daily baseline counts of acute gastrointestinal infections were simulated. Two thousand simulated WBDO signals were then superimposed on the baseline data. Sensitivity (Se) and positive predictive value (PPV) were both used to evaluate the detection algorithm. Multivariate regression was also performed to identify the factors associated with WBDO detection. Almost three-quarters of the simulated WBDOs were detected (Se = 73.0%). More than 9 out of 10 detected signals corresponded to a WBDO (PPV = 90.5%). The probability of detecting a WBDO increased with the outbreak size. These results underline the value of using the detection algorithm for the implementation of a national surveillance system for WBDOs in France.
Collapse
Affiliation(s)
- Damien Mouly
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Sarah Goria
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Michael Mounié
- Unité D'évaluation Médico-Economique, Université Paul Sabatier, CHU 31059 Toulouse, France.
| | - Pascal Beaudeau
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Catherine Galey
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Anne Gallay
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Christian Ducrot
- Institut National de la Recherche Agronomique, UR346-Unité d'Épidémiologie Animale, 63 122 Saint Genès Champanelle, France.
| | - Yann Le Strat
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| |
Collapse
|
10
|
Andrade L, O'Dwyer J, O'Neill E, Hynds P. Surface water flooding, groundwater contamination, and enteric disease in developed countries: A scoping review of connections and consequences. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 236:540-549. [PMID: 29428708 DOI: 10.1016/j.envpol.2018.01.104] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/23/2018] [Accepted: 01/30/2018] [Indexed: 05/27/2023]
Abstract
Significant volumes of research over the past four decades has sought to elucidate the social, infrastructural, economic, and human health effects of climate change induced surface flooding. To date, epidemiological and public health studies of flooding events have focused on mental health effects, vector-borne diseases, and infectious enteric disease due to floodwater contact (i.e. typically low consumption rates). The inherent nature of groundwater (i.e. out of sight, out of mind) and the widely held belief that aquifers represent a pristine source of drinking water due to natural attenuation may represent the "perfect storm" causing direct consumption of relatively large volumes of surface flood-contaminated groundwater. Accordingly, the current study sought to systematically identify and synthesize all available peer-reviewed literature pertaining to the nexus between surface flooding, groundwater contamination and human gastroenteric outcomes. Just 14 relevant studies were found to have been published during the period 1980-2017, thus highlighting the fact that this potentially significant source of climate-related exposure to environmental infection has remained understudied to date. Studies differed significantly in terms of type and data reporting procedures, making it difficult to discern clear trends and patterns. Approximately 945 confirmed cases of flood-related enteric disease were examined across studies; these concurred with almost 10,000 suspected cases, equating to approximately 20 suspected cases per confirmed case. As such, no regional, national or global estimates are available for the human gastrointestinal health burden of flood-related groundwater contamination. In light of the demonstrable public health significance of the concurrent impacts of groundwater susceptibility and climate change exacerbation, strategies to increase awareness about potential sources of contamination and motivate precautionary behaviour (e.g. drinking water testing and treatment, supply interruptions) are necessary. Mainstreaming climate adaptation concerns into planning policies will also be necessary to reduce human exposure to waterborne sources of enteric infection.
Collapse
Affiliation(s)
- L Andrade
- School of Architecture, Planning & Environmental Policy, University College Dublin, Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
| | - E O'Neill
- School of Architecture, Planning & Environmental Policy, University College Dublin, Ireland
| | - P Hynds
- Environmental Sustainability & Health Institute, Dublin Institute of Technology, Ireland.
| |
Collapse
|
11
|
Coly S, Vincent N, Vaissiere E, Charras-Garrido M, Gallay A, Ducrot C, Mouly D. Waterborne disease outbreak detection: an integrated approach using health administrative databases. JOURNAL OF WATER AND HEALTH 2017; 15:475-489. [PMID: 28771145 DOI: 10.2166/wh.2017.273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hundreds of waterborne disease outbreaks (WBDO) of acute gastroenteritis (AGI) due to contaminated tap water are reported in developed countries each year. Such outbreaks are probably under-detected. The aim of our study was to develop an integrated approach to detect and study clusters of AGI in geographical areas with homogeneous exposure to drinking water. Data for the number of AGI cases are available at the municipality level while exposure to tap water depends on drinking water networks (DWN). These two geographical units do not systematically overlap. This study proposed to develop an algorithm which would match the most relevant grouping of municipalities with a specific DWN, in order that tap water exposure can be taken into account when investigating future disease outbreaks. A space-time detection method was applied to the grouping of municipalities. Seven hundred and fourteen new geographical areas (groupings of municipalities) were obtained compared with the 1,310 municipalities and the 1,706 DWN. Eleven potential WBDO were identified in these groupings of municipalities. For ten of them, additional environmental investigations identified at least one event that could have caused microbiological contamination of DWN in the days previous to the occurrence of a reported WBDO.
Collapse
Affiliation(s)
- S Coly
- INRA, UR346 - Unité d'Épidémiologie Animale, Centre de recherche de Clermont-Ferrand, 63122 Saint Genès Champanelle, France
| | - N Vincent
- French National Public Health Agency, 12 rue du Val d'Osne, 94 415 Saint-Maurice Cedex, France E-mail:
| | - E Vaissiere
- French National Public Health Agency, 12 rue du Val d'Osne, 94 415 Saint-Maurice Cedex, France E-mail:
| | - M Charras-Garrido
- INRA, UR346 - Unité d'Épidémiologie Animale, Centre de recherche de Clermont-Ferrand, 63122 Saint Genès Champanelle, France
| | - A Gallay
- French National Public Health Agency, 12 rue du Val d'Osne, 94 415 Saint-Maurice Cedex, France E-mail:
| | - C Ducrot
- INRA, UR346 - Unité d'Épidémiologie Animale, Centre de recherche de Clermont-Ferrand, 63122 Saint Genès Champanelle, France
| | - D Mouly
- French National Public Health Agency, 12 rue du Val d'Osne, 94 415 Saint-Maurice Cedex, France E-mail:
| |
Collapse
|
12
|
Fonteneau L, Le Meur N, Cohen-Akenine A, Pessel C, Brouard C, Delon F, Desjeux G, Durand J, Kirchgesner J, Lapidus N, Lemaitre M, Tala S, Thiébaut A, Watier L, Rudant J, Guillon-Grammatico L. [The use of administrative health databases in infectious disease epidemiology and public health]. Rev Epidemiol Sante Publique 2017. [PMID: 28624133 DOI: 10.1016/j.respe.2017.03.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The public health burden resulting from infectious diseases requires efforts in surveillance and evaluation of health care. The use of administrative health databases (AHD) and in particular the French national health insurance database (SNIIRAM) is an opportunity to improve knowledge in this field. The SNIIRAM data network (REDSIAM) workshop dedicated to infectious diseases conducted a narrative literature review of studies using French AHD. From the results, benefits and limits of these new tools in the field of infectious diseases are presented. METHODS Publications identified by the members of the workgroup were collected using an analytical framework that documented the pathology of interest, the aim of the study, the goal of the developed algorithm, the kind of data, the study period, and the presence of an evaluation or a discussion of the performance of the performed algorithm. RESULTS Fifty-five articles were identified. A majority focused on the field of vaccination coverage and joint infections. Excluding vaccine coverage field, the aim of 28 studies was epidemiological surveillance. Twenty-six studies used hospital databases exclusively, 18 used ambulatory databases exclusively and 4 used both. Validation or discussion of the performed algorithm was present in 18 studies. CONCLUSIONS The literature review confirmed the interest of the French AHD in the infectious diseases field. The AHD are additional tools of the existing surveillance systems and their use will probably be more frequent in the coming years given their advantage and reliability. However, incoming users need to be assisted. Thus, the workgroup will contribute to a reasonable use of AHD and support future developments.
Collapse
Affiliation(s)
- L Fonteneau
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | | | - A Cohen-Akenine
- REDSIAM, groupe de travail infectieux, France; Haute Autorité de santé, Saint-Denis la Plaine, France
| | - C Pessel
- Haute Autorité de santé, Saint-Denis la Plaine, France
| | - C Brouard
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - F Delon
- REDSIAM, groupe de travail infectieux, France; Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - G Desjeux
- REDSIAM, groupe de travail infectieux, France; Caisse nationale militaire de sécurité sociale, Toulon, France
| | - J Durand
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - J Kirchgesner
- REDSIAM, groupe de travail infectieux, France; Inserm, unité mixte de recherche en santé 1136, institut Pierre-Louis d'épidémiologie et de santé publique, Paris, France
| | - N Lapidus
- REDSIAM, groupe de travail infectieux, France; Département de santé publique, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), Sorbonne universités, UPMC université Paris 06, hôpital Saint-Antoine, AP-HP, 75000 Paris, France
| | - M Lemaitre
- REDSIAM, groupe de travail infectieux, France; Haute Autorité de santé, Saint-Denis la Plaine, France
| | - S Tala
- REDSIAM, groupe de travail infectieux, France; Département études sur l'offre de soins, direction de la stratégie, des études et des statistiques, Caisse nationale d'assurance maladie des travailleurs salariés, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - A Thiébaut
- REDSIAM, groupe de travail infectieux, France; Biostatistics, biomathematics, pharmacoepidemiology and infectious diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, 75000 Paris, France
| | - L Watier
- REDSIAM, groupe de travail infectieux, France; Biostatistics, biomathematics, pharmacoepidemiology and infectious diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, 75000 Paris, France
| | - J Rudant
- REDSIAM, groupe de travail infectieux, France; Département études de santé publique, direction de la stratégie, des études et des statistiques, Caisse nationale d'assurance maladie des travailleurs salariés, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - L Guillon-Grammatico
- REDSIAM, groupe de travail infectieux, France; Service d'information médicale d'épidémiologie et d'économie de la santé, unité régionale d'épidémiologie hospitalière (UREH), université F.-abelais, CHRU de Tours, 37000 Tours, France
| |
Collapse
|