Health Impact Assessment of Cyclone Bejisa in Reunion Island (France) Using Syndromic Surveillance

Increase in emergency department visits related to cannabis reported using syndromic surveillance system

BACKGROUND

Cannabis is illegal in France but, as in many countries, legalization is under debate. In the United States, an increase of emergency department (ED) visits related to cannabis exposure (CE) in infants and adults was reported. In France, a retrospective observational study also suggested an increase of CE in children under 6 years old. This study only included toddlers and the data sources used did not allow repeated analysis for monitoring.

METHODS

Our study aimed to evaluate the trend in visits for CE in ED in patients younger than 27 years old in Southern France. A cross-sectional study using the Electronic Emergency Department Abstracts (EEDA) included in the national Syndromic Surveillance System. CE visits were defined using International Classification of Disease (ICD-10).

RESULTS

From 2009 to 2014, 16 EDs consistently reported EEDA with <5% missing diagnosis code. Seven hundred and ninety seven patients were admitted for CE including 49 (4.1%) children under 8 years old. From 2009-11 to 2012-14, the rate of CE visits increased significantly across all age groups. The highest increase was in the 8-14 years old (+144%; 1.85-4.51, P < 0.001) and was also significant in children under 8 (0.53-1.06; P = 0.02). Among children under 8, hospitalization rate (75.5% vs. 16.8%; P < 0.001) and intensive care unit admissions (4.1% vs. 0.1%; P < 0.001) were higher compared with patients older than 8 years.

CONCLUSION

These trends occurred despite cannabis remaining illegal. EEDA could be useful for monitoring CE in EDs.

General Practitioner House Call Network (SOS Médecins): An Essential Tool for Syndromic Surveillance - Bordeaux, France

INTRODUCTION

In the French mainland administrative region Nouvelle-Aquitaine, syndromic surveillance is based on hospital emergency data, mortality data, and data from associations belonging to the SOS Médecins network. The aim of the present article is to describe the functioning of this network and to illustrate its use for syndromic surveillance in Nouvelle-Aquitaine.

METHOD

The SOS Médecins network participates in the syndromic surveillance system SurSaUD, developed by Santé publique France (SpF; the French National Public Health Agency; Saint-Maurice, Paris, France). Near real-time data are automatically transmitted daily to a data server and analyzed by SpF's Nouvelle Aquitaine's regional unit to identify, monitor, and evaluate the impact of expected and unexpected health events in the region.

RESULTS

The SOS Médecins network has five local associations spread across the region with 146 participating physicians. Data have been recorded for more than 10 years and represented nearly 481,000 visits in 2017. The resulting database has helped to identify and monitor seasonal epidemics and unexpected events, as well as measure the health impact of these events.

CONCLUSION

The data from the SOS Médecins network are an essential source in syndromic surveillance. They complement surveillance data from other sources. More specifically, mortality and emergency unit traffic reflect the most severe cases, while SOS Médecins data help early detection of epidemics and health events in the general population. The network has shown its responsiveness and its reliability, not only for the surveillance of seasonal epidemics, but also for the detection of unusual signals. It therefore constitutes an essential link in syndromic surveillance in France, and specifically in the Nouvelle-Aquitaine region.

Evaluation of Change in Knowledge and Attitude of Emergency Medicine Residents after Introduction of a Rotation in Emergency Medical Services and Disaster Medicine

Background:

Saudi Board of Emergency Medicine (SBEM) graduates are involved in a 1-month rotation in emergency medical services (EMSs) and disaster medicine. The purpose of this study was to evaluate change in knowledge and attitude of EM residents after the introduction of the EMS and disaster medicine rotation.

Materials and Methods:

The study included 32 3^rd-year SBEM residents. A pretest/posttest design and a five-point Likert scale were used. The data included a response to a questionnaire developed by EMS and disaster experts. The questionnaire was distributed on the 1^st day of the rotation and 45 days after. Satisfaction questionnaires were distributed after the rotation. The data were analyzed using SPSS 20.

Results:

Twenty-five residents responded to the satisfaction survey (75%). The overall satisfaction with the course modules was high; the course content showed the highest level of satisfaction (96%), and the lowest satisfaction was for the air ambulance ride outs (56%). The results of the pre-/post-test questionnaire showed an increase of 18.5% in the residents mean score (P < 0.001). In the open-ended section, the residents requested that the schedule is distributed before the course start date, to have more field and hands-on experience, and to present actual disaster incidents as discussion cases. The residents were impressed with the organization and diversity of the lectures, and to a lesser extent for the ambulance ride outs and the mass casualty incident drill l. Seventy-one percent indicated that they would recommend this course to other residents.

Conclusion/Recommendation:

This study showed that a structured course in EMS and disaster medicine had improved knowledge and had an overall high level of satisfaction among the residents of the SBEM. Although overall satisfaction and improvement in knowledge were significant, there are many areas in need of better organization.

[Outbreak of carbon monoxide poisoning in the Ile-de-France region during the spring 2016 Seine flooding]

INTRODUCTION

Heavy rainfall in May 2016 caused large-scale flooding of the Seine and its tributaries. Analysis of this unusual event showed that it could recur on an even larger scale. The sanitary consequences were less frequently assessed in this analysis, particularly the risk of accidental collective carbon monoxide (CO) poisoning caused by the use of combustion engine drainage pumps.

METHODS

We retrospectively reviewed all cases of acute accidental carbon monoxide exposure observed in the Ile-de-France region, related to the use of drainage pumps in spring and summer 2016 and notified to the Ile-de-France CO poisoning surveillance network.

RESULTS

Five events were identified, including 45 people exposed to carbon monoxide. Thirty-four of these people were poisoned, 5 were not poisoned and insufficient data were available for 6 people. Three people showed signs of severity and 2 were treated by hyperbaric oxygen therapy. The other poisoned individuals were managed in hospital and treated by oxygen therapy. All were cured.

DISCUSSION

Collective CO poisonings are common sanitary events during flooding and can be potentially severe. They can occur during the event or over the following days. Preventive measures may help to reduce the risk of CO poisoning, such as increased awareness among professionals, better information of individuals who rent these types of devices or even the use of CO detectors during their use.

No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters

Introduction How the burden of disease varies during different phases after floods and after storms is essential in order to guide a medical response, but it has not been well-described. The objective of this review was to elucidate the health problems following flood and storm disasters.

METHODS

A literature search of the databases Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); Cinahl (EBSCO Information Services; Ipswich, Massachusetts USA); Global Health (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science Core Collection (Thomson Reuters; New York, New York USA); Embase (Elsevier; Amsterdam, Netherlands); and PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA) was conducted in June 2015 for English-language research articles on morbidity or mortality and flood or storm disasters. Articles on mental health, interventions, and rescue or health care workers were excluded. Data were extracted from articles that met the eligibility criteria and analyzed by narrative synthesis.

RESULTS

The review included 113 studies. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections all increased after storms. Gastrointestinal infections were more frequent after floods. Leptospirosis and diabetes-related complications increased after both. The majority of changes occurred within four weeks of floods or storms.

CONCLUSION

Health changes differently after floods and after storms. There is a lack of data on the health effects of floods alone, long-term changes in health, and the strength of the association between disasters and health problems. This review highlights areas of consideration for medical response and the need for high-quality, systematic research in this area. Saulnier DD , Brolin Ribacke K , von Schreeb J . No calm after the storm: a systematic review of human health following flood and storm disasters. Prehosp Disaster Med. 2017;32(5):568-579.

Infectious Diseases and Tropical Cyclones in Southeast China

Southeast China is frequently hit by tropical cyclones (TCs) with significant economic and health burdens each year. However, there is a lack of understanding of what infectious diseases could be affected by tropical cyclones. This study aimed to examine the impacts of tropical cyclones on notifiable infectious diseases in southeast China. Disease data between 2005 and 2011 from four coastal provinces in southeast China, including Guangdong, Hainan, Zhejiang, and Fujian province, were collected. Numbers of cases of 14 infectious diseases were compared between risk periods and reference periods for each tropical cyclone. Risk ratios (RRs) were calculated to estimate the risks. TCs were more likely to increase the risk of bacillary dysentery, paratyphoid fever, dengue fever and acute hemorrhagic conjunctivitis (ps < 0.05) than to decrease the risk, more likely to decrease the risk of measles, mumps, varicella and vivax malaria (ps < 0.05) than to increase the risk. In conclusion, TCs have mixed effects on the risk of infectious diseases. TCs are more likely to increase the risk of intestinal and contact transmitted infectious diseases than to decrease the risk, and more likely to decrease the risk of respiratory infectious diseases than to increase the risk. Findings of this study would assist in developing public health strategies and interventions for the reduction of the adverse health impacts from tropical cyclones.

Management of information within emergencies departments in developing countries: analysis at the National Emergency Department in Benin

Introduction

The management of health information is a key pillar in both emergencies reception and handling facilities, given the strategic position and the potential of these facilities within hospitals, and in the monitoring of public health and epidemiology. With the technological revolution, computerization made the information systems evolve in emergency departments, especially in developed countries, with improved performance in terms of care quality, productivity and patient satisfaction. This study analyses the situation of Benin in this field, through the case of the Academic Clinic of Emergency Department of the National University Teaching Hospital of Cotonou, the national reference hospital.

Methods

The study is cross-sectional and evaluative. Collection techniques are literature review and structured interviews. The components rated are resources, indicators, data sources, data management and the use-dissemination of the information through a model adapted from Health Metrics Network framework. We used quantitative and qualitative analysis.

Results

The absence of a regulatory framework restricts the operation of the system in all components and accounts for the lack and inadequacy of the dedicated resources.

Conclusion

Dedication of more resources for this system for crucial needs such as computerization requires sensitization and greater awareness of the administrative authorities about the fact that an effective health information management system is of prime importance in this type of facility.

Development and Application of Syndromic Surveillance for Severe Weather Events Following Hurricane Sandy

OBJECTIVE

Following Hurricane Superstorm Sandy, the New Jersey Department of Health (NJDOH) developed indicators to enhance syndromic surveillance for extreme weather events in EpiCenter, an online system that collects and analyzes real-time chief complaint emergency department (ED) data and classifies each visit by indicator or syndrome.

METHODS

These severe weather indicators were finalized by using 2 steps: (1) key word inclusion by review of chief complaints from cases where diagnostic codes met selection criteria and (2) key word exclusion by evaluating cases with key words of interest that lacked selected diagnostic codes.

RESULTS

Graphs compared 1-month, 3-month, and 1-year periods of 8 Hurricane Sandy-related severe weather event indicators against the same period in the following year. Spikes in overall ED visits were observed immediately after the hurricane for carbon monoxide (CO) poisoning, the 3 disrupted outpatient medical care indicators, asthma, and methadone-related substance use. Zip code level scan statistics indicated clusters of CO poisoning and increased medicine refill needs during the 2 weeks after Hurricane Sandy. CO poisoning clusters were identified in areas with power outages of 4 days or longer.

CONCLUSIONS

This endeavor gave the NJDOH a clearer picture of the effects of Hurricane Sandy and yielded valuable state preparation information to monitor the effects of future severe weather events. (Disaster Med Public Health Preparedness. 2016;10:463-471).

Health Impact Assessment of Cyclone Bejisa in Reunion Island (France) Using Syndromic Surveillance

Introduction

On January 2, 2014, Cyclone Bejisa struck Reunion Island (France). This storm led to major material damages, such as power outages, disturbance of drinking water systems, road closures, and the evacuation of residents. In this context, the Regional Office of French Institute for Public Health Surveillance in Indian Ocean (Cire OI) set up an epidemiological surveillance in order to describe short-term health effects of the cyclone.

Methods

The assessment of the health impact was based mainly on a syndromic surveillance system, including the activity of all emergency departments (EDs) and the Emergency Medical Service (EMS) of the island. From these data, several health indicators were collected and analyzed daily and weekly. To complete this assessment, all medical charts recorded in the EDs of Reunion Island from January 2, 2014 through January 5, 2014 were reviewed in order to identify visits directly and indirectly related to the cyclone, and to determine mechanisms of injuries.

Results

The number of calls to the EMS peaked the day of the cyclone, and the number of ED visits increased markedly over the next two days. At the same time, a significant increase in visits for trauma, burns, and carbon monoxide poisoning was detected in all EDs. Among 1,748 medical records reviewed, eight visits were directly related to the cyclone and 208 were indirectly related. For trauma, the main mechanisms of injury were falls and injuries by machinery or tools during the clean-up and repair works. Due to prolonged power outages, several patients were hospitalized: some to assure continuity of care, others to take care of an exacerbation of a chronic disease. An increase in leptospirosis cases linked to post-cyclone clean-up was observed two weeks after the cyclone.

Conclusion

Information based on the syndromic surveillance system allowed the authors to assess rapidly the health impact of Cyclone Bejisa in Reunion Island; however, an underestimation of this impact was still possible. In the near future, several lines of work will be planned by the authors in order to improve the assessment.

VilainP, PagèsF, CombesX, Marianne Dit CassouPJ, Mougin-DamourK, Jacques-AntoineY, FilleulL. Health impact assessment of Cyclone Bejisa in Reunion Island (France) using syndromic surveillance. Prehosp Disaster Med. 2015;30(2):1-8