On 27 December 2019, the French Public Health Agency identified a large increase in the number of acute gastroenteritis and vomiting visits, both in emergency departments and in emergency general practitioners’ associations providing house-calls. In parallel, on 26 and 27 December, an unusual number of food-borne events suspected to be linked to the consumption of raw shellfish were reported through the mandatory reporting surveillance system. This paper describes these concomitant outbreaks and the investigations’ results.
ObjectiveDescribe short-term health effects of the Hurricane using the syndromic surveillance system based on emergency departments, general practitioners and dispensaries in Saint-Martin and Saint-Barthélemy islands from September 11, 2017 to October 29, 2017.IntroductionIn Saint-Martin (31 949 inhabitants) and Saint-Barthélemy (9 625 inhabitants) islands in the French West Indies, the surveillance system is based on several data sources: (1) a syndromic surveillance system based on two emergency departments (ED) of Saint-Barthélemy (HL de Bruyn) and Saint-Martin (CH Fleming) and on mortality (SurSaUD® network [1])); (2) a network of sentinel general practitioners (GP’s) based on the voluntary participation of 10 GPs in Saint-Martin and 5 in Saint-Barthélemy; (3) the notifiable diseases surveillance system (31 notifiable diseases to individual case-specific form); (4) the regional surveillance systems of leptospirosis and arboviruses based on the biological cases reported by physicians and laboratories of two islands.On September 6, 2017, Hurricane Irma struck Saint-Martin and Saint-Barthélemy islands. Both islands were massively destroyed. This storm led to major material damages, such as power outages, disturbance of drinking water systems, road closures, destruction of medical structures and evacuation or relocation of residents.In this context, the usual monitoring system did not work and life conditions were difficult. The regional unit of French National Public Health Agency set up an epidemiological surveillance by sending epidemiologists in the field in order to collect data directly from ED physicians, GP’s and in dispensaries. Those data allowed to describe short-term health effects and to detect potential disease outbreaks in the aftermath of Hurricane Irma. This paper presents results of the specific syndromic surveillance.MethodsBefore Irma, ED data were collected daily directly from patients’ computerized medical files that were filled in during medical consultations at ED. Among the collected variables, the diagnosis was categorized according to the 10th revision of the International Classification of Diseases (ICD-10). This surveillance system was completed by aggregated data of Emergency Medical Services (EMS), also including medical diagnosis coded using the ICD10.Because of the sudden disruption in hospital departments due to hurricane, electronic transmission was stopped. To replace it, ED data collection turned temporary into paper-forms and several epidemiologists were sent in Saint-Martin and Saint-Barthélemy to collect data directly from the ED physicians. This system remained until the end of October when connections and data transmission were restored.Because of destruction of medical structures, dispensaries were opened in different strategic areas of the island, 3 in Saint-Martin and none in Saint-Barthélemy. General practitioners have progressively reopened their practice (8 GP’s in Saint-Martin and 5 in Saint-Barthélemy) and patient's data were collected and integrated into the surveillance system.Based on a literature review and former experience, the main pathologies identified for the health risk assessment were: (1) somatic pathologies directly or indirectly related to the hurricane (trauma, wounds, cuts, burns, secondary infection); (2) infectious diseases related to the lack of hygiene partly due to damaged water and electricity networks and unavailable health care structures (gastroenteritis, food infections, respiratory diseases, skin infections, tetanus and other pathologies that may occur in the longer term linked to the incubation period especially leptospirosis and hepatitis A); (3) chronic pathologies by discontinuity of care (renal insufficiency, diabetic, cardio-respiratory decompensation, etc.); (4) pathologies related to animal bites and mosquito bites (vector-borne diseases); (5) psychological and / or psychiatry disorders.Then in the French West Indies, from September 11 to October 29,2017, data were routinely analyzed to detect and follow-up various expected or unusual variations of one or more pathology of the above list.ResultsThe following week after Irma (2017-37), the weekly number of ED visits compared to the mean activity observed in normal situation has increased: 1225 ED visits vs. 313 in 2017-35 in Saint-Martin and 227 ED visits vs. 94 ED visits in 2017-35 in Saint-Barthélemy. ED activity has gradually decreased to finally return to a based-activity as observed before the hurricane at the end of October.From September 11 to October 29, 25% of recorded emergency consultations in Saint-Martin island were trauma, wounds, burns and cuts. As in Saint-Martin, 42% of emergency visits in Saint-Barthélemy were pathologies directly or indirectly related to the passage of Irma (trauma, wounds, etc). Others major causes of ED visits were for treatment renewal (diabetes, renal insufficiency, etc.) and gyneco-obstetric activity because general practitioners had stopped their activity.In dispensaries and general practitioners, the most common pathology was gastroenteritis (11% in Saint-Martin) over the entire period of surveillance. At the beginning of the surveillance, skin infections were the most frequently found (20%) in Saint-Martin and psychological disorders (3%) in Saint-Bartélemy, while at the end respiratory infections were the most frequent (6%) in both islands.No increase in visits for chronic diseases, food-borne diseases, acute respiratory or diarrhea illness were detected. No autochthonous confirmed cases of cholera, leptospirosis, vector-bone disease, hepatitis A or typhoid fever had been reported, due to the destruction of the laboratory.ConclusionsSyndromic surveillance in the French West Indies allowed the epidemiologists to assess rapidly the health impact of hurricane in Saint-Martin and Saint-Barthélemy.The well-established relations between French National Public Health Agency and local professionals of both affected islands allowed to temporary switch from an electronic into a paper-based data transmission without any interruption of data analysis.Although several cluster suspicions have been investigated (especially of gastroenteritis, scabies, etc), no massive outbreak was detected. Then even with a degraded system, syndromic surveillance allowed to reinsure authority of the absence of major health impact due to Irma.References1-Caserio- Schönemann C, Bousquet V, Fouillet A, Henry V. Le système de surveillance syndromique SurSaUD ®. Bull Epidemiol Hebd 2014 ;3-4 :38-44.
Background The French syndromic surveillance (SyS) system, SurSaUD®, was one of the systems used to monitor the COVID-19 outbreak. Aim This study described the epidemiological characteristics of COVID-19-related visits to both emergency departments (EDs) and the network of emergency general practitioners known as SOS Médecins (SOSMed) in France from 17 February to 28 June 2020. Methods Data on all visits to 634 EDs and 60 SOSMed associations were collected daily. COVID-19-related visits were identified using ICD-10 codes after coding recommendations were sent to all ED and SOSMed doctors. The time course of COVID-19-related visits was described by age group and region. During the lockdown period, the characteristics of ED and SOSMed visits and hospitalisations after visits were described by age group and gender. The most frequent diagnoses associated with COVID-19-related visits were analysed. Results COVID-19 SyS was implemented on 29 February and 4 March for EDs and SOSMed, respectively. A total of 170,113 ED and 59,087 SOSMed visits relating to COVID-19 were recorded, representing 4.0% and 5.6% of the overall coded activity with a peak in late March representing 22.5% and 25% of all ED and SOSMed visits, respectively. COVID-19-related visits were most frequently reported for women and those aged 15–64 years, although patients who were subsequently hospitalised were more often men and persons aged 65 years and older. Conclusion SyS allowed for population health monitoring of the COVID-19 epidemic in France. As SyS has more than 15 years of historical data with high quality and reliability, it was considered sufficiently robust to contribute to defining the post-lockdown strategy.
ObjectiveThe presentation describes the results of the daily monitoring of health indicators conducted by the French public health agency during the major floods and the cold wave that occurred in January 2018 in France, in order to early identify potential impact of those climatic events on the population.IntroductionThe Seine River rises at the north-East of France and flows through Paris before emptying into the English Channel. On January 2018 (from 22th January to 11th February, Weeks 4 to 6), major floods occurred in the Basin of Seine River, after an important rainy period. This period was also marked by the occurrence on the same area of a first cold wave on Week 6 (from 5th to 7th February), including heavy snowfall and ice conditions from 9th to 10th February. A second similar cold wave occured from 28th February and 1st March.Floods of all magnitude are known to have potential health impacts on population [1], both at short, medium and long term both on physical (injuries, diarrhoeal disease, Carbon Monoxyde poisoning, vector-borne disease) and mental health. Extreme cold weather have also the potential to further impact on human health through direct exposure to lower temperatures, and associated adverse conditions, such as snow and ice [2]. Such situations may be particularly associated to direct impact like hypothermia, frostbite and selected bone/joint injuries).MethodsSince 2004, the French Public Health Agency (Santé publique France) set up a national syndromic surveillance system SurSaUD, enabling to ensure morbidity and mortality surveillance [3]. In 2018, morbidity data were daily collected from a network involving about 700 emergency departments (ED) and 58 emergency general practitioners’ associations SOS Médecins. 92% of the national ED attendances and 95% of national SOS Médecins visits are caught by the system.Both demographic (age and gender), administrative (date and location of consultation, transport) and medical information (chief complaint, medical diagnosis using ICD10 codes in ED and specific thesauri in SOS Médecins associations, severity, hospitalization after discharge) are recorded for each patient.The daily and weekly evolution of the number of all-cause ED attendances and SOS Médecins consultations during the flooding period were compared to the evolution on the two previous years. The number of hospitalisations after ED discharge was also monitored. The immediate health impact of floods and cold waves was assessed by monitoring eight syndromic indicators: gastroenteritis, carbon monoxide poisoning, burnt, stress, faintness, drowning, injuries and hypothermia.Analyses were performed by age group (<15 years, 15-64 years, more than 65 years) and at different geographical levels (national, Paris region and districts located in the Basin of Seine River).ResultsIn 2018, syndromic surveillance did not show any major impact on all-cause ED attendances and SOS Médecins consultations from week 4 to week 6, neither in Paris area nor in other areas along the Seine River. The recorded numbers were comparable to the two precedent years in all age groups.A decrease of the all-cause ED attendances was observed during the 1st day with ice conditions in Normandy and Paris, mainly in children and adults aged 15-64 years.During week 6 in Paris area, an increase of ED attendances was observed for injuries (+4% compared to the past weeks – figure 1) and to a lesser extent for hypothermia and frostbite (16 attendances compared to less than 9 for the past weeks). Similar increase in injuries were observed in Normandy during the second cold wave (Figure 1).ConclusionsDuring the flood episode, the rising water level was slow with foreseeable evolution, compared to other sudden flood events occurring in south of France in 2010 due to violent thunderstorms. This progressive evolution allows French authority to deploy wide specific organization in order to mitigate impact on concerned populations. That may explain the absence impact observed in ED at regional and national levels during the flood disaster. The evolution of injuries during 2018 episode is attributable to the cold wave that occurred simultaneously.As the French syndromic surveillance system is implemented on the whole territory and collects emergency data routinely since several years, it constitutes a reactive tool to assess the potential public health impact of both sudden and predictable disasters. It can either contribute to adapt management action or reassure decision makers if no major impact is observed.References[1] Ahern M, Kovats S. The health impacts of floods. In: Few R, Matthies F, eds. Flood hazards and health: responding to present and future risks. London, Earthscan, 2006:28–53.[2] Hughes H, Morbey R, Hughes T. et al. Using an Emergency Department Syndromic Surveillance System to investigate the impact of extreme cold weather events Public Health. 2014 Jul;128(7):628-35.[3] Caserio-Schönemann C, Bousquet V, Fouillet A, Henry V. The French syndromic surveillance system SurSaUD (R). Bull Epidémiol Hebd 2014;3-4:38-44.
Background Sanitary, societal and economic effects due to the COVID-19 pandemic could lead to an impact on population's mental health. Santé publique France (SpF), the French public health agency set up a specific monitoring based on emergency department (ED) and GP's associations (GPs) SOS Médecins (SOSMed) data to early assess the impact of COVID-19 pandemic on mental health. Methods Since 2004, SpF daily collects data from ED participating to the OSCOUR® network (93% of French emergency attendances) and from SOSMed network. For both data sources, visits for several mental health disorders were analyzed for different age groups in 2020 and 2021 (until Week 16) and compared to years 2018 and 2019 (mean) with a focus on the two lockdown periods (resp W11 to W19-2020 and W45 to W51-2020) Results During the first lockdown period, while a major decrease of all-cause activity was observed in both networks, the number of SOSMed visits for anxiety increased in adults with a peak of + 115% in W13-2020 compared to 2018-19 and remained higher than the 2 previous years until W12-2021. An increase in ED visits for mood disorders (including depression) for children (especially 11-17yo) were also observed from W36 (back to school) and reinforced at the beginning of the 2nd lockdown period to reach +111% in W12-2021 compared to 2018-19. 11-17yo children were also concerned by an increase in ED visits for suicide ideation since W36 (peak of + 170% in W12-2021) and suicide attempt from W04-2021 to W12-2021 (peaks of + 45% and +41% in W05 and W10-2021). Discussion ED and SOSMed visits are the most reactive data sources to assess the impact of COVID-19 pandemic on the mental health of French population. These results confirm that the impact concerns all age groups. For children, the condition seems to worsen in 2021 and highlight the need of a close follow-up of the situation and the reinforcement of preventive measures in order to prevent long-term impacts. Key messages Results confirm an impact of COVID-19 pandemic on populations mental health. Impact of COVID-19 on mental health: a long-term issue for children?
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