Following similar events in other European countries, some cases of dermatitis related to contact with China-imported furniture possibly treated with dimethyl(E)-butenedioate (dimethylfumarate [DMF]) were reported to the French institute for public health surveillance at the beginning of September 2008. An active multisource case collection was conducted in order to provide an epidemiological description of this outbreak. Results of this investigation show that, in France, mainly during the 4th quarter of 2008, a large number of people presented dermatological symptoms at least plausibly due to a contact with DMF-treated consumer products. The products involved were mostly shoes and sofa (94% of cases). This work offers an example of a multipartner investigation in the field of environmental health. It also shows how the results obtained contributed to decision-making and resulted in the limitation of DMF-treated products in France and in Europe.
ObjectiveTo describe the surveillance indicators implemented for the healthimpact assessment of a potential health event occurring before, duringor after the UEFA Euro 2016 football matches in order to timelyimplement control and prevention measures.IntroductionFrance hosted 2016 UEFA European Football Championshipbetween June 10 and July 10. In the particular context of severalterrorist attacks occurring in France in 2015 [1], the French nationalpublic health agency « Santé publique France » (formerly FrenchInstitute for Public Health Surveillance-InVS) was mandated bythe Ministry of Health to reinforce health population surveillancesystems during the UEFA 2016 period. Six French regions and10 main stadiums hosted 51 matches and several official andnonofficial dedicated Fan Zones were implemented in many citiesacross national territory. Three types of hazard have been identified inthis context: outbreak of contagious infectious disease, environmentalexposure and terrorist attack.The objectives of health surveillance of this major sportingevent were the same as for an exceptional event including massgathering [2] : 1/ timely detection of a health event (infectiouscluster, environmental pollution, collective foodborne disease...)to investigate and timely implement counter measures (control andprevention), 2/ health impact assessment of an unexpected event.The French national syndromic surveillance system SurSaUD® wasone of the main tools for timely health impact assessment in thecontext of this event.MethodsFrench national syndromic SurSaUD® system has been setup in 2004 and supervised by Santé publique France for 12 years.It allows the daily automatic collation of individual data from over650 emergency departments (ED) involved in the OSCOUR®network and 61 emergency general practitioners’ (GPs) associations(SOS Médecins) [3]. About 60,000 attendances in ED (88% of thenational attendances) and 8,000 visits in SOS Médecins associations(95% of the national visits) are daily recorded all over the territoryand transmitted to Santé publique France.Medical information such as provisional medical diagnosiscoded according to the International Classification of Diseases, 10thRevision (ICD-10) for EDs and specific thesaurus for SOS Médecinsis routinely monitored through different syndromic indicators (SI).SI are defined by medically relevant clusters of one or severaldiagnoses, serving as proxies for conditions of public health interest.From June 10 to July 10, 19 SI were daily analyzed throughautomatic national and regional dashboards. SI were divided into3 groups of public health surveillance interest :1/ description of population health: injuries, faintness, myocardialinfarction, alcohol, asthma, heat-related symptoms, anxious troubles ;2/ infectious diseases/symptoms with epidemic potential ordiseases/symptoms linked with an environmental exposure: fever,fever associated with cutaneous rash, meningitis, pneumonia,gastroenteritis, collective foodborne disease ;3/ symptoms potentially linked with a CBRN-E exposure:influenza-like illness, burns, conjunctivitis, dyspnea/ difficultybreathing, neurological troubles, acute respiratory failure.Daily analysis were integrated into specific UEFA 2016surveillance bulletins and daily sent to the Ministry of Healthincluding week-ends.ResultsSI followed during the UEFA Euro 2016 period were nonspecificand potentially affected or influenced by several events appart fromthe championship. Between June 10 and July 10, two moderateheat-wave periods occurred on a large part of mainland France : thefirst one from June 22 to 25 (beginning in the West-South of Franceand then moving North and East of the country) and the secondone from July 8 to 11 in the East-South. An increase in heat-relatedindicators (hyperthermia/heat stroke, dehydration, hyponatremia andburns) has been observed during both periods in five French regionsincluding four hosting regions. Only minor increases in the other SIfollowed during the Euro 2016 period were observed.ConclusionsHealth surveillance implemented during 2016 UEFA EuropeanFootball Championship through a daily analysis of non-specificSI from the French syndromic surveillance system SurSaUD® didnot show any major variation associated with the sporting event.The observed variations were related with specific environmentalconditions (heat-waves). Together with the health surveillancesystem, preventive plans were set up during the event essentially byoffering flyers with information and useful tips on the main preventiveattitudes and measures to adopt in a summer festive context (risksassociated with alcohol and drug intake, injuries, heat and sunexposure, dehydration, unprotected sexual behaviour...).
In France, carbon monoxide (CO) poisoning strikes over 5000 people who have to be managed in emergency conditions. In order to improve our knowledge on CO poisoning circumstances, a specific surveillance system has been set up. Its main objective is to provide epidemiological description of poisoning in order to improve preventive messages and rules.MethodsIn France, governmental procedures impose that each CO poisoning case has to be reported to poison control centres or public health services. A technical investigation is immediately conducted to identify causes of poisoning. A medical investigation is also set up to describe clinical symptoms, medical management and severity. Since there are no specific clinic symptoms of CO poisoning, an epidemiological case definition was built, combining both environmental and medical criteria (clinical symptoms, impregnation estimation, atmospheric measurements, and technological signs).ResultsAbout 1300 CO poisoning incidents involving 4000 exposed persons were yearly declared. 85% of those were domestic unintentional poisoning, half of which concerned home owners and were caused by gas furnaces with favouring conditions like voluntarily obstructed ventilation. Public health preventive messages focused on good ventilation and annual check of gas furnaces. During winter power outages, outbreaks were due to misuse of generators or portable heating devices. Preventive messages then focused on the right use of these devices.ConclusionsThis surveillance system has improved our knowledge about CO poisoning circumstances. A dual strategy of preventive messages and rules has been set up to transform public health knowledge into action.
Issue After a period of low-level circulation of a few cases per week during 2017, La Réunion experienced an outbreak of dengue in 2018 followed by a second and ongoing larger epidemic wave in 2019. Various surveillance systems have been progressively implemented to monitor and characterize the outbreak. Methods All laboratory diagnoses of dengue are routinely notified to the regional health authority (RHA) for investigation. With the outbreak onset additional programmes were implemented including the monitoring of presentations to emergency departments (EDs) and hospitalisations of dengue cases. In addition, all death notifications to the RHA which cite dengue are reviewed by an expert committee and the cause of death classified as directly, indirectly or unrelated to dengue. Finally, weekly data from a sentinel network of general practitioners is used to estimate the number of community consultations with dengue-like illness across the island. Results In 2017, 97 dengue cases were notified, with low level circulation continuing through the austral winter. In 2018, 6,679 cases (exclusively serotype 2) were notified. Western and southern regions of the island were most affected. The supplementary surveillance identified over 500 ED presentations for dengue-like illness and 160 hospitalisations. Three deaths were determined to be directly due to dengue, while 3 were indirectly related. Finally, there was an estimated 26,000 consultations for dengue-like illness in the community. After a second winter of persistent circulation, a second epidemic wave commenced in December 2018, and is still ongoing. Lessons The implementation of additional surveillance systems enabled a better understanding of the magnitude and impact of the outbreak. The use of sentinel network allowed the estimation of the number of people affected in the community without a laboratory diagnosis. The ongoing viral circulation since 2017 suggests a high risk of endemisation of dengue on the island. Key messages The outbreak has had a significant impact of health and community health services, and on the wider population. The second consecutive austral winter with interrupted transmission suggest a high risk of endemisation.
Issue/Problem The surveillance of seasonal infectious diseases in Reunion is based on a Sentinel physician’s network of 52 volunteers, which is coordinated by the Indian Ocean regional office. Description of the problem The main objectives are to identify and monitor outbreaks of infectious diseases like influenza-like-illness (ILI) gastroenteritis, dengue, and conjunctivitis. A virological surveillance set up to characterize circulating respiratory viruses from a nasal swab collected by the physicians. Swabs are tested by RT-PCR for influenza in the reference laboratory. Results The surveillance demonstrated that the influenza season during the 2018 austral winter ran from September to October. More than 55 000 consultations related to ILI were estimated. The virological surveillance confirmed the circulation of A (H3N2) principally in 2018. The physician’s network identified the first cases of chikungunya in Réunion Island in 2005 and data collected by this physician’s network provide the epidemic trends with weekly estimation’s of total numbers of consultations in the Reunion Island. More than 25 000 community consultations of dengue-like-illness have been estimated. The physician’s network took part in the surveillance of conjunctivitis outbreak in 2016 and identified an outbreak of norovirus gastroenteritis in Reunion Island in 2007 and 2012. Lessons This network is an essential tool for disease surveillance and control activities. Key messages The network provides provisional virological and severity data on circulating influenza several months before the onset of influenza season in mainland France. The network is engaged and active which enables the early detection of any emergent diseases.
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