Waterborne Disease Outbreak Detection: A Simulation-Based Study

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.

The effectiveness of syndromic surveillance for the early detection of waterborne outbreaks: a systematic review

“…A summary of the study characteristics of the included studies is presented in Additional File 1. Of these included articles, 12 were descriptive or analytical studies assessing either historical outbreaks or data of cases of gastrointestinal illness and data signals for early detection of waterborne outbreaks [19][20][21][22][23][24][25][26][27][28][29][30], and six were simulation studies evaluating the system performance of different SyS systems [31][32][33][34][35][36]. The included studies originated from the USA (n = 7), France (n = 4), the United Kingdom (n = 3), Sweden (n = 2), Canada (n = 1) and, with one study assessing data from several European countries suggesting a common surveillance approach [24], covering an overall study period of 1997 to 2013, with multiple agents causing waterborne outbreaks or illness.…”

The Effectiveness of Syndromic Surveillance for the Early Detection of Waterborne Outbreaks: A Systematic Review

“…Mouly et al 2018 (29) evaluated the performance of an algorithm using the French SyS system for waterborne outbreak detection through a simulation-based study using multivariate regression to identify the factors associated with outbreak detection. Almost three-quarters of the simulated outbreak were detected (sensitivity of 73%), and more than 9 out of the 10 detected signals corresponded to a waterborne outbreak (positive predictive value of 90.5%).…”

“…A summary of the study characteristics of the included studies is presented in Additional File 1. Of these included articles, 10 were retrospective studies assessing either historical outbreaks or data of cases of gastrointestinal illness and data signals for early detection of waterborne outbreaks (18)(19)(20)(21)(22)(23)(24)(25)(26)(27), and six were simulation studies evaluating the system performance of different SyS systems (28)(29)(30)(31)(32). The included studies originated from Sweden (n = 2), France (n = 5), the USA (n = 4), and the United Kingdom (n = 4), with one study assessing data from several European countries suggesting a common surveillance approach (25), covering an overall study period of 1997 to 2013, with multiple agents causing waterborne outbreaks or illness.…”

Syndromic Surveillance of Acute Gastroenteritis Using the French Health Insurance Database: Discriminatory Algorithm and Drug Prescription Practices Evaluations

“…The objectives of this system are to facilitate the identification and management of drinking water systems that need to be secured to protect consumers' health and to improve the prevention of waterborne disease outbreak. This surveillance system is the result of evaluation of different methods of detection of mAGE clusters with a possible waterborne origin [10,24,25], followed by a pilot study in seven French departments to test the feasibility of such a surveillance system before any national implementation [26]. It should increase 10 to 100-fold the number of waterborne outbreaks reported to health authorities [24,26].…”