Hervé Chaudet

Traditional and syndromic surveillance of infectious diseases and pathogens

Summary Background Infectious diseases remain a major public health problem worldwide. Hence, their surveillance is critical. Currently, many surveillance strategies and systems are in use around the world. An inventory of the data, surveillance strategies, and surveillance systems developed worldwide for the surveillance of infectious diseases is presented herein, with emphasis on the role of the microbiology laboratory in surveillance. Methods The data, strategies, and systems used around the world for the surveillance of infectious diseases and pathogens, along with current issues and trends, were reviewed. Results Twelve major classes of data were identified on the basis of their timing relative to infection, resources available, and type of surveillance. Two primary strategies were compared: disease-specific surveillance and syndromic surveillance. Finally, 262 systems implemented worldwide for the surveillance of infections were registered and briefly described, with a focus on those based on microbiological data from laboratories. Conclusions There is currently a wealth of available data on infections, which has been growing with the recent emergence of new technologies. Concurrently with the expansion of computer resources and networks, these data will allow the optimization of real-time detection and notification of infections.

Real-Time Microbiology Laboratory Surveillance System to Detect Abnormal Events and Emerging Infections, Marseille, France.

We implemented a laboratory data–based syndromic surveillance system that can be rapidly applied and used as a first tool.

Le paradoxe de la « T2A bibliométrique » SIGAPS : un risque d'effet délétère sur la recherche française ?

1. Aix-Marseille Université, Faculté de Médecine, Laboratoire d’Enseignement et de Recherche sur le Traitement de l’Information Médicale (LERTIM, EA 3283) F-13385 Marseille cedex 05, France 2. Assistance Publique – Hôpitaux de Marseille, Hôpital de la Timone, Service de Santé Publique et d’Information Médicale, F-13000 Marseille, France 3. CHU-Hôpitaux de Rouen, Fédération de la recherche clinique, Équipe CISMeF, F-76000 Rouen, France

Increasing burden of urinary tract infections due to intrinsic colistin-resistant bacteria in hospitals in Marseille, France.

The emergence of multidrug-resistant (MDR) Gram-negative bacteria has become a major public health problem, eliciting renewed interest in colistin, an old antibiotic that is now routinely used to treat MDR bacterial infections. Here we investigated whether colistin use has affected the prevalence of infections due to intrinsic colistin-resistant bacteria (CRB) in university hospitals in Marseille (France) over a 5-year period. All data from patients infected by intrinsic CRB were compiled from January 2009 to December 2013. Escherichia coli infections were used for comparison. Colistin consumption data were also collected from pharmacy records from 2008 to 2013. A total of 4847 intrinsic CRB infections, including 3150 Proteus spp., 847 Morganella spp., 704 Serratia spp. and 146 Providencia spp., were collected between 2009 and 2013. During this period, the annual incidence rate of hospital-acquired CRB infections increased from 220 per 1000 patients to 230 per 1000 patients and that of community-acquired CRB infections increased from 100 per 1000 patients to 140 per 1000 patients. In parallel, colistin consumption increased 2.2-fold from 2008 to 2013, mainly because of an increase in the use of colistin aerosol forms (from 50 unitary doses to 2926 unitary doses; P<10(-5)) that was significantly correlated with an increase in the number of patients positive for CRB admitted to ICUs and units of long-term care between 2009 and 2013 (r=0.91; P=0.03). The global rise in infections due to intrinsic CRB is worrying and surveillance is warranted to better characterise this intriguing epidemiological change.

Increase in reported adverse events following seasonal influenza vaccination among the French armed forces, 2008–2009: Possible role of stimulated reporting and background cases of influenza-like infection

OBJECTIVES In September 2009, an increase in seasonal influenza vaccine adverse events (VAE), compared with reports for previous years, was detected among the French armed forces in the setting of an extended immunization campaign. This work presents the results of this investigation. STUDY DESIGN VAE were surveyed among all French military personnel from 2008 to 2009 by Epidemiological Departments of the French Military Health Service. For each case, a notification form was completed, providing patient and clinical information. METHODS Case definitions were derived from the French drug vigilance guidelines. Three types of VAE were considered: non-serious, serious and unexpected. Incidence rates were calculated by relating VAE to the number of vaccine doses injected. RESULTS Forty-seven seasonal influenza VAE were reported in continental France: 18 in 2008 and 29 in 2009. The annual reporting rate was higher in 2009 (31.6 vs 16.6 VAE per 100,000 injections, respectively). The highest monthly incidence was observed in September 2009 (60.8 events per 100,000 injections). Two other peaks were observed in February 2008 and March 2009. The incidence in September 2009 was not significantly different from the incidences in February 2008 and March 2009. It was observed that incidence peaks occurred during influenza epidemic periods. One serious neurological VAE was observed. CONCLUSIONS The increase in seasonal influenza VAE in late 2009 mainly involved non-serious events, and could reflect stimulated reporting in the context of the A(H1N1)pdm09 pandemic. VAE reporting rates were highest during influenza epidemic periods, which could be explained by VAE being wrongly attributed to the vaccine when symptoms could reflect coincident background cases of viral infection.

Evaluating the Clinical Burden and Mortality Attributable to Antibiotic Resistance: The Disparity of Empirical Data and Simple Model Estimations

Given the proliferation of cataclysmic predictions about antibiotic resistance, cases of which are estimated to amount to 12500 per year in France, we herein decided to compare the empirical clinical microbiology data from our institution with estimates and predictions from 10 major international scientific articles and reports. The analysis of 7 years of antibiotic resistance data from 10 bacterial species and genera of clinical interest from our institution identified no deaths that were directly attributable to extremely drug-resistant bacteria. By comparing our observations to the 10 articles and reports studied herein, we concluded that their results lack empirical data. Interventions are urgently needed to significantly reduce both mortality and the healthcare costs associated with bacterial infections, including the implementation of local and national laboratory data-based surveillance systems for the routine surveillance of antibiotic resistance that would be helpful for a better understanding of how to manage antibiotic-resistant bacteria in the future.

Special issue on the 11th conference on naturalistic decision making

The naturalistic decision-making (NDM) approach deals with how humans make decisions in natural settings, especially professional situations, which can be difficult to reproduce in experimental laboratory studies. NDM explores collaboration and cooperation both between humans, and between humans and systems, as well as situations of diagnosis, planning, supervision, and control processes. Basically, decision researchers focus on the analysis of humans at work and their interactions with systems in context, including both environmental and social dimensions. Since the movement was founded, more than 20 years ago, several models of decision making have been developed, each offering a fresh view on how humans perform complex cognitive functions to accomplish situated activities. This very different way of studying human interactions in modern work environments has given rise to a worldwide research community sharing the same issues and a common theoretical background, and relying on ecological models of decision making (Brehmer 1992; Endsley 1995; Hutchins 1995; Rasmussen et al. 1994); models of intelligence, perception, and action as mental models (Johnson-Laird 1983); and activity theory (Engestrom 1999; Kuutti 1996; Nardi 1996). Looking further back, the field of naturalistic decision making can be seen to have its historical roots in the ground-breaking work of Vygotsky and Leont’ev (Leont’ev 1978; Leont’ev and Luria 1968), and even Piaget’s intelligence theory (Piaget 1972, 1977). The NDM approach, which is predicated upon a strong relationship between application fields, research, and models of complex cognitive tasks, is responsible for a now well-established definition of decision making (Klein et al. 1993): ‘‘eight important factors characterize decision making in naturalistic settings, but frequently are ignored in decision-making research. It is not likely that all eight factors will be at their most difficult levels in any one setting, but often several of these factors will complicate the decision task.

Increasing Trend of Invasive Group B Streptococcal Infections, Marseille, France

TO THE EDITOR—We read with interest the article by Lamagni et al that describes a steady rise from 700–800 to 1652 per annum during the 1991–2010 period of invasive group B streptococcus (GBS) infections in England and Wales, most pronounced among adults [1]. This was identified based on routine microbiology laboratory reports undertaken across these countries through an automated biosurveillance system [1, 2], and was triggered by the description of an increase of invasive GBS disease in nonpregnant adults in the United States [3]. Since 2002, a weekly surveillance system of infections based on clinical microbiology data was implemented in our center, which is similar to that described in England and Wales and aims at detecting abnormal events [4]. In spring 2013, we extended our surveillance panel to all bacterial species found from 2002 through 2012 in our laboratory, including 459 different species identified from approximately 500 000 bacterial isolates [5]. Unexpectedly, we detected that GBS was, from weeks 16–25 of 2013, the ninth most frequently identified bacteria. These data and Lamagni et al’s findings prompted us to analyze the incidence since mid-2008 (no earlier comprehensive data being available) of invasive GBS infections in our institution that gathers university hospitals of Marseille, the second-largest French city. A total of 334 invasive GBS infections were diagnosed over the July 2008–

Implementation of Syndromic Surveillance Systems in Two Rural Villages in Senegal

Infectious diseases still represent a major challenge for humanity. In this context, their surveillance is critical. From 2010 to 2016, two Point-Of-Care (POC) laboratories have been successfully implemented in the rural Saloum region of Senegal. In parallel, a homemade syndromic surveillance system called EPIMIC was implemented to monitor infectious diseases using data produced by the POC laboratory of the Timone hospital in Marseille, France. The aim of this study is to describe the steps necessary for implementing EPIMIC using data routinely produced by two POC laboratories (POC-L) established in rural Senegal villages. After improving EPIMIC, we started to monitor the 15 pathogens routinely diagnosed in the two POC-L using the same methodology we used in France. In 5 years, 2,577 deduplicated patients-samples couples from 775 different patients have been tested in the Dielmo and Ndiop POC-L. 739 deduplicated patients-samples couples were found to be positive to at least one of the tested pathogens. The retrospective analysis of the Dielmo and Ndiop POC data with EPIMIC allowed to generate 443 alarms. Since January 2016, 316 deduplicated patients-samples couples collected from 298 different patients were processed in the Niakhar POC laboratory. 56 deduplicated patients-samples couples were found to be positive to at least one of the tested pathogens. The retrospective analysis of the data of the Niakhar POC laboratory with EPIMIC allowed to generate 14 alarms. Although some improvements are still needed, EPIMIC has been successfully spread using data routinely produced by two rural POC-L in Senegal, West Africa.

Endocarditis in the Mediterranean Basin

Infective endocarditis is a severe disease with high mortality. Despite a global trend towards an increase in staphylococcal aetiologies, in older patients and a decrease in viridans streptococci, we have observed in recent studies great epidemiologic disparities between countries. In order to evaluate these differences among Mediterranean countries, we performed a PubMed search of infective endocarditis case series for each country. Data were available for 13 of the 18 Mediterranean countries. Despite great differences in diagnostic strategies, we could classify countries into three groups. In northern countries, patients are older (>50 years old), have a high rate of prosthetic valves or cardiac electronic implantable devices and the main causative agent is Staphylococcus aureus. In southern countries, patients are younger (<40 years old), rheumatic heart disease remains a major risk factor (45–93%), viridans streptococci are the main pathogens, zoonotic and arthropod-borne agents are frequent and blood culture–negative endocarditis remains highly prevalent. Eastern Mediterranean countries exhibit an intermediate situation: patients are 45 to 60 years old, the incidence of rheumatic heart disease ranges from 8% to 66%, viridans streptococci play a predominant role and zoonotic and arthropod-borne diseases, in particular brucellosis, are identified in up to 12% of cases.