Flahault A, Blanchon T, Dorléans Y, Toubiana L, Vibert J F, Valleron A J
Réseau Sentinelles, Inserm UMR-S707, Paris, France.
Stat Methods Med Res. 2006 Oct;15(5):413-21. doi: 10.1177/0962280206071639.
Inserm has developed, since 1984, an information system based on a computer network of physicians in France. It allows for constitution of large databases on diseases, with individual description of cases, and to explore some aspects of the mathematical theory of communicable diseases. We developed user-friendly interfaces for remote data entry and GIS tools providing real-time atlas of the epidemiologic situation in any location. The continuous and ongoing surveillance network is constituted of about 1200 sentinel voluntary and unpaid investigators. We studied their motivation, reasons for either withdrawal or compliance using survival analyses. We implemented early warning systems for outbreak detection and for time-space forecasting. We conducted epidemiological surveys for investigating outbreaks. Large available time and space series allowed us to calibrate and explore synchronism of influenza epidemics, to test the assumption of panmixing in susceptibles-infectious-removed type models and to study the role of closing school in influenza morbidity and mortality in elderly. More than 250 000 cases of influenza, 150 000 cases of acute diarrheas, 35,000 patients for whom HIV tests have been prescribed by general practitioners and 25,000 cases of chickenpox have been collected. Detection of regional influenza or acute diarrhea outbreaks and forecasting of epidemic trends three weeks ahead are currently broadcasted to the French media and published on Sentiweb on a weekly basis. Age-cohort-period models assessed field effectiveness of mass immunization strategies against measles and influenza in the country. Case-control studies with more than 1200 sets of cases of acute diarrheas and their matched controls showed the role of calicivirus and rotavirus as probable major causes of gastroenteritis during recurrent widespread outbreaks in winter in France. An age-specific model for chickenpox showed the probable role of children in disease transmission to their susceptible parents or grandparents. High level of synchronism between influenza epidemics has been demonstrated, either at a regional level (in France) or between France and the USA. The designation of our lab as a WHO collaborating center for electronic disease surveillance stimulates the development of global monitoring of diseases. We developed operational systems that are now available for the global monitoring of influenza (FluNet), and human and animal rabies (RABNET). Extension of electronic syndromic surveillance is needed in the world for improving surveillance capacities and real-time response against emerging diseases.
自1984年以来，法国国家健康与医学研究院（Inserm）开发了一个基于法国医生计算机网络的信息系统。它能够建立关于疾病的大型数据库，对病例进行个体描述，并探索传染病数学理论的一些方面。我们开发了便于用户操作的远程数据录入界面以及地理信息系统（GIS）工具，可提供任何地点疫情的实时地图集。这个持续运行的监测网络由约1200名自愿且无报酬的哨点调查员组成。我们运用生存分析研究了他们参与的动机、退出或坚持的原因。我们实施了疫情爆发检测和时空预测的早期预警系统。我们针对疫情爆发开展了流行病学调查。大量可得的时间和空间序列使我们能够校准和探索流感流行的同步性，检验易感 - 感染 - 康复型模型中随机混合的假设，并研究学校停课对老年人流感发病率和死亡率的影响。现已收集了超过25万例流感病例、15万例急性腹泻病例、35000例由全科医生开具HIV检测医嘱的患者病例以及25000例水痘病例。目前，区域流感或急性腹泻疫情的检测以及提前三周的疫情趋势预测会每周向法国媒体播报并发布在Sentiweb上。年龄 - 队列 - 时期模型评估了该国针对麻疹和流感的大规模免疫策略的现场效果。对1200多组急性腹泻病例及其匹配对照进行的病例对照研究表明，杯状病毒和轮状病毒在法国冬季反复出现的广泛疫情期间可能是肠胃炎的主要病因。一个针对水痘的年龄特异性模型显示了儿童在将疾病传播给易感的父母或祖父母方面可能起到的作用。已证明流感疫情在区域层面（法国境内）以及法国和美国之间都存在高度同步性。我们实验室被指定为世界卫生组织电子疾病监测合作中心，这推动了全球疾病监测的发展。我们开发了目前可用于全球流感监测（FluNet）以及人类和动物狂犬病监测（RABNET）的操作系统。为提高监测能力以及对新出现疾病的实时应对能力，全球需要扩展电子症状监测。
