1887
Surveillance Open Access
Like 0

Abstract

Background

Waterborne disease outbreaks (WBDO) associated with tap water consumption are probably underestimated in France.

Aim

In order to improve their detection, Santé publique France launched a surveillance system in 2019, based on the periodical analysis of health insurance data for medicalised acute gastroenteritis (mAGE).

Methods

Spatio-temporal cluster detection methods were applied to mAGE cases to prioritise clusters for further investigation. These investigations determined the plausibility that infection is of waterborne origin and the strength of association.

Results

Between January 2010 and December 2019, 3,323 priority clusters were detected (53,878 excess mAGE cases). They involved 3,717 drinking water supply zones (WSZ), 15.4% of all French WSZ. One third of these WSZ (33.4%; n = 1,242 WSZ) were linked to repeated clusters. Moreover, our system detected 79% of WBDO voluntarily notified to health authorities.

Conclusion

Environmental investigations of detected clusters are necessary to determine the plausibility that infection is of waterborne origin. Consequently, they contribute to identifying which WSZ are linked to clusters and for which specific actions are needed to avoid future outbreaks. The surveillance system incorporates three priority elements: linking environmental investigations with water safety plan management, promoting the systematic use of rainfall data to assess waterborne origin, and focusing on repeat clusters. In the absence of an alternative clear hypothesis, the occurrence of a mAGE cluster in a territory completely matching a distribution zone indicates a high plausibility of water origin.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2021.26.34.2001466
2021-08-26
2024-12-14
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2021.26.34.2001466
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/26/34/eurosurv-26-34-3.html?itemId=/content/10.2807/1560-7917.ES.2021.26.34.2001466&mimeType=html&fmt=ahah

References

  1. Craun GF, Brunkard JM, Yoder JS, Roberts VA, Carpenter J, Wade T, et al. Causes of outbreaks associated with drinking water in the United States from 1971 to 2006. Clin Microbiol Rev. 2010;23(3):507-28.  https://doi.org/10.1128/CMR.00077-09  PMID: 20610821 
  2. Murphy HM, Pintar KD, McBean EA, Thomas MK. A systematic review of waterborne disease burden methodologies from developed countries. J Water Health. 2014;12(4):634-55.  https://doi.org/10.2166/wh.2014.049  PMID: 25473972 
  3. Guzman-Herrador B, Carlander A, Ethelberg S, Freiesleben de Blasio B, Kuusi M, Lund V, et al. Waterborne outbreaks in the Nordic countries, 1998 to 2012. Euro Surveill. 2015;20(24):21160.  https://doi.org/10.2807/1560-7917.ES2015.20.24.21160  PMID: 26111239 
  4. Beer KD, Gargano JW, Roberts VA, Hill VR, Garrison LE, Kutty PK, et al. Surveillance for waterborne disease outbreaks associated with drinking water - United States, 2011-2012. MMWR Morb Mortal Wkly Rep. 2015;64(31):842-8.  https://doi.org/10.15585/mmwr.mm6431a2  PMID: 26270059 
  5. Furtado C, Adak GK, Stuart JM, Wall PG, Evans HS, Casemore DP. Outbreaks of waterborne infectious intestinal disease in England and Wales, 1992-5. Epidemiol Infect. 1998;121(1):109-19.  https://doi.org/10.1017/S0950268898001083  PMID: 9747762 
  6. Richardson HY, Nichols G, Lane C, Lake IR, Hunter PR. Microbiological surveillance of private water supplies in England: the impact of environmental and climate factors on water quality. Water Res. 2009;43(8):2159-68.  https://doi.org/10.1016/j.watres.2009.02.035  PMID: 19303126 
  7. Beaudeau P, Pascal M, Mouly D, Galey C, Thomas O. Health risks associated with drinking water in a context of climate change in France: a review of surveillance requirements. J Water Clim Chang. 2011;02(4):230-46.  https://doi.org/10.2166/wcc.2011.010 
  8. Lo Iacono G, Armstrong B, Fleming LE, Elson R, Kovats S, Vardoulakis S, et al. Challenges in developing methods for quantifying the effects of weather and climate on water-associated diseases: A systematic review. PLoS Negl Trop Dis. 2017;11(6):e0005659.  https://doi.org/10.1371/journal.pntd.0005659  PMID: 28604791 
  9. Beaudeau P, de Valk H, Vaillant V, Mannschott C, Tillier C, Mouly D, et al. Lessons learned from ten investigations of waterborne gastroenteritis outbreaks, France, 1998-2006. J Water Health. 2008;6(4):491-503.  https://doi.org/10.2166/wh.2008.051  PMID: 18401114 
  10. Fisher A, Castor C, Bonilla P, Noussitou M, Rolland P. Épidémie de gastro-entérites d’origine hydrique sur la commune de Laruns, Pyrénées-Atlantiques, Mars 2014. [Waterborne acute gastroenteritis outbreak in Laruns village, Pyrénées-Altantiques, France, March 2014]. Saint-Maurice: Institut de veille sanitaire; 2014.
  11. Yvon JM, Vincent N, Bourrin S. Investigation d’une épidémie de gastro-entérites aiguës d’origine hydrique à Vif-le Gua, Isère, mars 2016. [Investigation of an outbreak of acute gastroenteritis of waterborne origin at Vif-Le Gua, Isère, March 2016]. Saint-Maurice: Sante publique France; 2019. French. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-infectieuses-d-origine-alimentaire/gastro-enterites-aigues/documents/enquetes-etudes/investigation-d-une-epidemie-de-gastro-enterites-aigues-d-origine-hydrique-a-vif-le-gua-isere-mars-2016
  12. Mouly D, Van Cauteren D, Vincent N, Vaissiere E, Beaudeau P, Ducrot C, et al. Description of two waterborne disease outbreaks in France: a comparative study with data from cohort studies and from health administrative databases. Epidemiol Infect. 2016;144(3):591-601.  https://doi.org/10.1017/S0950268815001673  PMID: 26194500 
  13. Beaudeau P. Syndromic surveillance of acute gastroenteritis: an opportunity for the prevention of the infectious risk attributable to tap water. Rennes: Université de Rennes 1; 2012.
  14. Mouly D. Ecologie de la santé humaine : contribution à l'étude et à la surveillance des épidémies de gastro-entérite aigüe d'origine hydrique. [Ecology of human health: contribution to the study and to the surveillance of waterborne disease outbreaks of gastrointestinal illness]. Clermont-Ferrand: Université Blaise Pascal; 2016. French. Available from: https://tel.archives-ouvertes.fr/tel-01479931
  15. Goria S, Mouly D, Rambaud L, Guillet A, Beaudeau P, Galey C. Évaluation de différentes méthodes de détection d'agrégats de cas de gastro-entérites aiguës médicalisées d'origine hydrique. [Evaluation of different methods of detection of aggregates of cases of medicalized acute waterborne gastroenteritis]. Saint-Maurice: Santé publique France; 2017. French. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-infectieuses-d-origine-alimentaire/gastro-enterites-aigues/documents/rapport-synthese/evaluation-de-differentes-methodes-de-detection-d-agregats-de-cas-de-gastro-enterites-aigues-medicalisees-d-origine-hydrique
  16. Galey C, Pouey J, Guillet A, Goria S, Mouly D. Détection d'épidémies de gastro-entérite aiguë médicalisée d'origine hydrique : Étude pilote concernant 7 départements de 7 régions françaises. [Detection of outbreaks of acute medicalized waterborne gastroenteritis – Pilot study concerning 7 districts in 7 French regions]. Saint-Maurice: Santé publique France; 2018. French. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-infectieuses-d-origine-alimentaire/gastro-enterites-aigues/documents/rapport-synthese/detection-d-epidemies-de-gastro-enterite-aigue-medicalisee-d-origine-hydrique-etude-pilote-concernant-7-departements-de-7-regions-francaises
  17. Tuppin P, Rudant J, Constantinou P, Gastaldi-Ménager C, Rachas A, de Roquefeuil L, et al. Value of a national administrative database to guide public decisions: From the système national d’information interrégimes de l’Assurance Maladie (SNIIRAM) to the système national des données de santé (SNDS) in France. Rev Epidemiol Sante Publique. 2017;65(Suppl 4):S149-67.  https://doi.org/10.1016/j.respe.2017.05.004  PMID: 28756037 
  18. Bounoure F, Mouly D, Beaudeau P, Bentayeb M, Chesneau J, Jones G, et al. Syndromic surveillance of acute gastroenteritis using the French health insurance database: discriminatory algorithm and drug prescription practices evaluations. Int J Environ Res Public Health. 2020;17(12):4301.  https://doi.org/10.3390/ijerph17124301  PMID: 32560168 
  19. Bounoure F, Beaudeau P, Mouly D, Skiba M, Lahiani-Skiba M. Syndromic surveillance of acute gastroenteritis based on drug consumption. Epidemiol Infect. 2011;139(9):1388-95.  https://doi.org/10.1017/S095026881000261X  PMID: 21108871 
  20. Sante publique France. Surveillance des toxi-infections alimentaires collectives. Données de la déclaration obligatoire, 2018. [Surveillance of collective food poisoning. Data from mandatory notifications, 2018]. Saint-Maurice: Santé publique France; 2020. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-infectieuses-d-origine-alimentaire/toxi-infections-alimentaires-collectives/documents/bulletin-national/surveillance-des-toxi-infections-alimentaires-collectives.-donnees-de-la-declaration-obligatoire-2018
  21. Kulldorff M, Heffernan R, Hartman J, Assunção R, Mostashari F. A space-time permutation scan statistic for disease outbreak detection. PLoS Med. 2005;2(3):e59.  https://doi.org/10.1371/journal.pmed.0020059  PMID: 15719066 
  22. Coly S, Vincent N, Vaissiere E, Charras-Garrido M, Gallay A, Ducrot C, et al. Waterborne disease outbreak detection: an integrated approach using health administrative databases. J Water Health. 2017;15(4):475-89.  https://doi.org/10.2166/wh.2017.273  PMID: 28771145 
  23. Mouly D, Goria S, Mounié M, Beaudeau P, Galey C, Gallay A, et al. Waterborne disease outbreak detection: a simulation-based study. Int J Environ Res Public Health. 2018;15(7):E1505.  https://doi.org/10.3390/ijerph15071505  PMID: 30018195 
  24. Galey C. Guide d'investigation des épidémies d'infections liées à l'ingestion d'eau de distribution : Deuxième edition. [Guide for the investigation of outbreaks of infection related to tap water. Second ed]. Saint-Maurice: Santé publique France; 2017. Available from: https://www.santepubliquefrance.fr/docs/guide-d-investigation-des-epidemies-d-infections-liees-a-l-ingestion-d-eau-de-distribution-deuxieme-edition
  25. Ministry of Health. Instruction N° DGS/EA4/2019/46 du 27 février 2019 relative au dispositif de surveillance des cas groupés de gastro-entérites aiguës médicalisées en lien avec une origine hydrique plausible. [Recommendations N ° DGS / EA4 / 2019/46 of February 27, 2019 relating to the system for monitoring clusters of acute gastro-intestinal enteritis cases related to plausible water source]. Paris: Ministry of Health; 2019. p. 12. French. Available from: https://www.legifrance.gouv.fr/circulaire/id/44552
  26. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2013. Available from: https://www.R-project.org/2018
  27. Chang W, Cheng J, Allaire JJ, Sievert C, Schloerke B, Xie Y, et al. shiny: Web Application Framework for R. R package version 1.3.2. 2019. Available from: https://CRAN.R-project.org/package=shinye
  28. Van Cauteren D, De Valk H, Vaux S, Le Strat Y, Vaillant V. Burden of acute gastroenteritis and healthcare-seeking behaviour in France: a population-based study. Epidemiol Infect. 2012;140(4):697-705.  https://doi.org/10.1017/S0950268811000999  PMID: 21676346 
  29. Beaudeau P, Valdes D, Mouly D, Stempfelet M, Seux R. Natural and technical factors in faecal contamination incidents of drinking water in small distribution networks, France, 2003-2004: a geographical study. J Water Health. 2010;8(1):20-34.  https://doi.org/10.2166/wh.2009.043  PMID: 20009244 
  30. Center for Disease Control and Prevention (CDC). Strength-of-evidence classification for waterborne disease and outbreaks. Atlanta: CDC; 2019. Available from: https://www.cdc.gov/healthywater/surveillance/outbreak-classifications.html
/content/10.2807/1560-7917.ES.2021.26.34.2001466
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error