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Syndromic surveillance and climate change, a
possible use ? L. Josseran, MD,MPH A.
Fouillet, PhD N. Caillère, MsC Mathilde
Pascal, MsC, MPH D. Ilef, MD, P. Astagneau
MD, PhD. French Institute for Public Health
Surveillance (InVS) Public Health Department,
University of Paris VI ISDS 2008 Raleigh
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Background

• Climate change (CC) is widely accepted
• Climate change may affect health through a range
  of pathways
• increased frequency and intensity of extrem
  weather events, heat waves,
• increased floods and droughts,
• Increased frequency of food or water borne
  diseases,
• change in the distribution of vector-borne
  diseases.....
• The experience of the 2003 heat wave in Europe
  shows the heavy consequences of such phenomena
• All health effects of CC are not clearly
  identified at the current time but the need of a
  surveillance of those effects is a key element
  for the coming years

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Objective of the study

• Evaluate the ability of the French syndromic
  surveillance system (morbidity and mortality)
• - to monitor or identify the health impact of
  climate change
• On the basis of already recorded data matched
  with weather events or situation representing
  some aspects of CC.

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Methods Data sources

• Emergency departments Oscour Network
• Individual data automatically collected daily
• Date of birth, gender, discharge diagnosis
  (ICD10), zip code
• 120 ED gt 20 of the national ED activity
  (11,000 visits/day)
• Mortality data
• Civil status (city hall)
• Individual data automatically collected daily
• Age, date of death, place of death
• 1,042 cities gt 70 of the daily mortality in
  France (1,000 deaths/day)

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Architecture of the French syndromic surveillance
system
InVS St Maurice Cire
InVS Server
National server
Call Center
Regional servers
Insee
Call Center
Call Center
Patients
Patients
Patients
ED
City
City
City
City
ED
ED
City
Sos Médecins (GPs)
Mortality Network
Oscour (ED)
Direct FTP
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Oscour Network in 2008
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Mortality Surveillance Network
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Methods - Events

• Several weather events, outbreaks, syndromes or
  situation corresponding to a possible expression
  of climate change have been identified
• 2006 heat wave
• High temperatures
• Air pollution
• Food poisoning outbreaks
• 2005-2006 Chikungunya outbreak in Réunion Island
• Insect bite
• Data analysis cusum, historical means methods...

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of ED visits per day with a diagnosis linked
to hot weather Paris Area April to October
2006
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of cases per day of Asthma in Paris Area23 ED
04/01/06 to 09/20/06
Seasonal pollenosis
First weeks of school

• A particular situation
• air pollution (high temperatures)
• pollens
• storm and heavy rain

air pollution (high temperatures)
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of GI syndroms per day in Paris Area 23 ED
04/01/06 to 09/20/06
Food poisoning outbreak during a wedding party -
Around 40 cases gt 32 caught through Oscour
network - 3 hospitals concerned
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of ED visits per day with a diagnosis linked to
insect bites Paris Area March to October 2008
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La Réunion weekly mortality and chik outbreak
2005 - 2006
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Discussion - Conclusion

• Syndromic surveillance does not cover all the
  needs in health surveillance in the context of CC
• We think Syndromic Surveillance has an important
  role to play by avoiding the need to developp
  specific surveillance systems for each effect of
  CC
• Syndromic surveillance presents several
  advantages for monitoring the health effects of
  CC
• Ongoing surveillance with valid and available
  historical dataset
• Follow up of events in real time
• Follow up possible by diseases or syndromes
• Good flexibility for monitoring several diseases
  or syndromes
• Good stability of data transmission even during
  crisis
• Good coverage of France and overseas departments

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Discussion - Conclusion

• An approriate definition of syndromes based on
  ICD10 and ED physicians experience is necessary
  because ED activity and visits are too broad to
  observe small events
• A close cooperation is necessary between
  institutions in charge of
• syndromic surveillance
• weather forecast
• air pollution
• To developp an effective surveillance of health
  effects due to CC.