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

Frederic Bounoure,Malek Bentayeb,Damien Mouly,Catherine Galey,Julie Chesneau,Malika Lahiani-Skiba,Pascal Beaudeau,Gabrielle Jones,Mohamed Skiba

doi:10.3390/ijerph17124301

Abstract

The French national public health agency (Santé publique France) has used data from the national health insurance reimbursement system (SNDS) to identify medicalised acute gastroenteritis (mAGE) for more than 10 years. This paper presents the method developed to evaluate this system: performance and characteristics of the discriminatory algorithm, portability in mainland and overseas French departments, and verification of the mAGE database updating process. Pharmacy surveys with certified mAGE from 2012 to 2015 were used to characterise mAGE and to estimate the sensitivity and predictive positive value (PPV) of the algorithm. Prescription characteristics from these pharmacy surveys and from 2014 SNDS prescriptions in six mainland and overseas departments were compared. The sensitivity (0.90) and PPV (0.82) did not vary according to the age of the population or year. Prescription characteristics were similar within all studied departments. This confirms that the algorithm can be used in all French departments, for both paediatric and adult populations, with stability and durability over time. The algorithm can identify mAGE cases at a municipal level. The validated system has been implemented in a national waterborne disease outbreaks surveillance system since 2019 with the aim of improving the prevention of infectious disease risk attributable to localised tap water systems.

Highlights

Syndromic surveillance is defined by the Center for Disease Control (CDC) as an investigational approach where an existing automated data acquisition system is used for early outbreak detection or for the monitoring of disease indicators in real time or near real time [1]
The aim of this paper is (i) to evaluate the medicalised acute gastroenteritis (mAGE) discriminatory algorithm and its characteristics using independent data collected in pharmacy surveys; (ii) to compare the mAGE drug prescriptions obtained by using the algorithm on SNDS data from six French departments; and (iii) to describe how the updating process of the mAGE database is routinely checked at a national level for the most critical variables used in the algorithm
We evaluated the stability of the sensitivity and the predictive positive value (PPV) over time (2012–2015) and by age group (1–4 years old, 5–15 years old, and more than 15 years old), as well as the temporal stability of prescription characteristics

Summary

Introduction

Syndromic surveillance is defined by the Center for Disease Control (CDC) as an investigational approach where an existing automated data acquisition system is used for early outbreak detection or for the monitoring of disease indicators in real time or near real time [1]. Berger et al described all the data sources that can be used for waterborne surveillance [2]. Drug sales have been used in many countries to detect acute gastroenteritis (AGE) outbreaks. Res. Public Health 2020, 17, 4301; doi:10.3390/ijerph17124301 www.mdpi.com/journal/ijerph

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