This multi-source surveillance relies on a broad network of partners: it brings together various surveillance systems in community healthcare, long-term care facilities (LTCFs), and hospitals, utilizing data from clinicians, clinical laboratories, and wastewater analysis. The indicators produced will enable the monitoring of acute respiratory infections in aggregate or specific terms and provide a better estimate of their burden and impact on the healthcare system. They will be analyzed and reported weekly in an epidemiological bulletin published on the agency’s website starting October 11, 2023, and will mostly be available as open data on Géodes and/or data.gouv.fr.

An integrated approach to ARI surveillance with a broad network of partners

The winter of 2022–2023 was marked by the circulation of several respiratory viruses (COVID-19, RSV bronchiolitis, and influenza). This triple epidemic, which followed two years of pandemic, placed a heavy burden on the healthcare system. In this context, it is essential to closely monitor the upcoming winter season.

As part of its mandate, Santé publique France offers an integrated approach to ARI surveillance, enabling a better assessment of their public health burden and their impact on healthcare provision.

“Surveillance is at the heart of our work; it is carried out through a broad network of partners and highly engaged healthcare professionals. Today, we are entering a new phase that relies on adapting existing systems or newly created ones. The complementary nature of these surveillance systems will allow us to track the epidemic’s dynamics and assess its evolution both overall and by disease. These elements are essential for public decision-making and action, as well as for informing citizens. Santé publique France teams across the country work daily to constantly optimize surveillance. Thus, integrated surveillance of acute respiratory infections will be further enhanced in the coming months.” Dr. Caroline Semaille, Director General of Santé publique France.

Measuring and analyzing the circulation of viruses in the population and across the country

Virological surveillance enables the detection of viruses in the population. For SARS-CoV-2, influenza viruses, and RSV, it relies on the activities of the CNR Virus des infections respiratoires and the Sentinelles network for community-based care (general practitioners and pediatricians), as well as the RENAL network for hospitals. The SI-DEP system, created during the COVID-19 pandemic, has been replaced by a system that allows, using the same technical methods, for the continued reporting of COVID-19 PCR and TAG test results exclusively by public and private medical laboratories. This system, which is based on the inclusion of COVID-19 in the list of diseases requiring special surveillance, is intended to be gradually expanded to other acute respiratory infections (ARIs), namely influenza and RSV.

Genomic surveillance of SARS-CoV-2, established during the Covid-19 pandemic, enables the tracking of circulating viruses, their characterization, and the assessment of their public health impact. It is conducted under the auspices of the EMERGEN consortium, which brings together Santé publique France and ANRS|MIE. Monitoring of circulating SARS-CoV-2 variants is based on weekly Flash surveys conducted on a random sample of PCR tests. The CNR for Respiratory Viruses also conducts genomic surveillance of other viruses, notably influenza and RSV bronchiolitis.

In addition to indicators related to testing and variant monitoring, new indicators are generated through wastewater analysis. This surveillance makes it possible to detect the presence or absence of the COVID-19 virus in a given area and to track trends without relying on testing practices.

Monitoring and analyzing the severity and burden of outbreaks on the healthcare system

Clinical surveillance of acute respiratory infections (ARIs) allows for the quantification of medical procedures and emergency department visits due to ARIs, both overall and by specific condition. It is conducted in community practice through the Sentinelles network of general practitioners and the SOS Médecins associations; in emergency departments via the Oscour® network. It is supplemented by monitoring of severe cases of influenza, COVID-19, and RSV admitted to adult and pediatric intensive care units, as well as monitoring of clusters of ARI cases in long-term care facilities (LTCFs).
Mortality surveillance relies on the SurSaUD® system, using all-cause mortality data (INSEE) and electronically certified deaths mentioning influenza or COVID-19 (Inserm/CépiDc).

Understanding and measuring the population’s adherence to preventive measures and vaccination

Monitoring influenza and COVID-19 vaccination coverage in the general population and in specific groups (long-term care facilities and healthcare professionals) allows us to identify the percentage of people who have been vaccinated using health insurance databases updated by healthcare professionals administering the vaccines.

A study of changes in behaviors (precautionary measures, adherence to influenza and COVID-19 vaccination, testing practices, etc.) and mental health (well-being, depressive and anxiety disorders, and suicidal behavior) among the French population has been conducted since March 23, 2020, through the repeated cross-sectional CoviPrev surveys. The results of the latest of these surveys, conducted in September 2023, will be published on Thursday, October 5. Santé publique France has begun exploring ways to expand this series of surveys to all IRAs starting in 2024.