Surveillance of gastrointestinal disease in France using drug sales data

AbstractDrug sales data have increasingly been used for disease surveillance during recent years. Our objective was to assess the value of drug sales data as an operational early detection tool for gastroenteritis epidemics at national and regional level in France. For the period 2008–2013, we compared temporal trends of drug sales for the treatment of gastroenteritis with trends of cases reported by a Sentinel Network of general practitioners. We benchmarked detection models to select the one with the best sensitivity, false alert proportion and timeliness, and developed a prospective framework to assess the operational performance of the system. Drug sales data allowed the detection of seasonal gastrointestinal epidemics occurring in winter with a distinction between prescribed and non-prescribed drugs. Sales of non-prescribed drugs allowed epidemic detection on average 2.25 weeks earlier than Sentinel data. These results confirm the value of drug sales data for real-time monitoring of gastroenteritis epidemic activity

Surveillance of infectious diseases using drug sales data in pharmacies

Le suivi des ventes de médicaments en pharmacies est un outil de surveillance qui s’est développé au début des années 2000 pour la surveillance des maladies infectieuses et la détection d’épidémies. Ces données présentent en effet de nombreux avantages pour la surveillance de par le volume important, l’exhaustivité et la rapidité d’obtention des données collectées de façon automatique. L’objectif de cette thèse était de déterminer l’intérêt du suivi des ventes de médicaments pour la surveillance et la prévention des maladies infectieuses en France. Les données de ventes analysées dans cette thèse sont issues d’un échantillon de 3004 pharmacies en France Métropolitaine, développé par la société Celtipharm. Trois axes de recherche ont été développés dans cette thèse : Nous avons tout d’abord réalisé une revue systématique de la littérature sur la surveillance des maladies infectieuses à partir des ventes de médicaments. Vingt-sept articles ont été analysés et les résultats montrent que le suivi des ventes de médicaments est un outil valide pour la surveillance et la détection de la gastro-entérite et de la grippe. De plus, les médicaments achetés sans ordonnance ont le potentiel d’émettre une alerte plus précoce que les systèmes de surveillance traditionnels. Des études pourraient être développées pour la surveillance d’autres maladies infectieuses. Notre deuxième étude avait pour objectif d’évaluer l’intérêt du suivi des ventes de médicaments pour la détection des épidémies saisonnière de gastro-entérites en France. Les ventes de médicaments indiqués en cas de gastro-entérite ont été comparées au nombre de cas vus en consultation entre 2008 et 2013. La méthode de Serfling a été utilisée pour détecter les périodes épidémiques. Les cinq épidémies saisonnières ont pu être détectées à partir des ventes de médicaments, sans fausse alerte. De plus, les médicaments non-prescrits ont permis une détection précoce des épidémies, en moyenne 2,25 semaines plus tôt que les données de référence. La troisième étude a porté sur l’estimation de la couverture vaccinale (CV) contre la grippe et le rotavirus à partir des ventes de vaccins en pharmacies. Nous avons pu estimer la couverture vaccinale grippe chez l’ensemble de la population, et avons développé une méthode pour estimer en temps-réel la CV dans la population cible des plus de 65 ans. Il n’existe actuellement pas d’estimation de la CV rotavirus en France car le vaccin n’est pas remboursé, et nos analyses ont permis d’apporter une information sur cette couverture depuis 2008. Les études développées dans cette thèse ont permis de démontrer que le suivi des ventes de médicaments était un outil valide et utile pour la surveillance des maladies infectieuses. Ses intérêts principaux résident dans la rapidité d’obtention des données qui offre la possibilité de déclencher rapidement une alerte et l’obtention de données de ventes de médicaments non-remboursés qui permettent d’avoir des informations sur des pathologies légères ou les premiers symptômes de maladies.Drug sales data analysis is a tool that has been developed in the early 2000s for infectious diseases surveillance and outbreak detection. These data present indeed many advantages for disease surveillance: the large volume and the completeness of the data, the rapidity to obtain the data automatically collected from pharmacies. The objective of this thesis was to determine the value of drug sales analysis for infectious disease surveillance in France. Sales data analyzed in this thesis were collected from a sample of 3,004 pharmacies in Metropolitan France, set up by the company Celtipharm. Three research axes have been developed in this thesis: We first did a systematic literature review on the surveillance of infectious diseases based on drug sales data. Twenty-seven articles have been analyzed and results showed that drug sales data analysis is a valid tool for the surveillance and outbreak detection of gastroenteritis and influenza. Besides, over-the-counter (OTC) drugs have the potential to detect outbreaks earlier than traditional surveillance data. Further studies could be developed for other infectious diseases. The second study focused on the detection of seasonal gastrointestinal disease outbreak in France based on drug sales data. Drug sales data have been compared to the number of cases reported by a network of GPs between 2008 and 2013. The Serfling method was used to detect epidemic periods in the times series. The five seasonal epidemic periods have been detected based on drug sales data, without false alert. Moreover, non-prescribed drugs allowed the detection of outbreaks on average 2.25 weeks earlier than reference data. The third study focused on the estimation of vaccination coverage (VC) against influenza and rotavirus using vaccine sales in pharmacies. We estimated the influenza vaccination coverage in the whole population and developed a method to estimate the VC in real time in the target population of the ≥ 65 years old. There is no estimation of rotavirus vaccination coverage in France as the vaccine is not reimbursed and we were able to estimate vaccination coverage since 2008 based on vaccine sales. The studies developed in this thesis showed that drug sales data analysis is a valid and useful tool for infectious disease surveillance. The main interests of this method are the rapidity to obtain the data that allows early outbreak detection and the collection of non-prescribed drugs that can reflect mild diseases or the first symptoms of a disease

Caractéristiques et facteurs de risque du paludisme grave d'importation à Plasmodium falciparum chez l'adulte entre 2000 et 2009 en France métropolitaine

Le paludisme d'importation est un enjeu de santé publique dans de nombreux pays industrialisés, de par la fréquence et la létalité des formes graves à p.falciparum. Afin de décrire les caractéristiques des patients ayant présenté des formes graves et de mettre en évidence les facteurs de risque de gravité, nous avons conduit une étude rétrospective sur les cas de paludisme d'importation à p.falciparum en France métropolitaine chez l'adulte entre 2000 et 2009. Les données épidémiologiques, cliniques, et biologiques des patients ont été recueillies par un réseau de 120 correspondants et transmises au CNR Paludisme. La définition OMS 2000 du paludisme grave a été utilisée pour identifier les cas graves. Les facteurs associés à la gravité ont été mis en évidence par régression logistique. Les analyses ont porté sur 20556 patients infectés par p.falciparum, dont 1083 présentaient une forme grave. Les facteurs associés à la gravité étaient: l'absence de chimioprophylaxie, un âge élevé, l'origine caucasienne, un délai symptômes/diagnostic de 4 à 12 jours, une apparition des symptômes avant le retour et un diagnostic en automne/hiver. La proportion de formes graves a augmenté passant de 3,1% en 2000 à 10,5% des patients en 2009. La vigilance doit être accrue chez les patients de plus de 60 ans et les patients caucasiens. Une meilleure connaissance de la maladie par les médecins et une vigilance des voyageurs par rapport aux symptômes sont nécessaires afin de limiter les délais de diagnostic. La chimioprophylaxie doit être préconisée chez tous les voyageurs, notamment les patients d'origine africaine qui représentent une part croissante des patients présentant une forme grave.Imported malaria became an important public health issue in many developed countries, because of severe cases that can quickly lead to complications and death. To explore characteristics and risk factors for severe malaria, we conducted a retrospective study of imported p.falciparum malaria among adults returning to metropolitan France from malaria-endemic areas between 2000 and 2009. Epidemiological, clinical and biological data were collected by a network of 120 laboratories and were reported to the CNR Paludisme. The WHO definition (2000) was used to define the paients with severe malaria. Factors associated with severity were identified by logistic regression. The study evaluated 20,556 patients who presented p.falciparum malaria, including 1083 patients with severe malaria. In multivariate analysis, risk factors independently associated with severity were as follows: absence of chemoprophylaxis, older age, caucasian origin, onset of symptoms prior to return to France, time between onset of symptoms and diagnostis in the range of 4 to 12 days and diagnosis in autumn/winter season. The study period was marked by an increase in the proportion of severe cases from 3,1% in 2000 to 10,5% in 2009.Vigilance should be increased for adults above 60 years and for patients of caucasian origin. Regarding delay in diagnosis, greater physician awareness of the disease and increased vigilance of travellers concerning the symptoms are needed. Increasing compliance with chemoprophylaxis remains necessary for all travelers, including African patients, which represent an increased proportion of severe cases.LYON1-BU Santé (693882101) / SudocRENNES1-BU Santé (352382103) / SudocSudocFranceF

Potential Impact of Influenza A/H1N1 Pandemic and Hand-Gels on Acute Diarrhea Epidemic in France

International audience- Background - The 2009 A/H1N1 influenza pandemic has received a great deal of attention from public health authorities. Our study examines whether this pandemic and the resulting public health measures could have impacted acute diarrhea, a prevalent, highly transmissible and historically monitored disease.- Methods - Using augmentation procedures of national data for the previous five years (2004-2009), we estimated the expected timing and incidence of acute diarrhea in France in 2009-2010 and evaluated differences with the observed. We also reviewed national hand gels for the same period.- Findings - Number of episodes of acute diarrhea in France in 2009-2010 was significantly lower than expected until the third week of December (-24%, 95% CI [-36%; -9%]), then significantly higher (+40%, 95% CI [22%; 62%]), leading to a surplus of 574,440 episodes. The epidemic was delayed by 5 weeks with a peak 1.3 times higher than expected. Hand-gels sales inversely correlated with incidence of both influenza-like illness and acute diarrheal disease. Among individuals >65 yo, no excess cases of influenza and no excess rebound in acute diarrhea were observed, despite similar delay in the onset of the seasonal diarrheal epidemic.- Interpretation - Our results suggest that at least one endemic disease had an unexpected behavior in 2009-2010. Acute diarrhea seems to have been controlled during the beginning of the pandemic in all age groups, but later peaked higher than expected in the younger population. The all-age delay in seasonal onset seems partly attributable to hand-gels use, while the differential magnitude of the seasonal epidemic between young and old, concurrent for both influenza and acute diarrhea, is compatible with disease interaction

Quantitative assessment of preventive behaviors in France during the Fukushima nuclear crisis.

BACKGROUND: The Fukushima nuclear disaster has generated worldwide concern on the risk of exposure to nuclear radiations. In Europe, health authorities had to issue statements about the lack of usefulness of iodine based preventive treatments within their borders. However a lack of confidence in official messages has developed in various European countries due to recent perceived failures in managing public health crises. The lay population preventive behaviors in this context are largely unknown. Consequently, to examine the effects of public health crisis on lay behaviors leading to pharmaceuticals purchases, we studied the sales of iodine-based products in France before, during and after the crisis. METHODS: We focused our study on 58 iodine-based drugs available with and without a physician prescription. Our data came from a stratified sample of 3004 pharmacies in metropolitan France. Our study period was from January 2010 to April 2012, with a focus on March-April 2011. We differentiated sales of drugs prescribed by physicians from sales of drugs obtained without a prescription. We used a CUSUM method to detect abnormal increases in sales activity and cross-correlations to assess shifts in sales timing. RESULTS: Sales of iodine-based nutritional complements, and later sales of iodine-based homeopathic remedies, substantially increased (up to 3-fold) during a period of 20 days. Their temporal patterns were correlated to specific events during the crisis. Prescriptions for iodine-based homeopathy increased (up to 35% of all sales). Iodine pills, strictly regulated by health authorities, have also been sold but on a very small scale. CONCLUSION: These results indicate uncontrolled preventive behaviors resulting in the potentially unjustifiable consumption of available drugs. They have implications in public policy, and demonstrate the usefulness of drug sales surveillance for instantaneous evaluation of population behavior during a global crisis

Impact sanitaire des toxi-infections alimentaires collectives à coquillages dans une population d’étude bretonne. Étude pilote

The French population, and more particularly the population in Brittany, enjoys eating shellfish. However, their consumption can be the cause of foodborne illness outbreak (FIO), whose incidence, estimated within the framework of mandatory reporting, may be underestimated. The objectives of this pilot study were to quantify and describe the health impact of shellfish-related FIOs as well as the circumstances of their occurrence in the working population of Brittany, with the aim of eventually reducing their frequency. A multi-center descriptive cross-sectional study was therefore conducted among the staff of Lorient Agglomeration, the Ecole des Hautes Etudes en Santé Publique and the Agence Régionale de Santé Bretagne, i.e. 1,444 people, via an online questionnaire between May and July 2022. The questionnaire explored shellfish consumption between November 1, 2021 and April 30, 2022 (period of interest), the practice of shore fishing and the occurrence of shellfish FIOs over the past 5 years. A second part was used to describe the shellfish FIO episodes that occurred during the period of interest (symptoms, meals, etc.). A total of 438 responses were obtained (30 % response rate). The majority of respondents were women (70 %), the median age was 46 years old and 21 % practiced shore fishing. Over the period of interest, 93 % of the respondents reported having consumed shellfish. Scallops (80 %) and mussels (76 %) were the most consumed. A total of 38 (9 %) respondents reported at least one episode of shellfish FIO over 2017-2022. Over the period of interest, 9 episodes of FIO were reported by 9 respondents (2 %), including 8 episodes in which raw oysters were consumed. This pilot study supports the hypothesis of a significant under-reporting of shellfish FIO at the regional level (and therefore probably at the national level). Further consideration should be given to better quantifying the health impact of shellfish FIO in order to inform the shellfish industry and stakeholders in charge of coastal waters.La population française, et plus particulièrement la population bretonne, est amatrice de coquillages. Cependant, leur consommation peut être à l’origine de toxi-infections alimentaires collectives (TIAC), dont l’incidence évaluée par la déclaration obligatoire est probablementsous-estimée. Les objectifs de cette étude pilote étaient de quantifier et décrire l’impact sanitaire des TIAC à coquillages ainsi que les circonstances de leur survenue dans la population active bretonne dans le but de pouvoir à terme réduire leur fréquence.Une étude descriptive transversale multicentrique a donc été menée parmi les membres du personnel de Lorient Agglomération, l’École des hautes études en santé publique et l’Agence régionale de santé Bretagne. Mille quatre cent quarante-quatre personnes ont été interrogéesentre mai et juillet 2022 via un questionnaire en ligne. Ce dernier explorait les consommations de coquillages entre le 1er novembre 2021 et le 30 avril 2022 (période d’intérêt), la pratique de la pêche à pied et l’occurrence de TIAC à coquillages au cours des cinq dernières années. Une seconde partie était utilisée pour décrire les épisodes de TIAC à coquillages survenus sur la période d’intérêt (symptômes, repas…). Au total, 438 réponses ont été obtenues (taux de réponse 30 %). La majorité des répondants était des femmes (70 %), l’âge médian était de 46 ans et 21 % pratiquaient la pêche à pied. Sur la période d’intérêt, 93 % des répondants ont déclaré avoir consommé des coquillages. Les coquilles Saint-Jacques (80 %) et les moules (76 %) étaient les plus consommés.Finalement, 38 répondants (9 %) ont rapporté au moins un épisode de TIAC à coquillages entre 2017 et 2022. Sur la période d’intérêt, 9 épisodes de TIAC ont été rapportés par 9 répondants (2 %), dont 8 épisodes dans lesquels des huîtres crues avaient été consommées.Cette étude pilote conforte l’hypothèse d’une sous-déclaration importante des TIAC à coquillages au niveau régional (donc probablement au niveau national). Une réflexion mériterait d’être poursuivie pour mieux quantifier l’impact sanitaire des TIAC à coquillages dans un objectif d’informer la filière conchylicole et les acteurs chargés des eaux littorales

Psychotropic medication use in French children and adolescents

International audienceOBJECTIVE: The purpose of this study was to describe the patterns of psychotropic drug use in a large representative population of children and adolescents drawn from the French National Health Insurance databank. METHODS: Data were drawn from a sample of 1% of the beneficiaries of the French national health insurance, selecting those 0-17 years old in 2010 (n=128,298). In addition to age and gender, data included the identification number of each drug allowing a European Pharmaceutical Marketing Research Association (EphMRA) classification, as well as the type of the prescriber. RESULTS: Overall, 2.5% of children and adolescents had been prescribed psychotropic medication. A majority were prescribed anxiolytics (1.9%), followed by antidepressants (0.3%), antipsychotics (0.3%), and stimulants (0.2%). Between the ages of 15 and 17, 6.1% of girls were prescribed anxiolytics and 1.1% were prescribed antidepressants. For boys, the anxiolytics remained the most prescribed psychotropic medication; however, between the ages of 11 and 14, and between the ages of 15 and 17 they received more antipsychotics (0.7% and 0.8%) and between the ages of 6 and 10, and between the ages of 11 and 14 (0.7% and 0.6%), they were prescribed more stimulants than were girls. Among those who received a prescription, a majority of youth (84.6%) received only one class of drugs, and general practitioners were found to be prescribing most of these prescriptions (81.7%). CONCLUSIONS: The prevalence of psychotropic drug use in France is similar to that of the Netherlands and much lower than what is observed in the United States. Stimulants are less frequently prescribed in France than in other European countries, but anxiolytics are prescribed considerably more in France than in any other country

Comparison of iodine based products in one month in 2010 and the same month in 2011 after the beginning of the Fukushima crisis.

<p>Comparison of iodine based products in one month in 2010 and the same month in 2011 after the beginning of the Fukushima crisis.</p

Comparison between 2009–2010 observed acute diarrhea incidence and the expected incidence estimated from previous years (2004–2009) in France.

<p>Low and high incidence scenarios are given by the bound of bootstrapped 95% confidence interval. The studied period is divided in two sub-periods, before and after the week 52 when the observed and expected incidences intersect.</p

Timeline of events of the Fukushima crisis in Japan and in France from references [1], [2], [8].

<p>Timeline of events of the Fukushima crisis in Japan and in France from references <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0058385#pone.0058385-NuclearEmergencyResponseHeadquartersGovernmentof1" target="_blank">[1]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0058385#pone.0058385-Nuclear1" target="_blank">[2]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0058385#pone.0058385-Institut1" target="_blank">[8]</a>.</p