New Approach to the Surveillance of Pediatric Infectious Diseases From Ambulatory Pediatricians in the Digital Era

Abstract

Background: Many ambulatory networks in several countries have established syndromic surveillance systems to detect outbreaks of different illnesses. Here, we describe a new Pediatric and Ambulatory Research in Infectious diseases network that combined automated data extraction from the computers of primary care pediatricians. Methods: Pediatricians who used the same software, AxiSanté 5-Infansoft for electronic medical records were specially trained in infectious diseases, encouraged to comply with French treatments' recommendations, use of point-of-care tests and vaccination guidelines. Infectious disease diagnoses in children <16 years old in the records triggered automatic data extraction of complete records. A quality control process and external validation were developed.Results: From September 2017 to February 2020, 107 pediatricians enrolled 57,806 children (mean age 2.9 ± 2.6 years at diagnosis) with at least one infectious disease diagnosis among those followed by the network. Among the 118,193 diagnoses, the most frequent were acute otitis media (n = 44,924, 38.0%), tonsillopharyngitis (n = 13,334, 11.3%), gastroenteritis (n = 12,367, 10.5%), influenza (n = 11,062, 9.4%), bronchiolitis (n = 10,531, 8.9%), enteroviral infections (n = 8474, 7.2%) and chickenpox (n = 6857, 5.8%). A rapid diagnostic test was performed in 84.7% of cases of tonsillopharyngitis and was positive in 44%. The antibiotic recommendations from French guidelines were strictly followed: amoxicillin was the most prescribed antibiotic and less than 10% of presumed viral infections were treated. Conclusions: This "tailor-made" network set up with quality controls and external validation represents a new approach to the surveillance of pediatric infectious diseases in the digital era and could highly optimize pediatric practices.

A large-scale outbreak of hand, foot and mouth disease, France, as at 28 September 2021

“…Virological surveillance from week 24 showed that this epidemic was mainly associated with the CVA6 type. The biannual pattern in summer and autumn was similar to that usually expected for these diseases in Europe or Asia [2,4,7]. However, the 2021 epidemic was characterised by a sharp rise in the summer and an earlier autumn peak compared with previous years.…”

“…Since September 2017, PARI has been conducting prospective surveillance of the most common paediatric infectious diseases seen in outpatient settings. The EV-associated mucocutaneous illnesses HFMD/HA are included in the PARI surveillance panel [4]. The PARI network includes 113 paediatricians (as at September 2021; ca 4% of all French paediatricians) located throughout all French metropolitan regions except Corsica and is coordinated by the Association Clinique et Thérapeutique du Val de Marne (ACTIV).…”

“…Informed consent was obtained from all parents or guardians of children. The syndromic surveillance was approved by the ethical committee of CHI Créteil Hospital, France [4]. The virological surveillance was approved by the review committee of the University Hospital of Clermont-Ferrand, France (reference AU1098).…”

Trends in pediatric ambulatory community acquired infections before and during COVID-19 pandemic: A prospective multicentric surveillance study in France

“…In 2017, we set up a nationwide pediatric ambulatory infectious disease surveillance network (PARI, Pediatric and Ambulatory Research in Infectious diseases) to assess trends of in pediatric infectious diseases before and after the implementation of nationwide health interventions. 19 This study allowed us to observe the impact of the COVID-19 pandemic on infectious disease frequency, which sharply decreased in 2020. 19 While the pandemic remained ongoing for 2 years, the burden of COVID-19 is now reduced, and NPIs have been gradually lifted, the aim of this study is to investigate the trends of pediatric ambulatory infectious diseases before and up to two years after the onset of the pandemic.…”

European Pediatric Societies Call for an Implementation of Regular Vaccination Programs to Contrast the Immunity Debt Associated to Coronavirus Disease-2019 Pandemic in Children

“…A significant decline in infection rates was reported for pneumococcal diseases 18 , 19 , N. meningitidis infections 19,20 , pertussis 21 , 22 , varicella 21 , 23 , measles 21 , enterovirus infections 23 , influenza 5 , 23 , 24 , 25 and RSV infections 5 , 24 , 26 , 27 , 28 .…”