Santé Publique France, DiRe-CIRE Nouvelle Aquitaine (Bordeaux) - EPIET
Tel. + 33 5 57 01 46 24
Fax. + 33 5 57 01 47 95
Description of the institute
The French Institute for Public Health Surveillance (Institut de veille sanitaire, InVS), was created in 1998 based on the ‘Réseau National de Santé Publique’ (RNSP), created in 1992. It is the governmental institution responsible for surveillance and alert in all domains of public health, reporting to the Ministry of Health. InVS is responsible for the continuous monitoring of the population’s health status, health surveillance and alert. The missions of InVS cover all domains of public health: infectious diseases, chronic diseases and injuries, occupational and environmental health hazards, and international hazards.
The regional offices of InVS (‘Cellules de l’InVS en Région’, CIREs) represent InVS in the regions and act on behalf of the central office. The CIREs are located within Regional Health Agencies (‘Agence Régionale de Santé’, ARS) responsible for the management of the regional health system. There are 26 ARS in France. Each ARS consists of a central office and local offices in each of the ‘départements’ across the region. There is a formal partnership agreement between the InVS and each ARS describing the role of CIRE in support of ARS. This role encompasses the provision of surveillance and health risk evaluation as well as expertise in field investigation. There is a shared responsibility between ARS and CIRE for health alerts effected through a Regional Health Emergency platform where CIREs provide expertise to ARS local offices. There are 17 CIREs, 15 in metropolitan France and two overseas. Nine CIREs oversee more than one region, while eight supervise only one.
The Cire Aquitaine is located in Bordeaux (250,000 inhabitants) in south-west of France. Bordeaux is the capital of the région Aquitaine (3.2 million inhabitants) that includes 5 ‘départements’ (Dordogne, Gironde, Landes, Lot-et-Garonne, Pyrénées-Atlantiques). In Aquitaine, there are 182 hospitals, 35 emergency services and various laboratories providing support to nearly 56,000 health care professionals (including 5,300 general practitioners - GPs). The offices of the CIRE are located in the central office of ARS Aquitaine (a central location in Bordeaux, airport: 45 min. by public transport). The ARS has one central office and 5 local offices (one in each of ‘département’).
The CIRE comprises 6 epidemiologists, its head and an assistant. The CIRE deals with health events coming from 2 sources: 1) the surveillance systems and 2) direct calls to the Regional Health Emergency Platform from health care professionals, healthcare networks, laboratories and hospitals. The CIRE and the CVAGS of ARS (‘Cellule de veille, d’alerte et de gestion sanitaires’: 1 central office and 5 local offices – one in each ‘département’) jointly contribute to the Regional Health Emergency Platform.
The CIRE is involved in activities of surveillance, outbreak investigations, planned studies, teaching and communication:
- Surveillance through syndromic surveillance, surveillance for specific health problems in the region, and national surveillance systems implemented at regional level. CIRE’s activities in closed collaboration with InVS departments: protocol, data collection and analysis, interpretation and information of decision makers. Examples of syndromic surveillance: data from emergency services from hospitals and from GPs working on emergency, mortality data from city halls, absence data from schools, medicine sales from pharmacies. Examples of specific surveillance: infectious diseases (mandatory notifications, sexually transmitted infections, emerging tropical diseases such as chikungunya and dengue, etc.), seasonal pathologies, diseases within communities, environmental health hazards as carbon monoxide poisoning, heat-related illnesses, allergies and asthma.
- Outbreak investigations through easy access to health signals from the Regional Health Emergency Platform. CIRE’s activities in closed collaboration with InVS departments: protocol, questionnaires, data analysis, writing reports, relations with medias; support to ARS on validation of health signals, control measures and health crisis management. On average, the CIRE has been involved in 30 outbreak investigations per year (80% of infectious diseases, 15% in environmental health hazards and 5% of occupational health hazards). In 2011, CIRE was involved in the international outbreak of haemolitic uraemic syndrome (HUS) and bloody diarrhoea due to E. coli O104:H4 (several cases near Bordeaux), with a role for evaluation of local situation, investigation to identify the source, relations with medias, and to support ARS for control measures.
- Planned studies: the CIRE conducts some planned studies in collaboration with InVS departments. Examples: health impact of air pollution in urban areas, acute health effects of spraying pesticides in vineyards, risk assessment in industrialised areas, infectious waste management by private health-care professionals, mumps vaccine effectiveness. Due to the partnership agreement between InVS and Bordeaux School of Public Health (ISPED), the CIRE can be involved in research projects conducted by ISPED.
- Teaching activities: the CIRE is involved in teaching activities of ISPED according to the partnership agreement (see above), mainly in the Master in Public Health. For the next years, the CIRE expects to reinforce its teaching activities of ISPED in the fields of surveillance and outbreak investigations.
- Communication activities: it concerns regional bulletins – primary focus laid (e.g. ‘Point épidémiologique’: weekly CIRE report on health situation, ‘Bulletin de veille sanitaire’: quarterly CIRE report on outbreak investigations and surveillance results), local and national reports (published by the central office of InVS), articles peer-reviewed (e.g. ‘Bulletin épidémiologique hebdomadaire’: weekly InVS journal, EuroSurveillance) and communications to conferences (e.g. ‘Journée régionale de veille sanitaire’: CIRE conference at district level, InVS national days). In addition, due to its activities, notably on outbreak investigations and surveillance of seasonal pathologies, CIRE has often contact with media.
The training site offers many opportunities for a fellow in the fields of surveillance, outbreak investigations, planned studies, teaching and communication. The fellow is expected to participate and to manage outbreak investigations at local level. Involvement in outbreak investigations at national level is also possible. In the field of surveillance, activities can concern implementation of a system, analysis of data, and evaluation of a system. In terms of planned studies, it can include protocol design, data analysis, and writing results. The fellow has the possibility to participate in the teaching activities of ISPED, and can also contribute to the National Course in Applied Epidemiology (IDEA) and to the Local Training Program for Health Personnel of the Regional Health Emergency Platform. In the field of research, several opportunities are offered: research project in collaboration with ISPED (especially strong in biostatistics), local study in specific populations with the Regional Health Observatory (ORS Aquitaine), and several others opportunities with the Department of infectious diseases (DMI) of InVS. In the field of communication, there are opportunities to practise writing skills, notably for the regional bulletins, as well as present results in front of different audiences; so, writing reports and articles is expected, as well as communications on conferences. The possibility for the fellow to have media contacts is also possible. An additional opportunity concerns the access to the microbiology laboratories of the university hospital, due to close collaboration with CIRE for virological surveillance and for investigations whenever is needed. The fellow can visit the laboratories in order to become acquainted with their methods. The fellow will have internet on-line access to the InVS library, with the possibility to download articles of interest.
General supervision will be provided by Patrick Rolland, Head of CIRE Aquitaine, Public Health Epidemiologist. Supervision of specific projects will be provided by epidemiologists in the CIRE Aquitaine (most of them have been involved in the supervision of previous PROFET, French FETP program, and EPIET fellows).
French and English
Number of EPIET fellows trained at CIRE Aquitaine: one (start in 2012)
Number of PROFET (French FETP program) fellows trained at CIRE Aquitaine: Four (2004-2010)
Other trainees: Public Health Residents (2005-2015), Master of Public Health (2004-2015)