2017 The French Infectious Diseases Society_s readiness and response to epidemic or biological risk_the current situatio

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Originalarticle

The French Infectious Diseases Society’s readiness and response to epidemic

or biological risk–the current situation following the Middle East respiratory
(cid:2)
syndrome coronavirus and Ebola virus disease alerts

Préparation et réponse de la Société de pathologie infectieuse de langue franc¸aise au risque

épidémique et biologique – état des lieux suite aux alertes MERS-CoV et Ébola

H. Coignard-Biehlera,b,c,∗, C. Rappd,e, J.M. Chapplaina,f, B. Hoeng, D. Cheh, P. Bertheloti,
F. C azenave-Roblotj, C. Rab au dk, P. Bro uqui l, C. Leporta,m , a nd SPIL F- CORE B Emergences

group
aUnitédecoordinationopérationnelledurisqueépidémiqueetbiologique,AP–HP,75001Paris,France
bServi ce desmaladies infectieusesett rop icales, hôpitalNec ke r–Enfantsm alades,7 5015P aris,F rance
cSa mu75,hôpit al Necker–En fantsm alades,75015Pa ris,Franc e
dCM ET E,10,r ueduColonel-D riant,750 01Par is,Fra nce
eHôpitald’instructiondesarm ée sBé gin ,69,avenuedeP aris,9 4160S aint-Mandécedex,France
fServic edesmaladie sin fectieus esettro pic ales,hô pit alPon tchaillo u,35000Ren nes,Fr ance
gInsermCIC14-24,facultédemédecin eHy acinthe-B astaraud,u niv ersitédesA ntilles, centrehospita lierun iversitai re,97110Pointe-à-Pitre,Guadeloupe
hSantépubliq ueFrance, 944 10Saint -Mauri ce,France
iUnitéd’hygièneinterhospitalière,servicedesmalad iesinfect ieuseset labora toiredesagents infectieuxethygiène,CHUdeSaint-Etienne,42270

Saint-Priest-en-Jarez,France
jServicedesmaladiesinfectieusesettropicales,CH UdePoitiers,86021Poitiers,France
kService des maladies infectieuses e ttropicales ,CHR U deNancy ,54000 Nancy, France
lService des maladies infectieuses et tropicales, hôpital No rd,130 00Ma rseille, France
mU MR1137 ,Inserm,un ive rsitéParis Diderot ,7501 8Paris ,France

Received7April2016;receivedinrevisedform9August2017;accepted2October2017

Abstract
Context.–In2012,theFrenchInfectiousDiseasesSociety(FrenchacronymSPILF)initiatedthe“Coordinationofepidemicandbiologicalrisk”

(SPILF-COREB-Emergences[SCE])grouptosupportthereadinessandresponseofhealthcareworkers(HCWs)tonewalerts.

Objective.–TopresenttheSCEgroup,itsfunctioning,andthemainsupportitprovidedforfrontlineHCWs.

Methods.–Amultidisciplinarygroupofheadsofinfectiousdiseasedepartmentsfromreferencehospitalswascreatedtobuildanetworkof

clinicalexpertiseforcare,training,andresearchinthefieldofepidemicandbiologicalrisk(EBR).Thenetworkdevelopedasetofstandardized

operationalprocedures(SOPs)toguideinterventionstomanageEBR-suspectpatients.

Results.–AworkinggroupcreatedtheSOPaimedatfrontlineHCWstakingcareofpatients.Prioritywasgiventothedevelopmentofageneric

procedure,whichwasthenadaptedaccordingtothecurrentalert.Fivekeystepswereidentifiedandhierarchized:detecting,protecting,caring

for,alerting,andreferringtheEBRpatient.Theinteractionbetweencliniciansandthoseresponsiblefortheprotectionofthecommunitywas

crucial.TheSOPsvalidatedbytheSPILFanditsaffiliatesweredisseminatedtoawiderangeofkeystakeholdersthroughvariousmediaincluding

workshopsandtheSPILF’swebsite.

(cid:2) ThisworkwaspresentedasaposterattheEuropeanCongressofClinicalMicrobiologyandInfectiousDiseases,onMay10,2014,Barcelona,Spain.
∗ Corr espon ding author.Sa mu - Smur, GH EH -hospice scivilsde Ly on,grou pementhospit alier ,Édouard- Herriot,5 ,pl aced ’Ar sonval ,69347Lyo ncedex3,

France.
E-mailaddress:[email protected](H.Coignard-Biehler).

https://doi.org/10.1016/j.medmal.2017.10.002
0399-077X/©2017ElsevierMassonSAS.Allrightsreserved.

Pleasecitethisarticleinpressas:Coignard-BiehlerH,etal.TheFrenchInfectiousDiseasesSociety’sreadinessandresponsetoepidemicor

biologicalrisk–thecurrentsituationfollowingtheMiddleEastrespiratorysyndromecoronavirusandEbolavirusdiseasealerts.MedMalInfect

(2017),https://doi.org/10.1016/j.medmal.2017.10.002
+Model
ARTICLE IN PRESS
MEDMAL-3917; No.ofPages8

2 H.Coignard-Biehleretal./Médecineetmaladiesinfectieusesxxx(2017)xxx–xxx

Conclusion. – SPILF can easily adapt and timely mobilize the EBR expertise in case of an alert. The present work suggests that sharing

and discussing this experience, initiated at the European level, can generate a new collective expertise and needs to be further developed and

strengthened.
©2017ElsevierMassonSAS.Allrightsreserved.

Keywords: Clinicalnetwork;Emerginginfectiousdiseases;Epidemicandbiologicalrisk;Standardizedoperatingprocedures

Résumé
Contexte.–En2012,laSociétédepathologieinfectieusedelanguefranc¸aise(SPILF)acrééungroupe«CoordinationduRisqueÉpidémique

etBiologique(REB)»pourpréparerlaréponsedessoignantsàunenouvellealerte(SPILF–COREB-Émergences[SCE]).

Objectif.–PrésenterlegroupeSCE,sonfonctionnementetlesproductionsmisesàdispositiondessoignantsdepremièreligne.

Méthodes. – Avec les responsables des services de maladies infectieuses des établissements de santé de référence, un groupe multidisci-

plinaire SCE s’est structuré en partenariat avec les sociétés savantes impliquées. Il devait organiser en réseau l’expertise clinique pour soin,

formation, et recherche. Il élaborait des procédures opérationnelles pour guider les premières actions de prise en charge des patients suspects

REB.
Résultats. – Un groupe dédié rédigeait les procédures destinées aux premiers soignants prenant en charge les premiers patients. La priorité

a été l’élaboration d’une procédure générique, déclinée ensuite selon l’alerte en cours. Cinq étapes clés ont été identifiées et hiérarchisées :

dépister,protéger,prendreencharge,alerteretorienterlepatientREB.L’interactionentrecliniciensetacteursdelaprotectiondelacollectivité

étaitessentielle.LesprocéduresvalidéesparlaSPILFetsespartenairesconcernésontétélargementdiffusées,notammentsurlesitewebdes

infectiologues(infectiologie.com).

Conclusion. – La SPILF peut mobiliser rapidement en réseau l’expertise REB en cas d’alerte. Ce travail suggère que le partage et les

échanges de cette expérience, amorcés avec d’autres pays européens, peuvent générer une nouvelle expertise et méritent d’être développés et

consolidés.
©2017ElsevierMassonSAS.Tousdroitsre´serve´s.

Motsclés :Réseauclinique;Maladiesinfectieusesémergentes;Risqueépidémiqueetbiologique;Procéduresopérationnellesstandardisées

1. Introduction whichisresponsibleforcentralizedmedicalcallsinFrance.It

isunlikelythatEBR-suspectpatientswouldpresentthemselves

Since the 2001 anthrax alert in the United States (23 directlytooneofthereferencecentersidentifiedbythehealth

American case patients, 5 deaths, and approximately 2500 authorities; they would rather first consult other closer health

anthrax-suspectpatientsinFrance)andtheinternationalsevere facilitieswithinthenationalhealthsystem.Therefore,theneed

acuterespiratorysyndrome(SARS)outbreakin2003,anorga- foramultidisciplinarynetworktodelivertheoperationalexper-

nization has been developed in France to address the clinical tise to frontline HCWs for initial patient management (mainly

management of patients suspected of having an infectious SAMUCenter15,in-hospitalemergencydepartments,andfam-

disease (ID) related to a natural epidemic or an intentional ily physicians [FPs]) was urgent. The 2009 H1N1 influenza

biological risk (“Epidemic and Biological Risk”–EBR). The pandemic highlighted the importance for timely delivery of

responsetonuclear,radiological,biological,andchemicalrisks appropriatecaretopatientsandforinformingthegeneralpop-

inFranceisorganizedthrough12civilzonesofdefense(2003 ulationaboutmeansofprotection.Thisreinforcedtheconcept

applicationdecree).Ineachzone1–2hospitalsareidentifiedas thatthemid/long-termoutcomeofanepidemicdependsheavily

areferencefortheserisks(16referencehospitals,amongwhich on adequate and coherent coordination of individual care and

themilitaryreferencecenteroftheParis-Île-de-Francezoneand collective measures, decisions and actions undertaken during

theGuadeloupe-associatedreferencehospitalwereincluded)as the initial phase of the alert. In 2009, a dedicated regional

presentedinFig.1[1].Forbiologicalrisks,eachofthesehos- EBRCoordinationunit(Coordinationopérationnelledurisque

pitals has a dedicated ID department, reference microbiology épidémique et biologique [COREB]) was created in Paris -

laboratory, zonal prehospital emergency medical service unit Île-de-France. In 2012, the French Infectious Diseases Soci-

(SAMU center 15) including the medical regulation of emer- ety(SPILF)establishedanationalSPILF–COREB–Emergences

gency calls, and departments which include infection control (SCE) group to coordinate ID specialists’ response to EBR in

unit, intensive care unit, and a pharmacy involved in the care collaborationwithotherkeystakeholders,suchasotherspecial-

of these patients. EBR alerts might lead to disruption within istsandinstitutions.

thepublichealthsectorandthesocietyrelatedtofearoftrans- The aim of the present article was to describe the

mission and to the potential negative socio-economic impacts SPILF–COREB - Emergences group functioning and the

[2]. Immediate access to ID expertise was requested by front- standard operational procedures (SOPs) that were delivered

line healthcare workers (HCWs), especially SAMU Center 15 to frontline HCWs, particularly following the recent alerts of

Pleasecitethisarticleinpressas:Coignard-BiehlerH,etal.TheFrenchInfectiousDiseasesSociety’sreadinessandresponsetoepidemicor

biologicalrisk–thecurrentsituationfollowingtheMiddleEastrespiratorysyndromecoronavirusandEbolavirusdiseasealerts.MedMalInfect

(2017),https://doi.org/10.1016/j.medmal.2017.10.002
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H.Coignard-Biehleretal./Médecineetmaladiesinfectieusesxxx(2017)xxx–xxx 3

Fig.1. Defenseandsecurityareasfororganizationofnuclear,radiological,biological(epidemicandbiologicalrisksincluded),andchemicalrisksinmetropolitan

Franceandoverseasdepartments,withlocalizationofthereferencehospitals,March2016.

Zonesdedéfensecivilepourl’organisationdurisqueNucléaire-Radiologique-Biologique-Chimique(NRBC)incluantlerisqueépidémiqueetbiologique,enFrance

métropolitaineetd’outre-mer,aveclocalisationdesétablissementsdesantéderéférence,mars2016

Middle East respiratory syndrome coronavirus (MERS-CoV)

infectionsandEbolavirusdisease(EVD).

2. Methods

2.1. CompositionoftheSCEgroup

TheSCEgroupinitiallygatheredmotivatedandexperienced

ID specialists from national university and general hospitals,

involvedinfieldoperations.WithintheSCEgroup,aregularly

convened steering committee provided a strategic focus to the
Fig.2. OrganizationoftheSPILF–COREB–Emergences(SCE)group.
group,qu ickdecis ion-making incaseo f alerts,an dinter -cr isis O rganisationdu gr oup eSPILF–COREB–Émergence s(SCE ).

vigilance.Specialistsinthefieldsofmicrobiologyandinfection

controlwerealsoconvenedtoparticipateintheSCEgroup.Two

workinggroups(WG)werecreated:ResearchWGresponsible

forthepreparationofepidemiologicalandclinicalresearchand 2.2. WritingofaSOP

ProcedureWGresponsibleforeditingSOPsforclinicians(see

Fig.2fororganizationalstructure).TheProcedureWGinvolved Duringbothinter-crisisperiodsandalerts,theSCEgrouphad

varioushealthcareprofessionalsincludingID,infectioncontrol, to update available knowledge on emerging IDs and provided

emergencycarespecialists,FPs,andnursemanagers.ThePro- relevantinformationthroughprofessionalnetworks.Inaddition

cedureWGalsohadregularinteractionswithmicrobiologyand to academic scientific publications, websites were monitored

epidemiologyexperts;alllinkswereestablishedbeforeanalert andreviewedtovalidateinternationaldatathroughdocumenta-

crisisperiodtoenhancetherelevanceandtherapidadaptation tion from well-established networks such as the World Health

of the response. This WG collected and coordinated informa- Organization (WHO), the Centers for Disease Control and

tionandknowledgewiththeotherconcernedprofessionalsand Prevention (CDC), the European Center for Diseases Control

stakeholders, and summarized expertise when an EBR alert (ECDC) [3], and the Promed daily webmail alerts (a program

occurred. fromtheInternationalSocietyforInfectiousDiseases).

Pleasecitethisarticleinpressas:Coignard-BiehlerH,etal.TheFrenchInfectiousDiseasesSociety’sreadinessandresponsetoepidemicor

biologicalrisk–thecurrentsituationfollowingtheMiddleEastrespiratorysyndromecoronavirusandEbolavirusdiseasealerts.MedMalInfect

(2017),https://doi.org/10.1016/j.medmal.2017.10.002
+Model
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4 H.Coignard-Biehleretal./Médecineetmaladiesinfectieusesxxx(2017)xxx–xxx

The first task of the SCE group was to create a generic hierarchicalprincipleswereidentified;eachcouldbetailoredto

procedure which would provide a framework for EBR clini- specificsituations:

calsituationsthatHCWsmightencounter[4].Thegroupthen
wro te specifi c res ponse alert S OPs. Each tim e an alert was • howtodetectanEBR-suspectpatient(compatiblemanifesta-

triggered at an international or national level, with potential tionsandexposure).Thisfirststepisconductedcloselywith

problems for French frontline HCWs, the Procedure WG in theIDspecialistandtheepidemiologistresponsibleformoni-

collaboration with the steering committee, decided whether toringatanationallevelinordertobeascoherentandsensitive

or not to generate a specific SOP. A request to write a SOP aspossible;
co uld com e from t he SCE gr oup ( in agreeme nt with S P ILF), • ho w to protect HCWs, other patients, and the environment

from SPILF itself, or from health authorities represented by with a rapid and effective application of individual and col-

the General Directorate of Health of the Ministry of Health, lectivehygienemeasures;
or t heir ope rational part ner s. The d ec ision on how to respond • howto carefor thepatientcharacterizingtheclinicalpresen-

to an alert was then discussed with national experts from two tationandlookingforseveresymptomsorriskcomorbidities,

fields:epidemiologistsfromSantépubliqueFranceresponsible prescribing symptomatic and when possible specific anti-

formonitoringandimplementingtheepidemiologicalinvestiga- infectivetreatments;
tion s,andmicr obio logistsfromt heN ationalReferen ceCenter • how to alert the primary specialists, lead ID specialist,

forthecorrespondingpathogen.Additionally,abriefliterature lead infection control, SAMU Center 15 practitioner, epi-

reviewundertakenbytheSCEgroupofcurrentinformationpre- demiologists, and health authorities to classify the patient

cededeachdecision.Severaltypesofresponsestoanalertcould as an excluded or possible case patient, and adjust and

begenerated,suchasawarningbyemailtoamailinglist(short apply appropriate protective measures (e.g. follow-up of

time response), the creation of a ‘frequently asked questions’ contacts);
docu mentabout an ewpatho gen , oraSOPco ncerni ngthecare • how to refer the patient towards the appropriate healthcare

tobegiventoanEBR-suspectpatient(ifthealertseemedtobe department,forexampleisolationunit,commonhospitaliza-

ofnationalinterest).Thetimeframeforresponsevariedbetween tionward,orFPconsultation.

afewdaystomonthsdependingontheseverityandcomplexity

ofthesituation. Additional dedicated propositions for the most probable

infectious agents were enclosed in an appendix section added

at the end of this generic procedure: hemorrhagic viral fevers,

2.3. ValidationanddiffusionofaSOP anthrax,andpotentiallyepidemicpneumonia[4].

Four other specific SOPs were written between 2009 and

Each SOP or document written by the Procedure WG was 2012(Table1).

first submitted for review to the steering committee and the Eleven additional SOPs have been written and published

wholeSCEgroup.Itwasalsosubmittedtotheepidemiologists online on the SPILF’s website (http://www.infectiologie.com)

from Santé publique France and to representatives from each since 2012 – when the SCE Procedure WG was set up. They

of the relevant partner scientific societies (for example, emer- focused on various pathogens according to ongoing alerts,

gency, intensive care, hygiene, microbiologists, and pediatric includingMERS-CoVinfection(March2013)andEVD(April

specialists).Followingfeedback,theSOPwasmodifiedandthe 2014)(Table1).

revised version was re-submitted for approval to the steering

committeeandSPILFchair.Itwasthensenttonationalhealth 3.2. ExperiencewithMERS-CoVandEbolavirusalerts

authorities and their operational partner, the High Council for

PublicHealth(FrenchacronymHCSP),theSCEgroup,andthe TheworkflowtoprepareanewSOPforMERS-CoValertis

correspondingaffiliateofeachpartnersocietyforvalidationor highlighted in Fig. 3. On March 2012, a first case patient due

information, depending on the type of referral. Once the SOP to a new coronavirus infection was mentioned in the Promed

wasapproveditwaspublishedonlineontheSPILF’swebsite, mail. On September 2012, a total of nine patients infected

http://www.infectiologie.com/fr/coreb.html.Apressreleasewas with the novel coronavirus in Saudi Arabia, Qatar, and Jor-

also sent to wider stakeholders, such as FPs and the media if dan were reported to public health authorities and WHO. Two

appropriate. patients were referred to Europe for specialist care; this new

coronavirus was also characterized by genome sequencing at

the Erasmus Medical Center [5]. Following discussion at the

3. Results steering committee, the SCE group decided to wait and con-

tinue to pay particular attention to the evolution of this new

3.1. SOPsformanagementofEBR-suspectpatients infection as recommended by the epidemiology experts from

SantépubliqueFrancewhohadestablishedasystemforinter-

Frontline HCWs needed a generic procedure in case of an nationalsurveillance.TheSARSSOP(firstpublishedin2003)

EBRalert,whichcouldguidetheirinitialactionsindependently wasrepublishedonthe‘News’sectionoftheSPILF’swebsite.In

of the pathogen. This generic procedure was established in January2013,theBritishHealthProtectionAgencyannounced

2009bytheregionalCOREBgroupinParis–Île-de-France.Five thatanadditionalcasepatientofthenovelcoronavirusinfection

Pleasecitethisarticleinpressas:Coignard-BiehlerH,etal.TheFrenchInfectiousDiseasesSociety’sreadinessandresponsetoepidemicor

biologicalrisk–thecurrentsituationfollowingtheMiddleEastrespiratorysyndromecoronavirusandEbolavirusdiseasealerts.MedMalInfect

(2017),https://doi.org/10.1016/j.medmal.2017.10.002
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H.Coignard-Biehleretal./Médecineetmaladiesinfectieusesxxx(2017)xxx–xxx 5

Table1

TableofprocedureswrittenbytheSCEgroup,2009-2016.

TableaudesprocéduresrédigéesparlegroupeSCE,2009-2016.

Initiativeofthe Year Pathogen TypeofSOP Dateof

referral diffusion/publication
COREB 2009 AllEBR StandardizedgenericprocedureforSAMUandemergencydepartments January2011

Île-de-France, agents focusingoncareofEBR-suspectpatients

endorsedby

SPILF
2010 Seasonalflu Careofpatientssuspectedofseasonalfluinemergencydepartmentsandinitial January2010

patientmanagement

2011 Measles Careofpatientssuspectedofmeaslesinemergencydepartmentsandinitial May2011

patientmanagement

2012 Hantavirus CareofpatientssuspectedofHantaviruspulmonarysyndrome September2012

2013 MERSCoV HowtomanageapatientsuspectedofMERSCo-Vinfection May2013

SPILF-COREB- 2013 MERSCoV QuestionnaireforreceptionandreferralofpatientssuspectedofMERSCo-V Neverpublished

Emergences infectioninambulatoryoroutpatientcare

2014 HxNyflu HowtodetectandmanageaHxNy-suspectpatient February2014

2014 Ebola HowtodetectandmanageanEbola-suspectpatient Neverpublished

2014 Ebola HowtodetectandmanageanEbola-suspectpatient-Abstract April2014

2014 Ebola Questionnaireforfrontlineworkersforreceptionofapatientsuspectedof November2014

EVDinfection

2015 MERSCoV UPDATE:HowtomanageapatientsuspectedofMERSCo-Vinfection October2015

2016 Seasonalflu UPDATE:Globalcareforseasonalflu-suspectpatients February2016

2016 Zika FrequentlyAskedQuestions“Zikavirus”-InformationdocumentforSAMU April2016

medicalregulation

2016 Lassa FeveramongtravelersreturningfromWestAfrica-Informationnoteto May2016

emergencydepartmentsandSAMUpractitioners

MinistryofHealth 2014 Ebola Indicationsandmodalitiesformanagingbiologicalsamplesofan August2014

Ebola-infectedpatientinFrance-PMOR

2014 Ebola CareofanEbola-infectedpatientinFrance-PMOR Ongoingupdate

2015 AllEBRagent ManagementofanexposedpersontoanEBR-infectedpatient(suspect, Submittedtothe

probable,orconfirmed)inanon-healthcarecontext HCSP,September

2016
SAMU:prehospitalemergencymedicalserviceunit;EBR:epidemicandbiologicalrisk;PMOR:professionalmultidisciplinaryoperationalrecommendation;HCSP:

HighCouncilforPublicHealth.

Fig.3. Initiationofaspecificstandardoperatingprocedure(SOP):exampleoftheMiddleEastRespiratorySyndrome(MERS)-coronavirusStandardOperating

Procedure(SOP);UK:UnitedKingdom.

Initiationdelarédactiond’uneprocédureopérationnellespécifique:exempledelaprocédureMiddleEastRespiratorySyndrome(MERS)-coronavirus.

wasimportedandconfirmedinaresident.ThisledtotheSCE operatorHCSP.TheHCSPusedthisworktofinalizeitsownrec-

steeringcommitteedecidingtoprovideaspecificSOPforcare ommendations on March 19, 2013. On April 5, 2013 the SOP

ofMERS-CoV-suspectpatients,whichwaspreparedwithintwo wascirculatedtofrontlineemergencyspecialistsandIDpracti-

monthsandinformallysharedwithhealthauthoritiesandtheir tioners,andpublishedonlineontheSPILF’swebsite.Thefirst

Pleasecitethisarticleinpressas:Coignard-BiehlerH,etal.TheFrenchInfectiousDiseasesSociety’sreadinessandresponsetoepidemicor

biologicalrisk–thecurrentsituationfollowingtheMiddleEastrespiratorysyndromecoronavirusandEbolavirusdiseasealerts.MedMalInfect

(2017),https://doi.org/10.1016/j.medmal.2017.10.002
+Model
ARTICLE IN PRESS
MEDMAL-3917; No.ofPages8

6 H.Coignard-Biehleretal./Médecineetmaladiesinfectieusesxxx(2017)xxx–xxx

patientpresentingwithMERS-CoVwasdiagnosedinFrancein and management (for example, physicians, microbiologists,

May2013[6]. hygiene specialists, nurses, managers, hospital administrators,

More recently, the SCE group has created documentation and health authorities) has been convened since 2015. This

coveringtheEVDpreparationinFrance.Oncethepublichealth meetingprovidesaneffectiveopportunitytosharebestpractice

emergency of international concern was declared by WHO in andexperiencetodevelopgrowingknow-howandinsightinto

August 2014, French hospitals had to prepare for the possible addressing key issues related to the management of EBR-

arrivalofpatientssuspectedofEVDinfection.TheSCEgroup associatedIDtreatmentinFrance.

was asked by the relevant health authorities to rapidly prepare

a specific SOP. The first step was to republish, on the ‘News’

pageoftheSPILF’swebsite,thespecificviralhemorrhagicfever 4. Discussion

appendixrelatedtothe2011genericprocedure.Then,duringthe

firsttwomonthsofthealert(April–June2014)aspecificSOP Thisarticledescribestheapproachofthescientificmedical

for clinical care of an Ebola virus-suspect patient and a ques- IDsocietytocreateanoperationalphysician-basedmultidisci-

tionnaire for all professionals in specific hospital facilities for plinarynetworkcontributingtothepreparationandresponseto

suchpatientswereprepared.AsummaryoftheSCEEVDclin- anEBRsituation.

icalSOPwasaddedtotheAlertResponseBulletinsentbythe

FrenchMinistryofHealthtoallconcernedHCWsonSeptember

2, 2014. From May to July 2014, the first formal Professional 4.1. ClinicalapproachinEBRnetworks

Multidisciplinary Operational Recommendation (PMOR) was

writtenfollowingarequestfromtheMinistryofHealth,todefine Since the 2001 anthrax and 2003 SARS alerts, response

theappropriateandfeasibletechnicalconditionsformanipula- strategiesfromFrenchpublichealthauthoritieswereprimarily

tions of biological samples potentially containing Ebola virus basedonepidemiologicalandbiologicalnetworks.Attheinter-

by the microbiological laboratories in the EBR reference hos- nationallevel,areviewoftheliteratureinthePubMeddatabase

pitals. This led to the publication of a decree by the Health showedthediversityofthesenetworks.Severaltransitoryorvir-

authorities adapting the legal framework for the management tualphysiciannetworkswerethenestablishedduringoutbreaks,

ofEbola-containingbiologicalsamplesonAugust6,2014.The withtheaimofcollectingdataonpatientstoimprovetheclini-

PMORraisedquestionsabouttheappropriatepersonalprotec- calresponseand/ortoconductreal-timeclinicalresearch(SARS

tive equipment (PPE) against EVD in the reference hospitals, crisis–WHO[9],REVAGRIPPE–SRLF[10],(H1N1)pdm2009

and a dedicated working group was formed to cooperate with - HPA [11]). The experience of the 2003 SARS crisis and the

theNationalInstituteofResearchandSafetyforPreventionof 2009pandemicflusuggestedthatpatientcareneededtobeinte-

OccupationalAccidentsandDiseases(FrenchacronymINRS) gratedintotheresponsepreparation.Thisconceptwasadopted

toaddresstheissue.Muchofthepreparationfocusedontheuse at the international level for the recent MERS-CoV and EVD

ofPPEand,whilewaitingfornationalguidelines,eachhospi- epidemics, with the creation of the Emerging Disease Clin-

tal created a contingency plan using their own equipment and ical Assessment and Response Network (EDCARN) [12] in

clothingtouseinlocalenvironment.Inparallel,theSCEgroup which the French SCE group participated. Here again, there

andtheINRScollected,analyzed,andsynthesizedprocedures was strong evidence to suggest that biological and epidemio-

fromeachreferencehospitalandharmonizedrecommendations logicalnetworkingorganizationsshouldbetteraddressclinician

were proposed for the donning and doffing of the PPE in case expertise.Indeed,themainobjectivesandactionsofhealthcare

ofEbola-infectedpatientcare[7].Thisdocumentwasalsodis- system managers needed to focus on ensuring and improv-

seminatedtotheHCSPandhealthauthorities,andpublishedon ing timely and adjusted patient care and appropriate infection

theINRSwebsite. controlmeasures[13].Sincethen,severalEuropeaninitiatives

have created multidisciplinary structures with the aim of shar-

3.3. Otherachievements inginformationonEBR-associatedIDstoenhancepreparedness

and response (EUNID [14–16]) or to establish a framework

Following the above-mentioned alerts, the inter-crisis shar- forintegratingclinicalresearchintoepidemicresponse(collab-

ing of information was embedded through regular newsletters orations named PREPARE [17], ISARIC [18], REACTING).

(two times a year) to primary care physicians. They aimed to Another initiative is the European Training in Infectious Dis-

facilitate the sharing of information and experiences between ease Emergencies program (ETIDE), conducted since 2006

HCWs facing EBR through the national network of 16 ref- which aims to “enhance European capacity to recognize and

erence hospitals. The newsletter was made of three parts: an respondinacoordinatedfashiontoanyinfectiousdiseaseemer-

editorialwrittenbytheSCEgrouponrecentactionsundertaken gency,whetheraccidentalordeliberateinorigin”andwhichwas

bythegroup,anopenforumarticlealternatelywrittenbytheID opened to multidisciplinary professionals including frontline

expertsfromoneofthe16referencenationalhospitals,andan HCWsinEurope[19].Basedonthisexperience,theFrenchSCE

update of potentially operational epidemiological information groupaimedtocontributetoaninternationalapproach,keeping

andscientificarticles[8]. at its core patient’s care and encouraging operational interac-

Finally, a yearly meeting with the 16 reference hospi- tion between ID specialists, epidemiologists, biologists (etc.)

tals and all the main stakeholders of the EBR preparation with frontline physicians. This field-based validated expertise

Pleasecitethisarticleinpressas:Coignard-BiehlerH,etal.TheFrenchInfectiousDiseasesSociety’sreadinessandresponsetoepidemicor

biologicalrisk–thecurrentsituationfollowingtheMiddleEastrespiratorysyndromecoronavirusandEbolavirusdiseasealerts.MedMalInfect

(2017),https://doi.org/10.1016/j.medmal.2017.10.002
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H.Coignard-Biehleretal./Médecineetmaladiesinfectieusesxxx(2017)xxx–xxx 7

can be available to physicians, patients and health authority 5. Conclusion

decision-making.
The need for a clinical network, linked with epidemiolog-

ical and microbiological networks, is now recognized as a
4.2. Operationaleffectivenessandsustainabilityof

pre-requisiteforimprovingthereadinessandresponsetoEBR
preparedness

alerts.TheemergingexpertisefromtheFrenchSPILF–COREB

- Emergences group can be rapidly mobilized for the main
Unfortunately,attheendofeachrecentEBRcrisis,network
stakeholders: it helps frontline HCWs to manage patients and
activityvanishedandmostEuropeanprojectswerenotsustained
contributestointegratingfieldexperienceintostrategicdecision-
becauseofalackoffunding.SOPsandactionsmustbeworked
making by health authorities and crisis managers. The SCE
out,tested,andrevisedduringinter-crisisperiodstopreparefor
group’sactivityandefficiencyforcreatingSOPsnowneedsto
future crises. A new COREB national mission was created in
beevaluated.Thepresentworkneverthelesssuggestedthatshar-
2014 to share and reinforce the experience of the French SCE
inganddiscussingthisexperienceinitiatedattheEuropeanlevel
group; this new mission was supported and funded concomi-
was able to generate new collective expertise; this needs to be
tantlybytheFrenchMinistryofHealthandtheSPILF.Itsmain
furtherdevelopedandstrengthened.
objectivewastoallowmaintenanceactivityandcontinuouspro-

fessional multidisciplinary operational expertise. The COREB
missionh asbeenembedded intheNatio nalPlande dica tedtothe Steeringcommittee

managementofExceptionalHealthSituationspublishedbythe
French Minis try of Health i n 2014 (ORSAN plan) [20] . H ere S. Alfandari (Tourcoing), H. Aumaitre (Perpignan), F.
the ma in task is , d uring th e inter-c risis time , to m aintai n the Brica ire (Paris) , P. Brouqui* (M arseille), J-M. Chappl ain
skil ls–st rongl yb asedon trai ningofhea lthpro fes sionals– and (Rennes ), M-C. Cho pin (Valen ciennes), H. Coign ard-Biehler
to stim u late a pe rmane nt activity of the EB R clinical ne tw ork (Paris), B . Hoen * (Poin te-à-Pitre), V. Ja rlie r (Paris), C. Lep-
of the16ref er encehospit alsforp rep arat ionad justedto therisk ort (Par is), O. Lor tholary* (Paris), A. Méren s (Saint Ma ndé),
lev el. Inp arallel,pr eparinga ndp ublishingS OPsusin ga PM OR D. Peyramo nd (Lyon), C. R abaud* (N ancy), C . Rapp * (Saint-
metho do logy is considered ess ential. A f uture supple m entary Ma ndé),F.Rob lot(Poi tier s),J.Salo mon(Ga rch es),P.T attevin
strategytobe de velopedist heprepara tio nand managementof (Rennes) .

EBR-suspectpatientsbyoutpatientmedicalstaff,whichreflects

therealityofapatientpathway.Suchanin-depthresponsestrat- OtherIDmembers

egy would increase frontline practitioners’ involvement, limit

the activity overload of reference hospitals, and allow for a J.Beytout(Clermont-Ferrand),E.Bouvet(Paris),A.Cabié*

more operational, graduated, and adjusted mobilization of the (Fort-de-France), F. Caron (Rouen), E. Caumes* (Paris), C.

healthcaresystemifanalertoccurs. Chidiac* (Lyon), D. Christmann (Strasbourg), F. Djossou*

(Cayenne), M. Dupont* (Bordeaux), J. Gaillat (Annecy),

B. Guéry* (Lille), Y. Hansmann* (Strasbourg), D. Malvy
4.3. Internationalcooperation

(Bordeaux),B.Marchou(Toulouse),C.Michelet*(Rennes),M-

P.Moiton*(Saint-DenisdeLaRéunion),C.Perronne(Garches),
Consideringthatmicroorganismstravelacrosstheworldas
P-M. Roger (Nice), E. Senneville (Tourcoing), J-P. Stahl
fast as – or even more rapidly than – humans, international
(Grenoble), R. Verdon (Caen), D. Vittecoq (Kremlin-Bicêtre),
networks will benefit from gathering relevant experience from
Y.Yazdanpanah*(Paris).
localandregionalnetworks.
*ResponsibleIDspecialistsinzonalcenters.
InDecember2013,WHOandtheInternationalSevereAcute

RespiratoryandEmergingDiseasesConsortium(ISARIC)con-
venedphysi cian streating patientsp resentingwi thMERS CoV Representativesofthescientificpartnersocieties

infectionfromthefiveaffectedcountriesintheMiddleEastand
otherEB Rexp erie nce dcountri es,tolear nf rom theirfi rst-h and SUdF: F. Braun, M. Nahon, SF2H: B Grandbastien,
exper ience ,exchangebe stpractice ,an ddisc ussp otenti alclinical P. Parneix , S FP: B C habr ol, R Co hen, SFA R: C. Ecoffay, R
intervention s.TheFre nch SCEgro upp articipa tedinthi swork- G auzit, SF M: R. C ourcol, A . M érens, S FMU: P-Y . Gueugn i-
shop.Similar work shopsf orac tivein teractionsam o ngc linical aud,Y- E.Clae sse ns,SMV: E. Caumes, P-H.Co nsig ny,SRLF:
exper ts across the world we re run when EVD spread in West P-F. Later re,JLDieh l.

Africa (2014–2015). These were the basis for developing the

EDCARNnetwork. Procedureworkinggroup

ThedevelopmentoftheFrenchSCEgrouphasbeenmirrored

inothercountriessuchasGermanyandItaly.TheSCEproject P. Berthelot (Saint Etienne), T. Blanchon (Paris), M-

startedtobedevelopedattheEuropeanlevelinFebruary2016. C. Chopin (Valenciennes), H. Coignard-Biehler (Paris),

Three meetings of physicians from eight European countries Y.Kieffer(Paris),M.Lardière(Lyon),A.Mahamat(Cayenne),

closetoFrancewereorganizedinParis,Berlin,andMadridto M. Méchain (Bordeaux), C. Rapp (Saint Mandé), O. Rogeaux

tryandsettleanEBRclinicaloperationalnetwork. (Chambéry),L.Rossignol(Paris).

Pleasecitethisarticleinpressas:Coignard-BiehlerH,etal.TheFrenchInfectiousDiseasesSociety’sreadinessandresponsetoepidemicor

biologicalrisk–thecurrentsituationfollowingtheMiddleEastrespiratorysyndromecoronavirusandEbolavirusdiseasealerts.MedMalInfect

(2017),https://doi.org/10.1016/j.medmal.2017.10.002
+Model
ARTICLE IN PRESS
MEDMAL-3917; No.ofPages8

8 H.Coignard-Biehleretal./Médecineetmaladiesinfectieusesxxx(2017)xxx–xxx

Contributionsofauthors MiddleEastRespiratorySyndromecoronavirus:areportofnosocomial

transmission.Lancet2013;381(9885):2265–72.

H.Coignard-Biehlerwrotethearticle. [7] Institut national de recherche et de sécurité pour la prévention des

accidents du travail et des maladies professionnelles. Maladie à
C. Rapp, J.M. Chapplain, B. Hoen, F. Cazenave-Roblot, C.
virus Ebola. Tenues et procédures de déshabillage des soignants en
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établissement de santé de référence; 2015 [Internet. Available from:
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