Research – France – Acute gastroenteritis: results of winter surveillance 2019-2020

Sante Publique

Food Borne Illness - Norovirus -CDC Photo

Public Health France publishes the 2019-2020 annual winter surveillance report for acute gastroenteritis in mainland France, marked by two major events and in particular a historic drop in AGEs never observed over the past 10 years. 

Acute winter gastroenteritis (AGE) is mainly of viral origin, with a dominant circulation of noroviruses and rotaviruses. Noroviruses are responsible for AGE in people of all ages, while rotaviruses mainly affect children under 5 years of age. A winter resurgence of cases is observed each year, in France, as in Europe, generating an increase in medical consultations for AGE usually between December and April. A peak is often observed during the first two weeks of January. 

Fluctuating activity for GEA over the 2019-2020 winter season

A significant peak observed in connection with an episode of collective food poisoning in several metropolitan areas

As in the two previous seasons, an increase in the number of AGE cases was observed at the start of the winter season, followed by a sharp increase in visits to hospital emergencies and general medicine at the end of December 2019 – beginning of January 2020, higher than the peaks of the 7 previous seasons in week 01-2020, and reaching 3.1% of total activity in hospital emergencies.

This upsurge in the number of AGE cases coincided with a significant and unusual occurrence of collective food poisoning that impacted several metropolitan areas in connection with the consumption of contaminated oysters that occurred in 2019* during the end-of-year celebrations. 

A sharp decrease in activity to historically low levels, most likely related to the measures put in place during the Covid-19 pandemic

Following the first confinement (March-April 2020) introduced as part of the Covid-19 pandemic , very low levels of activity for GEA were recorded from March and April 2020 in hospital emergencies and in general medicine (Sentinels Network and SOS Médecins).

Indeed, the proportion of emergency visits for gastroenteritis fell sharply at the start of 2020 to reach historically low levels and then stabilized at 0.5% of activity from April 2020 . According to data from the Sentinel Network, the 2019-2020 winter season was characterized by the lowest cumulative incidence rate of cases of acute diarrhea seen in general medicine consultations over the last 10 seasons .

This historic decrease in epidemic activity for acute gastroenteritis in France is most likely related to the measures introduced in the context of the COVID-19 pandemic (confinement, physical distancing, reinforcement of hand hygiene). Such levels have not been observed over 10 years of retrospective data for all monitoring indicators.

Key points 2019 – 2020 regarding acute gastroenteritis 

The analysis period corresponds to the winter monitoring period, from November 18, 2019 to April 13, 2020. 

  • 96,713 hospital emergency visits , i.e. 1.6% of emergency visits. 44.4% of visits for acute gastroenteritis concerned children aged under 5 years.
  • 144,499 SOS Médecins consultations for acute gastroenteritis, i.e. 8.7% of total consultations.
  • Cumulative incidence rate at the Sentinel Network: 
    • 2,963 cases per 100,000 inhabitants of all ages
    • 6,605 cases per 100,000 inhabitants, in children under 5 , the most affected population during this period.
  • Predominance of norovirus genotype GII.4 2012[P16], followed by genotype GII.17[P17].
  • Significant peak of activity observed at the end of December 2019-beginning of January 2020 , concomitant with a significant upsurge in collective food poisoning linked to the consumption of oysters
  • Following the first containment introduced as part of the Covid-19 pandemic, very low levels of activity were recorded from week 13-2020 

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