“Integrated surveillance system is an essential element in national respiratory virus pandemic preparedness plan.”
The winter season is fast approaching, and the debate about how the respiratory viruses spread has restarted. Citizens wonder whether the COVID-19 cases will show an upsurge or whether we will have a severe influenza season. While the public health community discusses the national testing and the vaccination strategy and investigates what happened in the southern hemisphere, the public debate concerning the expected infection control measures returns. Across Europe, national authorities are tackling this issue in different ways. As a virologist, I started receiving the infamous question of: What shall we expect this season?
The answer remains the same within the virology community: we should strengthen our monitoring strategy and pay attention to the early signs in order to inform public health authorities. There have been a number of pandemic and epidemic events in the last few decades caused by respiratory viruses (e.g., influenza A(H1N1)pdm09 and SARS-CoV-2). The COVID-19 pandemic triggered an international drive for a high capacity genomic surveillance, which impacted various aspects of the pandemic response, including emergency coordination, laboratory surveillance, clinical management, and community engagement.
The World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC), endorse the development of national plans that address the potential pandemics caused by respiratory viruses. One of the key elements of this plan is integrated surveillance, where there is an urgent need to develop a sustainable integrated surveillance system for influenza, COVID-19, and RSV. The WHO-Europe and ECDC are planning to develop a global respiratory viruses surveillance platform by 2023.
A well-designed, representative sentinel surveillance system in primary and secondary care is the cornerstone of a sustainable integrated surveillance system for acute viral respiratory infections. Since 2003, Luxembourg has been developing its primary care sentinel system which covers 1.7% of registered physicians. Moreover, it also and offers epidemiological data that are routinely collected using common syndromic case definitions with reliable denominators and virological testing that covers a panel of 16 respiratory viruses. The current system needs to be implemented also in secondary care in order to ensure a wider representation which would make it the basis of an integrated impact assessment for influenza, COVID-19 and RSV.
In Luxembourg, the national SARS-CoV-2 genomic surveillance program implemented by LNS has been a proof of concept for an integrated genomic surveillance system. The Health inspection gathered data from positive cases across the country and integrated the genomic data generated by the national reference laboratory at the LNS with the aim of producing an essential resource for the decision making authorities during the pandemic. The laboratory surveillance activity is currently aiming to cover Influenza viruses by the end of 2022. In the meantime, the Luxembourg Institute of Science and Technology (LIST) has also implemented a waste water surveillance system which could be combined into one Health surveillance hub.
We truly believe in the power of working side by side with national partners and under the leadership of the health directorate. We think that, in this way, Luxembourg would be a showcase for a health integrated surveillance system for respiratory viruses based on a functional sentinel program that would detect virus variants and would accurately follow virus-specific disease incidences and classify them by level of severity/age/place in order to assess vaccine effectiveness. The digital transformation of the current systems would be key in achieving this objective and its integration in one data hub would provide Luxembourg with a live epidemiology tool.
Finally, we will organize a workshop in November that will bring together different national partners in order to be ready for any upcoming respiratory virus emergency, address the national genomic strategy, identify opportunities to strengthen our existing framework, ensure our alignment with the WHO strategy.