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Abstract
Aim The French High Council of Public Health (HCPH) was asked by the Ministry of Health to draw up a list of priority infectious diseases in metropolitan France and its overseas territories.
Material and Method Multi-criteria decision analysis (MCDA) was used, as recommended by the ECDC. A list of 95 entities (diseases or groups of infectious diseases) was drawn up, and 10 assessment criteria were defined: potential for emergence and spread, incidence, lethality, individual impact, societal impact, impact on vulnerable populations, impact on the health system, unmet needs for prevention, therapeutic tools, and health surveillance. The criteria were weighted by a multidisciplinary panel of 77 HCPH-experts. Then, a panel of 98 physicians from 8 specialties rated each disease according to the criteria using a 4-point rating scale through an online questionnaire.
Results Fifteen of the 95 entities were ranked as high priorities: 14 were known diseases such as viral hemorrhagic fevers, various respiratory viral infections, arboviral infections, antibiotic-multiresistant bacterial infections, invasive meningococcal and pneumococcal infections, prion diseases, rabies, and tuberculosis; ‘Disease X’ ranked highest (figure 1). Out of 98 physicians, 11 pediatricians participated (61% response rate), and their 513 entity-ratings represented 11% of the total.
Involvement of the different prioritization criteria in determining the score of the 14 high-priority entities. E1: Viral hemorrhagic fevers, E2: Acute respiratory infections due to viruses other than influenza, emerging coronaviruses, RSV and hMPV, E3: Mosquito-borne arboviruses, E4: Influenza virus infections with zoonotic potential, E5: Seasonal influenza A and B, E6: Emerging coronavirus infections (Severe Acute Respiratory Syndrome, Middle-East Respiratory Syndrome, COVID-19), E7: Respiratory syncytial virus and human metapneumovirus respiratory infections, E8: Creutzfeldt- Jakob disease and other human transmissible spongiform encephalopathies, E9: Systemic infections due to multi-resistant bacteria to antibiotics, E10: Infections due to emerging highly- resistant bacteria to antibiotics, E11: Invasive infections due to Neisseria meningitidis, E12: Rabies, E13: Tuberculosis due to antibiotic-susceptible strains, E14: Invasive pneumococcal disease. Simulated ratings for Disease X ranged between 59.4 and 75.4.
Conclusions The ECDC-MCDA made it possible to establish a list of priority infectious diseases in a relatively short period of time. Adaptability of the method allowed to consider the specificities of France, mainland and overseas. Most priority infectious risks are well covered by national surveillance and warning systems. The participation of pediatricians in this study was necessary to take into account the specific pediatric burden and thus to defend the needs of children when orienting the priority social means in the field of infectious diseases (surveillance, health organization, and research).