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LETTERS TO THE EDITOR

Answer to comments regarding the article “New Coronavirus infections: new challenges, new legacies”

David Alejandro Cabrera-Gaytán,^a Concepción Grajales-Muñiz^a

^aCoordinación de Vigilancia Epidemiológica. Instituto Mexicano del Seguro Social, Distrito Federal, México

Telephone: (52) 1 5536-8861 extension 15713.

Email: david.cabrerag@imss.gob.mx, dcpreventiva@gmail.com

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We read with satisfaction the comments from Castañón-González et al., on our publication "Infección del nuevo Coronavirus: nuevos retos, nuevos legados" (“New Coronavirus infections: new challenges, new legacies”). There is complete agreement on “emphasiz[ing] that while there is no information available about the epidemiology," in order to "take into account the bioinformatics and computational resources available."

The authors say, “in response to constant outbreaks of serious infections starting in the airways such as with MERS-CoV, Influenza A H5N1, A H1N1, SARS, etc.,¹ and other communicable diseases with pandemic potential involving high mortality," it is necessary to "adopt a national surveillance system for the epidemiological surveillance of serious diseases with epidemic potential," which would be in "real time" with the ability to issue early warnings.

In this regard, the Instituto conducts surveillance of influenza-type illness, severe acute respiratory infection, and influenza virus, with sampling for diagnostic confirmation; if it is negative, they are processed to identify the following items included in the panel: respiratory syncytial virus, adenovirus, coronavirus, enterovirus, rhinovirus, parainfluenza and metapneumovirus. This operates in the medical units of the three levels of care of the Instituto (1,099 first-level units and 259 secondary and tertiary hospitals),¹ through online registration in real time through the platform called Sistema de Notificación en Línea, para la Vigilancia Epidemiológica de Influenza" (SINOLAVE),² which makes available clinical and epidemiological information on cases, in order to characterize the behavior of the disease in time, place, and person; systematic evaluation of the situation, creation of a traffic light of risk by municipality by geographical area, trend, intensity, or rate of attack and impact on the capacity of health services; in order to make timely decisions to limit the spread and harm to the population.
The Institute also participates with the Secretaría de Salud Federal in sentinel epidemiological surveillance in Unidades de Salud Monitoras de Influenza (USMI), through online data transfer of case and death information.³

Some successes of this system are that the Institute was the first in the country to detect the presence of influenza A H3N2 during the 2010-2011 season and the identification of cases of influenza A H7N3 in Jalisco during 2012.⁴

Castañón-González et al. highlighted the development and implementation of a system that "can discriminate between a catastrophic event that has local or regional impact" by the method of accumulated sums for severe airway infection that has been piloted in several hospital units. This method has been used for influenza,^5,6 and other emerging diseases,⁷ in order to determine these thresholds. The methodology has been recommended by the World Health Organization.8 We believe that all successful experiences should be shared to enrich our Sistema Nacional de Vigilancia Epidemiológica.

References

1. Dávila J, Chowell G, Borja-Aburto VH, Viboud C, Grajales Muñiz C, Miller M. Substantial Morbidity and Mortality Associated with Pandemic A/H1N1 Influenza in Mexico, Winter 2013-2014: Gradual Age Shift and Severity. PLOS Currents Outbreaks. 2014 Mar 26. Edition 1. doi: 10.1371/currents.outbreaks.a855a92f19db1d90ca955f5e908d6631.
2. Instituto Mexicano del Seguro Social. Plan Institucional de preparación y respuesta ante una epidemia de influenza. México, 30 de octubre de 2009.
3. Secretaría de Salud. Manual para la vigilancia epidemiológica de influenza. Subsecretaría de Prevención y Promoción de la Salud. México, 2014.
4. Barrera-Badillo G, Ramirez-Gonzalez E, Aparicio-Antonio R, Nuñez-Garcia T, Arellano-Suarez D, et al. Highly Pathogenic Avian Influenza A (H7N3) Virus Infection in Two Poultry Workers — Jalisco, Mexico, July 2012. MMWR 61(36); 2012: 726-727.
5. Polanco C, Castañón-González JA, Macías AE, Samaniego JL, Buhse T, Villanueva-Martínez S. Detection of Severe Respiratory Disease Epidemic Outbreaks by CUSUM-Based Overcrowd-Severe-Respiratory-Disease-Index Model. Comput Math Methods Med 2013. Article ID 213206.
6. Cowling BJ, Wong OL, Lai-Ming H, Riley S, Leung GM. Methods for monitoring influenza surveillance data. International Journal of Epidemiology 2006;35:1314–1321.
7. Watkins RE, Eagleson S, Veenendaal B, Wright G, Plant AJ. Applying cusum-based methods for the detection of outbreaks of Ross River virus disease in Western Australia. BMC Medical Informatics and Decision Making 2008, 8:37 doi:10.1186/1472-6947-8-37.
8. World Health Organization. WHO Interim Global Epidemiological Surveillance Standards for Influenza (July 2012). http://www.who.int/influenza/resources/documents/technical_consultation/en/index.html

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