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Introduction Carbon monoxide poisonings cause 400 to 600 deaths and over 5000 hospital admissions every year in France. 500 to 1000 incidents, involving several thousands patients, are recorded yearly by the public health services which are in charge of investigating the causes and taking corrective measures. Nevertheless, this source of data is inaccurate. It specifically lacks in sensitivity. Moreover, even if most poisoning cases were reported (which is not the case), all potentially dangerous situations would be ignored before an acute poisoning occur. A new surveillance & early detection system is thus to be implemented. Its objectives are: to identify dangerous situations (this includes places where a poisoning already took place but also other situations, such as exposure to low level of carbon monoxide or presence of a malfunctioning device) in order to correct them; to provide an epidermiological description of poisonings in order to better organize primary prevention; to evaluate corrective interventions, primary prevention and medical care to victims.

Methods Poisoning cases will be reported by health care professionals and services (Doctors, Emergency Services and Laboratories) in a similar way as the reporting infectious diseases; Dangerous situations will be the target of several screening programs involving:-Comprehensive diagnosis tools designed for heating systems installation & maintenance professionals-Simple Diagnosis Tools designed for lay persons such as social workers-Fixed and Mobile carbon monoxide detectors-Analyzers of expired carbon monoxide Reports will be made by fax or phone to Poison Control Centers. Public health services at Regional and Communal levels will remain, as they are today, in charge of technical investigations and implementation of corrective measures. But they will have the possibility to sub-contract technical investigations to private experts. The “Institut national de veille sanitaire” (National Institute for Public Health Surveillance) will periodically analyze epidemiological data at the national level and make them available to professionals and general public. Evaluation of sensitivity and specificity will mostly rely on comparisons with other sources of data such as mortality statistics and hospital admissions.

Results No result is yet available. This new system will start in 2004

Conclusion The main improvements brought by the new systems are: standardized case definitions (quite similar in spirit to those adopted by the US Council of State and Territorial Epidemiologists in 1998); common forms and procedures for data gathering; the extension of the field of surveillance beyond passive reporting of actual poisoning incidents unto active screening for potentially dangerous situations; new procedures for investigations and interventions; a newly defined partnership between local public health services, Poison Control Centers and the National Institute for Public Health Surveillance. The direct benefit for victims and persons in dangerous situations in having their situation reported should constitute a powerful motivation for informers and should help to achieve a satisfactory level of sensitivity. Nevertheless, this result will be obtained only if human resources and budgets allocated match the expectations.

(1) Institut De Veille Sanitaire

(2) Ministry of Health, Family and Disabled Persons

© 2003 Lippincott Williams & Wilkins, Inc.