A comparison of coronavirus disease 2019 and seasonal influenza
surveillance in five European countries: France, Germany, Italy, Spain
and the United Kingdom
Abstract
Background: In response to the coronavirus disease (COVID-19) outbreak
that unfolded across Europe in 2020, the World Health Organisation
called for repurposing existing influenza surveillance systems to
monitor COVID-19. This analysis aimed to compare descriptively the
extent to which influenza surveillance systems were adapted and
enhanced, and how COVID-19 surveillance could ultimately benefit or
disrupt routine influenza surveillance. Methods: We used a previously
developed framework in France, Germany, Italy, Spain and the United
Kingdom to describe COVID-19 surveillance and its impact on influenza
surveillance. The framework divides surveillance systems into 7
sub-systems and 20 comparable outcomes of interest, and uses 5
evaluation criteria based on WHO guidance. Information on influenza and
COVID-19 surveillance systems were collected from publicly available
resources shared by European and national public health agencies.
Results: Overall, non-medically attended, virological, primary care and
mortality surveillance were adapted in most countries to monitor
COVID-19, whilst community, outbreak, and hospital surveillance were
reinforced in all countries. Data granularity improved, with more
detailed demographic and medical information recorded. A shift to
systematic notification for cases and deaths enhanced both geographic
and population representativeness whilst the sampling strategy benefited
from the roll out of widespread molecular testing. Data communication
was greatly enhanced, contributing to improved public awareness.
Conclusions: Well-established influenza surveillance systems are a key
component of pandemic preparedness and their upgrade allowed European
countries to respond to the COVID-19 pandemic. However, uncertainties
remain on how both influenza and COVID-19 surveillance can be jointly
and durably implemented.