Shifting From Sectoral to Integrated Surveillance by Changing Collaborative Practices: Application to West Nile Virus Surveillance in a Small Island State of the Caribbean

Abstract

After spreading in the Americas, West Nile virus was detected in Guadeloupe (French West Indies) for the first time in 2002. Ever since, several organizations have conducted research, serological surveys, and surveillance activities to detect the virus in horses, birds, mosquitoes, and humans. Organizations often carried them out independently, leading to knowledge gaps within the current virus' situation. Nearly 20 years after the first evidence of West Nile virus in the archipelago, it has not yet been isolated, its impact on human and animal populations is unknown, and its local epidemiological cycle is still poorly understood. Within the framework of a pilot project started in Guadeloupe in 2019, West Nile virus was chosen as a federative model to apply the "One Health" approach for zoonotic epidemiological surveillance and shift from a sectorial to an integrated surveillance system. Human, animal, and environmental health actors involved in both research and surveillance were considered. Semi-directed interviews and a Social Network Analysis were carried out to learn about the surveillance network structure and actors, analyze information flows, and identify communication challenges. An information system was developed to fill major gaps: users' needs and main functionalities were defined through a participatory process where actors also tested and validated the tool. Additionally, all actors shared their data, which were digitized, cataloged, and centralized, to be analyzed later. An R Shiny server was integrated into the information system, allowing an accessible and dynamic display of data showcasing all of the partners' information. Finally, a series of virtual workshops were organized among actors to discuss preliminary results and plan the next steps to improve West Nile Virus and vector-borne or emerging zoonosis surveillance. The actors are willing to build a more resilient and cooperative network in Guadeloupe with improved relevance, efficiency, and effectiveness of their work.

Keywords: Guadeloupe (French West Indies); One Health; West Nile virus; information system; integrated surveillance; social network analysis.

Figure 1

Chronogram of surveillance activities that took place from 2002 to 2020 in horses, poultry, wild birds, mosquitoes, and humans, based on the datasets provided by the partners.

Figure 2

(A) Screenshot of the VirusTracking West Nile Virus surveillance platform. The graphs show the reports submitted on the information system on eight communes of Guadeloupe (Baie-Mahault, Basse-Terre, Goyave, Les Abymes, Petit-Bourg, Sainte-Anne, Sainte-Rose) during 2020. The time unit is a month. The data are not real epidemiological data; they were the ones entered by the participants in the workshop for testing the tool. (B) Screenshot of the WNIS. WNV report section: The report ID with the organization that submitted the report is listed as well as the component under surveillance, commune, and number of tested and positive cases. The information and data do not correspond to actual data (participants entered them to test the platform).

Figure 3

Hierarchy chart of themes obtained from the SNA questionnaire using Nvivo software. The bigger the box, the more frequent the theme.

Figure 4

Map of the West Nile Virus surveillance network in Guadeloupe. The colors represent the sectors the actors belong to: animal (Blue), human (Magenta), and the environment (Gray). Larger nodes have more edges. The thicker the lines, the more weight in the communication between two actors.

Figure 5

Main actions that were recommended by actors to increase the resilience of the WNV surveillance system.