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\begin{document}

\title{A comparison of coronavirus disease 2019 and seasonal influenza
surveillance in five European countries: France, Germany, Italy, Spain
and the United Kingdom}



\author[1]{Hélène Bricout}%
\author[2]{Rigoine de Fougerolles Thierry }%
\author[3]{Joan Puig-Barbera}%
\author[4]{Georges Kassianos}%
\author[5]{Philippe Vanhems}%
\author[6]{Jorg Schelling}%
\author[7]{Pascal Crepey}%
\author[8]{Raul Ortiz de Lejarazu}%
\author[9]{Filippo Ansaldi}%
\author[10]{Markus Fruehwein}%
\author[11]{Cristina Galli}%
\author[12]{Anne Mosnier}%
\author[11]{Elena Pariani}%
\author[13]{Anvar Rasuli}%
\author[14]{Olivier Vitoux}%
\author[15]{John Watkins}%
\author[16]{Thomas Weinke}%
\affil[1]{Sanofi Pasteur SA}%
\affil[2]{Corporate Value Associates}%
\affil[3]{Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)}%
\affil[4]{Royal College of General Practitioners}%
\affil[5]{CNRS UMR 5558, University of Lyon}%
\affil[6]{Ludwig Maximilians University Munich}%
\affil[7]{EHESP}%
\affil[8]{Hospital Clínico Universitario de Valladolid}%
\affil[9]{University of Genoa}%
\affil[10]{Dr.Frühwein\&Partner}%
\affil[11]{University of Milan}%
\affil[12]{Groupes Régionaux d’Observation de la Grippe (GROG), Paris, France}%
\affil[13]{Sanofi Pasteur}%
\affil[14]{Corporate Value Associates }%
\affil[15]{Cardiff University}%
\affil[16]{Klinikum Ernst von Bergmann gGmbH}%


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  \date{May 20, 2024}


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\begin{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.%
\end{abstract}%



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\verb`COVID-19 and Influenza EU 5 Surveillance Systems_FINAL_13OCT2021.docx`  available at \url{https://authorea.com/users/444880/articles/544524-a-comparison-of-coronavirus-disease-2019-and-seasonal-influenza-surveillance-in-five-european-countries-france-germany-italy-spain-and-the-united-kingdom}

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