The widespread outbreak of Group A streptococcal infections, which occurred in early 2023, primarily among children under the age of 10 in various regions of France, was subject to active surveillance.

Regarding outbreaks of COVID, influenza, and bronchiolitis, so-called integrated surveillance was implemented starting with the 2023–2024 season with the publication of an “acute respiratory infections” bulletin to measure and analyze the circulation of viruses in the population and across the country using a single weekly reporting format:

• COVID-19: continuous surveillance of the disease has focused both on the evolution of genomic surveillance of SARS-CoV-2 variants (Emergen Consortium) and on the impact of the epidemic on the mental health of the population;

• Influenza: As part of research on the benefits of extending seasonal influenza vaccination to children without comorbidities, Santé publique France provided the HAS with an analysis of influenza surveillance data in mainland France during the 2011–2012 to 2021–2022 epidemics;

• bronchiolitis (RSV): the annual report on the 2022-2023 winter surveillance of bronchiolitis in France indicates a winter marked by very high intensity, particularly in terms of emergency room visits and hospitalizations. Information posters were shared to remind the public of the preventive measures to adopt to protect children from the virus that causes bronchiolitis.

As part of its mandate, Santé publique France monitors infections linked to the consumption of contaminated food and issues alerts regarding contaminated cases:

• Five severe cases of listeriosis, including four in pregnant women who experienced premature births and were infected with the Listeria strain, reported symptoms between April and December 2022.

• From Monday, September 4, to Sunday, September 10, 2023, a restaurant reportedly served food suspected of having caused botulism in customers. On this occasion, Santé publique France issued a reminder of the emergency measures to be taken by anyone who had visited the establishment.

Contagious diseases most often affect children very early in life. Because children are particularly vulnerable, they are a priority target for vaccination programs. In 2023:

• To mark European Immunization Week (EIW) 2023, Santé publique France published data on vaccination acceptance among the general population and 2022 vaccination coverage at the national and regional levels: 84.6% of respondents in mainland France reported being in favor of vaccination in general, a figure up from 2021. The agency has also made numerous tools available to inform and promote vaccination among the public and healthcare professionals.

• The updated surveillance data on hepatitis B, C, and Delta published on our website showed an increase in hepatitis B vaccination and in screening for hepatitis B and C.

• Numerous cases of diphtheria have emerged in mainland France, with the majority of cases reported among migrants and travelers. Continuous surveillance of the situation has been implemented, revealing an increase in diphtheria cases among migrants and travelers, particularly those who are not up to date on their vaccinations. In response to this rise, measures have been taken: the dissemination of a message informing associations working with migrant populations and healthcare professionals of the increase in cases among these individuals.

Santé publique France is tasked with monitoring and preventing these infections in healthcare facilities, long-term care facilities, and outpatient settings, thereby helping to limit their impact.

Healthcare-associated infections are infections acquired in healthcare facilities during or following patient care that were neither present nor in the incubation period at the start of that care. The 2022 National Survey on the Prevalence of Healthcare-Associated Infections and Antimicrobial Treatments in Healthcare Facilities (ENP), coordinated by Santé publique France as part of the Network for the Prevention of Healthcare-Associated Infections (Repias), showed that 1 in 18 hospitalized patients is affected.

The agency leads epidemiological surveillance and the prevention of antibiotic resistance in France and participates in European surveillance through various initiatives aimed at preserving the effectiveness of antibiotics. Data on antibiotic consumption in urban areas in France in 2022, collected as part of the campaign "Antibiotics: Treating Yourself Well Means Using Them Properly," reveal a resurgence in antibiotic prescriptions in private practice, confirmed in 2022.

Since October 2021, Europe has been experiencing the most devastating outbreak of highly pathogenic avian influenza (bird flu) it has ever seen. In France, following a lull of several months in poultry farms, several outbreaks have been detected since late November 2023. This situation calls for heightened vigilance among people exposed to these viruses as well as among various stakeholders in animal and human health. Santé publique France has published epidemiological updates on the circulation of the viruses and has reiterated the recommendations to follow to protect oneself in the event of exposure to risk.

From a One Health perspective, Santé publique France has assessed the potential risks to the population following the detection, on October 6, 2023, of the Crimean-Congo hemorrhagic fever virus in ticks of the genus Hyalomma collected from cattle raised in the Pyrénées-Orientales. Although the Hyalomma marginatum tick is present along the Mediterranean coast and in Corsica, no indigenous cases of CCHF have yet been detected in France.

At the request of the Ministries of Health and Prevention and of Sports and the Olympic and Paralympic Games, a new epidemiological surveillance system for drowning was implemented during the summer of 2023 by Santé publique France and the National System for Monitoring Water Safety (SNOSAN).

Previously conducted every three years, the new surveillance system is shifting to annual monitoring with the goal of producing performance indicators to guide tailored prevention efforts during the summer season.

In 2023, France hosted the Rugby World Cup from September 8 to October 28. Given the large number of fans expected, Santé publique France took steps well in advance of the start of the tournament to detect any unusual events that might impact public health and to mitigate health risks. Consequently, a health surveillance and monitoring protocol—based on the one developed for the 2024 Olympic and Paralympic Games—was implemented to ensure enhanced surveillance during the 2023 Rugby World Cup. Healthcare professionals and partner networks were instructed to immediately report any unusual occurrences that could pose a public health risk. Regional bulletins were published summarizing the results of surveillance conducted in the cities hosting matches.

The goal of the surveillance system is to detect and report notifiable diseases (NDs) in order to take action and prevent the risk of epidemics, as well as to analyze their trends over time and adapt public health policies to the needs of the population. Today, 38 diseases are notifiable. Among them, leptospirosis, a disease transmissible from animals to humans, has been included on this list since August 24, 2023.

The department of Mayotte has faced an unprecedented drought, with the largest rainfall deficit since 1997. In response to this drought, Santé publique France has stepped up health surveillance to prevent the risk of epidemics caused by disruptions in the water supply. As part of this surveillance effort, regular updates have been produced and published:

• An outbreak of acute gastroenteritis

• Typhoid fever and hepatitis A

To address this exceptional situation in Mayotte, Santé publique France mobilized on-site public health reservists to reinforce the Mayotte Regional Health Agency (ARS) teams in their water analysis and management efforts. Healthcare professionals were also mobilized for a typhoid vaccination reinforcement mission.

The health reserve also provided support to the Mayotte Hospital Center, particularly in the perinatal and emergency departments. The Pharmaceutical Agency, for its part, provided expertise on additional supplies of hand sanitizer, on the shipment of freezers to boost vaccine storage capacity, and on vaccine supply procedures (typhoid, hepatitis A, cholera, and polio).

Human interactions with the environment, along with climate change, are factors contributing to the spread of vector-borne diseases. These diseases have gradually become more common, necessitating the implementation of specific surveillance measures:

• From May 1 to November 30, 2023, Santé publique France coordinated enhanced surveillance of cases of chikungunya, dengue, and Zika in mainland France.

• On the occasion of the awareness day on Lyme disease and other tick-borne illnesses, organized last May by the National Reference Centers, the agency published the results of the Health Barometer conducted in the Grand-Est region, demonstrating that the rate of diagnosed cases is among the highest in this region.

• Santé publique France published a report on the first two years of surveillance through mandatory reporting of tick-borne encephalitis (TBE) cases for the period from May 2021 to May 2023.

Furthermore, in 2023, the agency continued its efforts to combat the health impacts of global warming, notably through:

• The publication of a report estimating the impact of heat on mortality in metropolitan France during the summer periods of 2014–2022. Thus, nearly 33,000 deaths are attributable to heat, including 23,000 deaths among people aged 75 and older.

• The production of a weekly epidemiological report, 15 days after the end of each heatwave, including an initial estimate of excess mortality from all causes observed during the heatwave.

• The provision of tools to remind the public of the proper precautions to take during heat waves.

• The publication of “Words from Experts: Health as a Lever for Action Against Climate Change.” It reports on the interdisciplinary conference on health as a lever for action against climate change organized by Santé publique France and IANPHI. The objective was to highlight the links between climate, biodiversity, and health and to encourage concrete actions at the local, national, and European levels.

As part of the Air and Health Monitoring Program, Santé publique France participated in the CEPEM project (Characterization of Pollution Episodes and Evaluation of Measures Implemented) to analyze the impacts of pollution episodes and spikes on the health of the exposed population and to assess the effectiveness of specific public policies that were implemented. The results of this project were published in a report detailing lessons learned regarding the measures implemented to reduce emissions and exposure to ambient air pollution.

Santé publique France published the results of the PEPS’PE study launched in 2021, a consultation survey on health effects to be monitored as a priority due to their link to endocrine disruptors, which is part of the 2nd National Strategy on Endocrine Disruptors. This study collected information on the current state of scientific knowledge, relevant biological parameters and biomarkers, as well as proposals for surveillance systems to be implemented. These results therefore indicate the need to expand the scope of the Agency’s surveillance beyond reproductive health to include broader monitoring of the health effects of endocrine disruptors.

Overall, health risks—whether linked to air pollution or other environmental factors such as air, water, and soil—expose individuals to harmful effects on a daily basis. The underlying question was whether the French population is aware of this issue. To answer this question, Santé publique France examined how the French perceive the environmental risks to their health using data from the second phase of the Health Barometer.

The Committee’s mission is to provide interpretations, opinions, and recommendations aimed at protecting the health of populations exposed to environmental or occupational hazards. Established in 2022, it celebrated its first anniversary on November 8, 2023.

The first meeting of the SET expert committee was held on March 31. The goal of these initial discussions was to provide the experts with the information necessary to fully understand the committee’s role and the context in which it operates. Since then, other regular meetings have been held throughout the year.

Using systems to monitor and identify occupational determinants of health, Santé publique France has highlighted the health effects of the workplace by publishing several reports:

• the results of the surveillance program for occupational diseases (MCP) conducted between 2012 and 2018 indicate a predominance of musculoskeletal disorders and psychological disorders, with a significant increase in reported cases;

• the results of a study analyzing the correlation between telework conditions, the onset of low back pain, and depressive symptoms; in particular, they highlight the importance of the physical conditions of telework as well as certain aspects of work organization in reducing the health impacts of telework;

• Data from the Constance cohort provided useful insights for the prevention of work-related asthma; they showed that regardless of the definition of asthma used, significant associations were observed with indicators of career trajectory in both men and women.

Another factor that may contribute to work-related illnesses is a sedentary lifestyle. To reduce and break up sedentary behavior, particularly in office settings, Santé publique France has published a literature review on the implementation and effectiveness of interventions and intervention strategies aimed at improving employee health.

The National Perinatal Survey for the French Overseas Departments and Regions (DROM), conducted for the first time in 2021, is a study jointly led by Santé publique France and the relevant regional health agencies (ARS). It provides an overview of the key indicators of the health status of women and children at birth and two months postpartum, and allows for a more detailed analysis of the situation in each of the overseas departments, regions, and communities. The results obtained in Guadeloupe, Martinique, and Réunion show indicators that are generally less favorable than in mainland France and highlight the need to better understand the factors driving these trends in order to adapt prevention and care strategies. As part of the “First 1,000 Days” strategy, the ENP-DROM thus enables the production of perinatal indicators that will help drive changes in public policies and clinical practices in the overseas departments, regions, and communities.

To mark World Diabetes Day, Santé publique France published an article in an issue of BEH on the prevalence of diabetes in four overseas regions: Guadeloupe, Martinique, French Guiana, and Réunion. This study was based on data from the 2021 Santé publique France DROM Health Barometer, a cross-sectional survey of the general population conducted among individuals aged 18 to 85. It estimated the prevalence of diagnosed diabetes in the general adult population and explored the concept of “mild diabetes.” In conclusion, in Réunion as in the other DROMs, the prevalence of type 2 diabetes is particularly high, and chronic complications are more frequent.

Throughout the year, preventive measures were implemented to facilitate the early identification and treatment of mental distress.

• To reduce the risk of repeat suicide attempts, the VigilanS program—which aims to maintain contact with individuals hospitalized following a suicide attempt—was piloted in six regions: Nord-Pas-de-Calais, Brittany, Upper and Lower Normandy, Languedoc-Roussillon, and Jura. On World Suicide Prevention Day, the results of the evaluation of this system were published. They show a significant reduction in this risk among individuals who received this follow-up care.

• The results of the evaluation of the second phase of the 2022 information campaign for 11- to 17-year-olds, #JenParleA, have been published and show that the campaign was very well received by adolescents. The campaign also helped increase the use of the Fil Santé Jeunes service.

In 2023, Santé publique France launched three key initiatives focused on sexual health prevention:

• The 4th edition of the “Rapport au sexe” Sexual Health and Prevention Survey, conducted from February 23 to April 6, 2023, among men who have sex with men, was launched in the specific context of the emergence of the mpox (monkeypox) virus. This edition will provide information on the impacts of the monkeypox outbreak on the health and sexuality of this population.

• A broad information campaign on sexuality—“Everyone has questions about sexuality, and everyone can find answers on QuestionSexualite.fr”—was rolled out from May 2 to June 25, 2023. The goal of this campaign and the tools made available is to enable the entire population to make informed and responsible decisions about their sexual health through reliable information.

• Following an initial phase titled “Everyone has questions about sexuality,” which ran during Sexual Health Week, the second phase of the campaign—focused on STIs and HIV and aimed at the general public as well as key populations in the fight against HIV—ran from November 24 to December 15, 2023.

• The feature in La Santé en action magazine, issue No. 464, on the concepts of consent and ethics analyzes the conditions that professionals in all fields—health as well as social education—must meet, as well as all the questions they must ask themselves to obtain consent from individuals before any action is taken.

The results of the CoviPrev survey on the adoption of preventive measures and vaccination intentions at the start of the 2023 winter season reveal generally insufficient compliance. Two campaigns have been launched to remind the public of the proper precautions:

• From October 16, 2023, to January 31, 2024, a campaign promoting preventive measures developed by the National Health Insurance and Santé publique France is being broadcast on TV, radio, and online.

• A campaign promoting vaccination against the flu and COVID-19 was launched on October 29, 2023.

The life-stage approach proposed by the National Health Strategy offers an opportunity to optimize the support provided to different populations.

• As part of its efforts to promote perinatal health, Santé publique France shared the results of an evaluation conducted between 2017 and 2019 that aimed to measure changes in children’s behaviors and parenting practices within the framework of the Family and Parenting Support Program for 6- to 11-Year-Olds (PSFP)

• Santé publique France brought together researchers and prevention stakeholders on March 30 and 31, 2023, for a seminar titled “Perspectives on Conducting Research on Intrafamilial Abuse of Children and Adolescents.” The conclusions of this event were published as part of Paroles d'experts, highlighting the challenges encountered in conducting the studies. Solutions were suggested to overcome these obstacles and successfully carry out surveys on the topic of intrafamilial maltreatment of children and adolescents.

• Midlife, defined as ages 40–55, is a pivotal period for prevention and promoting population health. It is pivotal yet underutilized because it is not sufficiently recognized as a turning point in maintaining health. Health in Action No. 463 presents the current state of scientific knowledge regarding the health status of this population and analyzes, through examples from France and abroad, the effectiveness of interventions aimed at improving the health of 40- to 55-year-olds.

In 2023, on World No Tobacco Day, published data revealed that in 2022, France had nearly 12 million daily smokers. These findings underscore the need to strengthen strategies for tobacco prevention and the reduction of social inequalities, as outlined in the third national tobacco control program.

The 8th edition of Tobacco-Free Month drew on team spirit and solidarity, and nearly 157,576 people successfully took up the challenge. Santé publique France published the first economic evaluation of Tobacco-Free Month. The results show that it is considered an effective initiative, generating healthcare savings and making a strong case for supporting the commitment to tobacco control in France and internationally.

The Knowledge Hub organized its first webinar on tobacco awareness, focusing on the theme: “Funding Anti-Tobacco Awareness Programs and Initiatives: Tools and Best Practices.” The objective was to present funding mechanisms and provide guidance on how to secure and structure them.

For several years, Santé publique France has been implementing a comprehensive strategy to reduce the risks associated with the use of products harmful to health, and in 2023 it published:

• results on the levels of CBD and nitrous oxide use among the French adult population and consumer profiles in 2022;

• unprecedented data on emergency room visits related to cocaine use, coinciding with the release of the report by the French Monitoring Center for Drugs and Drug Addiction (OFDT) on trends in the supply and consumption of cocaine in France between 2000 and 2022.

Following the “Amis aussi la nuit” initiative, which ran from 2019 to 2022, the Ministry of Health and Prevention and Santé publique France launched a communication campaign titled “C’est la base” targeting young people aged 17 to 25 to combat alcohol and cannabis use at parties.

In France, accidental drownings claim approximately 1,000 lives each year, nearly half of which occur during the summer months. Yet most of these drownings are preventable. The ministries of Health and Sports have launched an unprecedented prevention campaign focused on encouraging parents to keep a close watch on young children: “You care about them—don’t take your eyes off them!”

• The "Betting Is No Small Matter" campaign, aimed at supporting efforts to prevent the risks associated with sports betting.

• The campaign “Getting teens active isn’t easy. But encouraging them is important.”

• The “en 2-2 – Season 2” campaign encouraging young people to cook at home more often

• Santé publique France’s research on postpartum depression two months after childbirth: the presentation “Depression, Anxiety, and Suicidal Thoughts Two Months After Childbirth: Data from the 2021 National Perinatal Survey” received the 2023 Encéphale Congress Award

• The HistorIRIS tool won first prize in the Green Data for Health Challenge

• Five members of the Enteric, Foodborne, Zoonotic, and Vector-Borne Infections Unit within the Infectious Diseases Division were named “Knights” in the Order of Agricultural Merit

As part of cancer surveillance, several findings have been published:

• Data on participation rates in colorectal cancer screening for 2021–2022. These show that participation in the program has remained stable compared to the previous period but is still below the European standard.

• Data on women’s participation in the organized breast cancer screening program for the 2021–2022 period. The data show that fewer than one in two women underwent an organized breast cancer screening mammogram in 2021–2022.

• The results of the 4th Cancer Barometer, conducted in collaboration with the National Cancer Research Institute. This barometer, conducted every five years, provides insight into the attitudes and behaviors of the French population regarding cancer. This edition is based on data collected in 2021 from approximately 5,000 people aged 15 to 85.

Santé publique France has undertaken several initiatives aimed at improving the well-being of the population while reducing morbidity and mortality associated with mental disorders. Mental health surveillance has been expanded to cover the entire population as well as specific groups such as workers, adolescents, children, and young people. In particular, the agency has published the initial results of the Enabee study, a groundbreaking national study on the well-being and mental health of children aged 3 to 11 attending school in metropolitan France. Obtained by cross-referencing information from three sources—parents, teachers, and children—the Enabee results show that 13% of elementary school children have a probable mental health disorder (probable emotional disorder, probable oppositional defiant disorder, or probable attention-deficit/hyperactivity disorder).

Santé publique France has continued to use and adapt its surveillance tools to deepen its understanding of the effects of appropriate nutritional prevention, setting two main objectives:

• Particular attention was paid to monitoring changes in behavior to provide information on the nutritional situation in France, particularly regarding related diseases such as diabetes.

• The promotion of health-promoting behaviors regarding diet, physical activity, and sedentary lifestyles was emphasized, with a particular focus on the use and improvement of the Nutri-Score.

As part of its efforts to promote physical activity, Santé publique France published a feature in its journal La Santé en Action No. 462 that traces the history of the prescription of adapted physical activity, which was introduced in the law on the modernization of the healthcare system with the aim of improving the health of the entire population.

Santé publique France has launched the 14th edition of its "Health Barometers." This is one of the largest national surveys, covering more than 30 topics such as smoking, nutrition, well-being, sleep, living conditions, and vaccination practices. It provides a better understanding of the opinions, habits, and health status of the population residing in France, and aims to guide prevention and public information policies.

The Inserm Center for Epidemiology of Medical Causes of Death (CépiDc-Inserm), the Directorate for Research, Studies, and Evaluation of Statistics (DREES), and Santé publique France analyzed the medical causes of death among residents who died in France in 2021: In 2021, the total number of deaths was 660,168, lower than in 2020. COVID-19 remains the third leading cause of death in France (9.2% of all deaths), behind tumors (25.7%), the leading cause, and diseases of the circulatory system (20.9%), the second leading cause. The results of the studies were presented in the Weekly Epidemiological Bulletin of December 19, 2023: leading causes of death in 2021 compared to the 2015–2019 period and to 2020.

The Geodes epidemiological indicator mapping platform, produced by Santé publique France, allows anyone to access more than 800 health indicators across France via open data.

In 2023, Géodes was expanded to include new indicators on topics such as tuberculosis, breast cancer, and colorectal cancer, as well as depression, based on data from the Health Barometer.