National Reference Centers for Communicable Diseases (NRCs)

To carry out its infectious disease surveillance activities, Santé publique France relies on a network of 43 National Reference Centers (Article L 1413-3 of the Public Health Code).

National Reference Centers (NRCs) are laboratories located within public or private healthcare, educational, or research institutions. They are appointed for a five-year term by the Minister of Health upon the recommendation of Santé publique France, following a call for applications and an evaluation of those applications by a committee of experts (the NRC Committee).

The mission of the National Reference Centers (NRCs) (Decree of March 2, 2022) is:

Expertise

  • Identification and characterization of strains submitted by analytical and clinical laboratories

Identification or confirmation, as needed, of common species for which identification techniques are not available. The NRCs perform this identification until the technique is made available to laboratories, particularly those designated by the Regional Health Agencies (ARS). Identifications of common strains and serological diagnoses, which constitute routine diagnostic activities of clinical laboratories, are entrusted to the CNRs only in exceptional cases and, in such cases, are subject to billing; Genotypic
and/or phenotypic characterization of strains of pathogens under their purview, either independently or collaboratively as part of a network-based approach. The expertise of the CNRs may be requested on an emergency basis by health authorities.

  • Maintenance and retention of diagnostic and/or identification and characterization techniques

The CNRs manage the biological samples collected and the related databases under the conditions specified in Article L. 1413-8 of the Public Health Code for the duration of their mandate. These samples remain the property of the State. If the facility hosting an NRL is required to change, particularly at the start of a new term, these collections of reference strains, antigens, or reference immune sera, as well as epidemiological, serological, and molecular markers and databases, are transferred to the laboratory newly designated as an NRL.

  • Development or validation of diagnostic tests

Participation in the development, optimization, validation, dissemination, and recommendations regarding clinical laboratory tests (diagnostic, identification, and/or typing techniques) related to the pathogens under their responsibility.
For emerging pathogens requiring urgent epidemic control measures, the relevant CNRs ensure the development and/or validation of diagnostic techniques and contribute to their dissemination as quickly as possible and at the request of the Ministry of Health. To the extent possible, they contribute to the procedures for registering these techniques in the registry of innovative procedures outside the standard nomenclature (RIHN) or in the nomenclature of medical laboratory procedures (NABM).
The CNR may be required to distribute reference reagents if these are not available. In such cases, in the face of a public health risk, health authorities may rely on public or private operators to ensure the production and distribution of sufficient quantities of reagents, seeking the support of the CNR as needed (expertise, access to the sample repository, development and validation of a diagnostic technique).
The CNR must establish a scaling-up plan in the event of an exceptional public health situation, particularly to handle a surge in samples.
They also participate in the following activities, the expected outcomes of which are specified in the specific terms of reference.

  • Contribution to the assessment of susceptibility to anti-infectives and the definition of resistance thresholds for pathogens to anti-infectives. The CNRs must contribute to international databases in this field.

  • Participation in the evaluation of pathogen inactivation procedures.

  • Information, training, and, where appropriate, the development and publication of technical guidelines.

  • NRCs may be called upon by health agencies and institutional partners to provide their expertise, within the limits of their resources, in the context of risk assessment (e.g., transfusion risk, vaccination campaigns) or management measures in collaboration with partners

Advice

  • to healthcare professionals;

  • to the Ministry of Health, regional health agencies, the National Public Health Agency, other health safety agencies, the High Authority for Health (HAS), and the High Council for Public Health (HCSP);

  • participation in the development of measures for the prevention and control of infectious diseases;

  • responding to requests for expert opinions or investigations.

Contribution to epidemiological surveillance

  • Surveillance of the trends and characteristics of infections

The CNRs perform the analyses necessary for the surveillance of the pathogens under their purview, particularly the characterization of strains. They also coordinate a network of corresponding laboratories that perform some of these analyses and centralize the results.
NCRs involved in the surveillance of an infection must, at a minimum, contribute to providing relevant sociodemographic, epidemiological (e.g., exposure, concept of clustered cases, healthcare-associated origin, resistance to anti-infectives, etc.), and clinical management data, in coordination with the National Public Health Agency. The CNRs will also ensure the representativeness of identified cases according to the following criteria:

  • geographic;

  • location and mode of care;

  • selection of specific strains that are difficult to identify;

For rare infections, the CNRs must actively encourage laboratories to send them all strains isolated in France.
They also participate in the following activities, the requirements for which are specified in the specific terms of reference.

  • Participation in the surveillance of pathogen resistance to antimicrobial agents through the collection of microbiological and clinical-epidemiological data tailored to specific pathogens.

  • Contribution to the detection of healthcare-associated infections and the analysis/investigation of epidemic phenomena in collaboration with the Support Centers for the Prevention of Healthcare-Associated Infections (CPIAS), the National Public Health Agency, and the regional health agencies.

  • Contribution to the study of immune coverage in a population that is or is not protected by one or more vaccines, and its evolution.

  • Participation in the investigation of epidemic phenomena (strain typing, comparison of strains isolated from patients and other sources).

  • Contribution to international surveillance networks, particularly European ones, and to the maintenance of related databases.

  • Contribution to ad hoc investigations at the request of the Ministry of Health or the National Public Health Agency.

Alert

  • Immediate reporting of any event that could pose a risk to public health to the National Public Health Agency, the Directorate General of Health (DGS), and, where applicable, the relevant Regional Health Agencies (ARS), including:

    • an increase in the frequency of pathogen isolation, or reports of clusters of a disease;

    • identification of a new, rare, or emerging pathogen (coronavirus, poliovirus, Ebola virus, etc.) or a variation or mutation of a known pathogen that may confer a selective advantage;

    • the emergence of new clinical forms or pathologies in new populations;

    • information regarding similar events in other countries.

The specific missions of each CNR are detailed in a specific set of specifications (PDF format) consistent with a standard set of specifications defined by the decree of March 2, 2022. To carry out certain of its missions, a CNR may rely on one or more (up to three) laboratories known as “associated laboratories.” In this case, the head of the CNR is responsible for coordinating all activities of the associated laboratories and submits an annual report to Santé publique France summarizing the activities carried out by the various laboratories (Decree No. 2022-1770 of December 30, 2022).

Laboratories performing only the missions mentioned in 1° and 2° are designated “National Reference Centers—Expert Laboratories” in accordance with Article D1413-46.

A committee of National Reference Centers operates under the authority of the Directorate General of Santé publique France. It is composed of representatives from the Directorate General of Health, the Directorate General of Healthcare Provision, and Santé publique France, as well as experts in epidemiology, microbiology, infectious diseases, or public health appointed for their expertise. At least half of its members belong neither to the directorates of the Ministry of Health nor to Santé publique France.

Committee members are appointed for a five-year term by the Director General of Santé publique France.

Composition of the Committee of National Reference Centers

Decision No. 132-DG-2023 of April 26, 2023

The term of office for members of the NRC Committee runs from April 26, 2023, until its renewal no later than April 25, 2028.

The members of the NRC Committee are:

  • Chair

Christophe Burucoa

  • As experts in epidemiology, microbiology, infectious diseases, or public health

Christophe Burucoa, François Caron, Clarisse Dupin, Vincent Foulongne, Anne Goffard, Christophe Hennequin, Jérôme Le Goff, Simon Le Hello, Alban Le Monnier, Raphaël Lepeule, Hervé Pelloux, Françoise Raynaud Ramisse, Gilles Salvat.

  • As representatives of the Directorate General for Health

Alexis Pernin (Alternate: Walid Mokni)

  • Representing the Directorate General for Healthcare Provision

Pending appointment

  • Representatives of Santé publique France

Bruno Coignard, Didier Che, Henriette De Valk, Julie Figoni, Isabelle Parent

The scientific secretariat of the CNR Committee is provided by the Infectious Diseases Directorate of Santé publique France.

Responsibilities of the CNR Committee:

  • to propose to the General Directorate of Santé publique France, for a five-year period and in light of the epidemiological situation, a list of pathogens requiring a National Reference Center (CNR);

  • update the general terms of reference for the NRCs and develop specific terms of reference for each NRC (PDF format);

  • review proposals and rank applications in response to a call for applications;

  • evaluate the activity of the National Reference Centers annually and at the end of the five-year period;

  • contribute to the coordination of the NRC network.

Santé publique France relies on this committee to ensure the scientific quality and efficiency of the activities carried out by the NRCs within the scope of their missions and compliance with their specifications, to coordinate the network of laboratories thus created, and to coordinate their activities. During the five-year period, the NRC Committee may propose to the General Directorate of Santé publique France the creation of new National Reference Centers or associated laboratories to address public health needs not covered under Article D. 1413-50 of the Public Health Code.

At any time, in the event of a breach of the obligations stipulated in the Order of March 2, 2022, and in accordance with Decree No. 2016-806 of June 16, 2016, and Decree No. 2022-1770 of December 30, 2022, the committee may propose to the Directorate General of Public Health France the suspension or removal of a laboratory from the list of CNRs. The Directorate General of Public Health France shall then notify the laboratory director of the facts justifying this decision. The laboratory director has one month to submit comments. At the end of this period, or if the laboratory director’s comments are deemed unsatisfactory, the Directorate General of Public Health France submits a proposal for suspension or removal to the Minister of Solidarity and Health.

  • Decree of September 18, 2024, amending the Decree of August 22, 2011, regarding the mandatory reporting of infectious diseases and other diseases referred to in Article D. 3113-7 of the Public Health Code, and amending the Decree of December 30, 2022, establishing the list of national reference centers, national reference centers-associated laboratories, and national reference centers-expert laboratories for disease control.

  • Decree of January 18, 2023, amending the Decree of December 30, 2022, establishing the list of national reference centers, national reference centers-coordinating laboratories and associated laboratories, and national reference centers-expert laboratories for the control of communicable diseases.

  • Decree of December 30, 2022, establishing the list of national reference centers, national reference centers-associated laboratories, and national reference centers-expert laboratories for the control of communicable diseases.

The list of the 43 designated NRCs is available below. It includes the names of the heads of the NRCs, coordinating NRCs, NRC-associated laboratories (NRC-AL), and NRC-expert laboratories (NRC-EL) participating in the network, as well as their contact information.

The head of each CNR submits an annual activity report to the Minister of Health and to Santé publique France. This report is used by the CNR Committee to monitor the activities of the CNRs.

Contact information, instructions for sending specimens, and CNR activity reports are directly accessible via their websites at the addresses listed below.

Regulatory texts for the 2023–2027 CNR term

  • Decree of September 18, 2024, amending the Decree of August 22, 2011, regarding the mandatory reporting of infectious diseases and other diseases mentioned in Article D. 3113-7 of the Public Health Code, and amending the Decree of December 30, 2022, establishing the list of national reference centers, national reference centers-associated laboratories, and national reference centers-expert laboratories for disease control.

  • Decree of January 18, 2023, amending the Decree of December 30, 2022, establishing the list of national reference centers, national reference centers—coordinating laboratories and associated laboratories, and national reference centers—expert laboratories for the control of communicable diseases.

  • Decree No. 2022-1770 of December 30, 2022, on national reference centers, amending the provisions regarding the designation, missions, and funding of national reference centers.

  • Order of December 30, 2022, establishing the list of national reference centers, national reference centers-associated laboratories, and national reference centers-expert laboratories for the control of communicable diseases.

  • Decree of March 2, 2022 establishing the specifications for national reference centers for the control of communicable diseases

Regulatory texts for the 2017–2022 NRC mandate

  • By order of June 11, 2021 (published in the Official Journal No. 0140 of June 18, 2021), two expert laboratories for SARS-CoV-2 sequencing support are added to Article 1(39) of the order of March 7 (AP-HM Infectious Diseases Center, Marseille; Virology Laboratory, Henri Mondor Hospital, AP-HP, Paris)

  • Decree of July 28, 2021, amending the decree of March 7, 2017, establishing the list of national reference centers (amendment to the CNR for Transfusion-Related Infectious Risks)

  • Decree of May 17, 2021 amending the decree of March 7, 2017 establishing the list of national reference centers

  • Decree No. 2021-605 of May 17, 2021 extending the term of inclusion on the list of national reference centers until December 31, 2022

  • Decree of December 12, 2019, amending the Decree of March 7, 2017, establishing the list of National Reference Centers (amendment to the Hantavirus National Reference Center)

  • Order of July 10, 2018 amending the Order of March 7, 2017 (Pneumococcus NRC amendment)

  • Decree of March 7, 2017 establishing the list of national reference centers, national reference centers-associated laboratories, and national reference centers-expert laboratories for the control of communicable diseases

  • Decree No. 2016-806 of June 16, 2016, concerning national reference centers for the control of communicable diseases

  • Decree of June 16, 2016 establishing the specifications for national reference centers for the control of communicable diseases

  • Article L1413-3 as amended by Order No. 2016-462 of April 14, 2016 - Art. 1

  • These documents are published on the website: http://www.legifrance.gouv.fr