Page 21 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan
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General introduction 19
 systems developed by governments, response and recovery organizations, com- munities and individuals, to effectively anticipate, respond to, and recover from the impacts of likely, imminent, emerging, or current emergencies (25). This emergency preparedness applies, like the IHR, to all hazards that may cause an emergency, and includes biological, chemical, radiological, and nuclear threats, but also threats of natural, other technological, and societal origin. The WHO’s JEE includes indicators to assess emergency preparedness and emergency re- sponse operations (10). On European level, the European Centre for Disease Prevention and Control (ECDC) developed the health emergency preparedness self-assessment tool (HEPSA tool) to support countries in improving their level of public health emergency preparedness. Surveillance and response manage- ment are two out of the seven defined main capacities to assess a country’s level of emergency preparedness (26). Recently, an Epidemic Preparedness In- dex (EPI) has been developed, complementary to JEE’s, measuring relative ep- idemic and pandemic preparedness across 188 countries. Besides the classical capacities as surveillance, response and health capacities, the EPI also takes into account non-public health system factors as physical infrastructure, institution- al capacity and economic resources (27). An overview of frameworks for these emergency preparedness capacities is shown in figure 2.
1.2 Notification and response chain for infectious diseases: a timeframe for measuring timeliness
In this thesis, we investigate how the functionality of surveillance and response capacities can be measured, through analyzing timeliness in the chain of events of infectious disease notification and response measures. Timely detection of a po- tential infectious disease threat or outbreak is crucial to initiate effective outbreak investigation and install timely control measures. Early detection of outbreaks relies amongst others on a legal notification system. In the Dutch Public Health Act, 48 infectious diseases are notifiable for physicians and heads of laboratories, to enable Local Health Departments (LHD/GGD) to initiate early response (5).
A notification of an infectious disease is the result of a chain of events from the moment a person is infected, until the notification is registered at the LHD, see figure 1, page 8 of this thesis. After developing symptoms, the patient may decide to consult a physician (‘patient delay’). The physician needs to initiate appropriate laboratory investigation (‘doctor delay’). After receiving diagnostic sample(s) the laboratory needs to perform the appropriate diagnostic test (‘laboratory delay’).
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