Page 223 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

the former Law on Infectious Diseases between June 2003 - December 2008. Medians of total local reporting delay (D1, from disease onset until notification at the MHS) of six diseases were compared with one and two disease specific in- cubation periods. Medians of notification delays were compared with the legal timeframe of one working day. For two out of six diseases, shigellosis and STEC, only a minority was reported within two incubation periods 2.9% and 23.8% resp.. A substantial percentage of cases were notified more than three days after laboratory confirmation (range 12.0 – 42.0%). These results were alarming as such delays hinder timely response. MHS with covenants enabling laborato- ries to notify on behalf of physicians showed significantly shorter notification delays. Fax was faster than postal mail or e-mail, at that time. We urged for direct laboratory notification to MHS to reduce notification delays.
Chapter 3 describes a systematic literature review to assess timeliness of notification systems and a possible association between system, either conven- tional, electronic or mobile phone, and timely notification. We included 48 arti- cles published between 2000 -2017 in Pubmed, Scopus or grey literature. Per ar- ticle, the investigated delay was categorized according to the notification chain (figure 1, this thesis) and measured according the predefined timeframe of the involved study, the standardized timeframe applied for all studies, and a disease specific timeframe for outbreak control. We introduced the threshold of ≥ 80% for sufficient timely notification, in line with the WHO JEE and Dutch thresholds, between 50% - 80% as partly sufficient, and < 50% as insufficient. Notifications were only sufficient timely in 11 out of 39 studies with a predefined timeframe (28%), and only in 13 out of 45 studies according the standardized timeframe (29%). Strict disease specific timeframes were not met by any of eight stud- ies. We concluded that only a minority of notification systems achieve timely notification, while systems involving laboratories were most often associated with sufficient timely notification. Outcomes were not related to notification systems, electronic systems were only faster in comparative studies. Monitor- ing notification delays and providing feedback to reporting health professionals were facilitating factors for timely notification.
In Chapter 4, we developed a model for six person-to-person transmissi- ble diseases, to determine timeframes for maximum total local reporting delay (D1) which still enables the MHS to install timely measures to control disease transmission, i.e. for which the expected number of onward transmissions by a first generation case at the moment of notification of the index case is below 1 (R x PIR2<1). The model calculates the proportion of secondary cases caused by the index and by secondary cases at the time the index case is notified at the
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