Page 23 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan
P. 23

General introduction 21
 European Commission in case notification criteria are met according IHR or EU Decision 1082 respectively.
The terms notification and reporting of infectious diseases are used inter- changeably in literature, although notifications tend to be related to legal obli- gations from a diagnosing physician or laboratory to the public health services, and reports can include a variety of events, from an individual case to cumu- lative numbers of cases, either between curative and public health sector or between different layers of the public health sector. In this thesis notification is defined as a legally obligatory notified case or cluster of infectious diseases by physicians or laboratories to local public health services, and reporting the process of reporting notified cases by the local public health services to the national public health services.
Schematic steps of notification and reporting systems are described in sev- eral studies in relation to the evaluation of timeliness of the investigated sur- veillance system (1, 30-35). We first developed a generic description of a ‘notifi- cation and reporting chain’, including steps, time points, related to surveillance (36, 37). For this thesis, we merged notification and reporting into ‘notification’ and further extended this chain with the response activities following notifica- tion at MHS level and reporting at national level. We renamed the framework into ‘notification and response chain’, figure 1 of this thesis. The definitions of the time points and delays between these time points are explained in the section ‘definitions’ of this thesis. Main delays in the notification and reporting chain are: disease identification delay (D1X, from onset of disease until labo- ratory confirmation), notification delay (D3, from laboratory confirmation until notification received by LHD) and reporting delay (D6, from receiving notifica- tion at LHD until reporting at the NHD/RIVM).
Disease identification delay is the sum of ‘patient delay’, ‘doctor delay’, and ‘laboratory test delay’. Information on some time points is not routinely collect- ed by LHD or RIVM in the Netherlands, and therefore visualized in grey color in figure 1. Provision of dates on consultation of the physician and initiation labo- ratory testing is not legally required. Regional Health Departments do not exist and therefore only information on reporting delay from LHD to RIVM is available in the Netherlands.
In this thesis we define notification systems as the structure in which no- tifications to the LHD and reports by the LHD to the RIVM are made, including legislation, infrastructure and involved persons and organizations. We will refer to LHD as ‘Municipal Health Services’ (MHS), which is used more commonly in the Netherlands, and to the CID/RIVM as ‘RIVM’.
1




























































































   21   22   23   24   25