Page 29 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan
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General introduction 27
 cation framework (figure 1) were scored against the timeframe of the involved study, according a standardized timeframe applied for all studies, and a disease specific timeframe. We introduce the threshold of 80% of timely notifications as sufficient, in line with the WHO JEE and Dutch thresholds. Again, associa- tions between notification systems and timeliness were analyzed. To determine a disease specific timeframe for timely notification to enable outbreak control, we developed a model presented in Chapter 4. For six person-to-person trans- missible diseases, the median local reporting delay (D1) was determined for outbreak control conditions, taking into account reporting delay distributions, generation (serial) interval distributions and distributions of symptom-onset period. Delays of Dutch notifications between 2003 and 2012 were compared with this outbreak control timeframe.
In Chapter 5, the effect of law change in December 2009 was analyzed us- ing notification (D3) and reporting (D6) delays until November 2017. Timeliness according to a legal timeframe, outbreak control timeframe, and incubation pe- riods were calculated using the 80% threshold for sufficient timeliness. Cases notified in 2016 and 2017 provide the most accurate picture of timeliness of notification and reporting for the Netherlands. We demonstrate that as notifi- cations and reporting delay now are minimized, insight in patient, doctor and laboratory delay is necessary to identify recommendations for further reduction of the notification and response chain.
Section 2 analyses aspects related to timeliness of response systems in the Netherlands, as studied during the two main outbreaks of the last decade: the pandemic influenza A/H1N1 in 2009; and the Ebola outbreak in West Africa in 2014-2015. In Chapter 6, we determined delays of tracing flight contacts of laboratory confirmed cases of influenza A(H1N1) during the pandemic in 2009. Delays were related to timely provision of post-exposure prophylaxes for these contacts. Chapter 7 presents the Ebola preparedness in the Netherlands as evaluated through a mixed method study: delays of referral of 13 possible Eb- ola cases to a university medical center were determined and experiences in preparedness among curative and public health stakeholders were evaluated through semi-structured interviews and focus group sessions. This resulted in recommendations for a multi-disciplinary approach in preparedness. Lastly, the costs made by the curative and the public health sector for Ebola preparedness was analyzed. As presented in Chapter 8, the estimated total costs were substan- tial; we provide advice to reduce costs and increase efficiency in preparedness.
In Chapter 9, we discuss the results, answer the research questions, and formulate conclusions and recommendations for practice.
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