Page 131 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

Timeliness of infectious disease reporting, the Netherlands, 2003-2017 129
gives an indication of laboratory delay [4,5,20]. However, dates of doctor’s con- sultation and laboratory test initiation are not routinely collected in European Union countries (personal communication: M Diercke, Robert Koch Institute, February 2019; AM O’Connor, Public Health England, February 2019; A Jacks, Public Health Agency Sweden, February 2019). We recommend including these time points in every notification to enable monitoring of causes of delay before laboratory confirmation and measuring the effect of raising awareness among public and physicians during outbreaks. Although additional data in surveillance systems should, in order to maintain compliance by reporting health profession- als, not be requested lightly, insight in these time points is important. Therefore, it is worthwhile to investigate how these data can be collected automatically in the electronic reporting systems at a minimal workload for the notifying health providers. As an alternative, these data can be collected only when specifically needed during outbreaks when healthcare providers will be more motivated to provide this information.
Another limitation is missing data on the completeness of notification in the Netherlands. Incompleteness of notified infectious diseases is an even larg- er concern for public health than delayed notification. Completeness rates for laboratory-confirmed hospitalised pertussis cases have been determined as low as 16.5–22% for ≥ 2 year-old cases and between 52–61% for children < 2 years [21]. Reporting completeness during the measles outbreak in 2013-2014 has been estimated as low as 9%, although this is mainly the result of patients not seeking medical care (underascertainment) [22]. Better insight in notifica- tion completeness is necessary, at local as well as national level, in order to improve the surveillance system.
Conclusions
Adjustments in the law regulating infectious disease control successfully re- duced notification delays by physicians and laboratories to the MHS and report- ing delays to the RIVM. Legal timeliness thresholds were achieved, although no- tification delays can still be shortened for some diseases and therefore need to be monitored by the MHS. To achieve outbreak control thresholds, also disease identification delays need to be reduced, which especially applies for measles and bacterial gastroenteritis. We recommend including dates of doctor’s con- sultation and laboratory request into notification records to determine patient, doctor and laboratory delays during outbreaks of emerging infectious diseases.
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