Page 140 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

138 Chapter 6
Schiphol Airport is the only airport in the Netherlands where trans-Atlantic flights arrive. Its Municipal Health Services (MHS, GGD Kennemerland) and the Center for Infectious disease Control (CIb-RIVM) frequently experienced that, despite all efforts, the time period elapsing from exposure to administration of the first oseltamivir dose exceeded the required 48 h. Acquiring contact details from airlines was time consuming, and contact details on passenger lists were often minimal, so that contacts were difficult to trace. In this study, we assess the time delay in contact tracing of flight passengers for influenza A/H1N1 2009 as performed in the Netherlands during the initial phase of the pandemic. Our data show that despite all efforts the effectiveness of this control measure in daily practice is minimal.
Methods
From April 29th until June 22nd 2009, contact tracing among flight passengers in the Netherlands was indicated for laboratory confirmed influenza A/H1N1 2009 cases, who traveled on a flight for 4 h or longer while being contagious, defined as 1 day before, until 7 days after disease onset. These criteria were installed by the CIb, which also functions as National focal point (NFP).
The procedure for contact tracing is complex, see Figure 1. Requests for contact tracing to the CIb for Dutch index patients originate from any Dutch MHS which identifies a patient who traveled by plane while being contagious for an infectious disease which requires contact tracing. Other nation’s health authorities will make a request to the CIb in case they diagnosed a patient which arrived at Schiphol airport for transit while being infectious. Requests for CT in the last group are submitted to the National Focal Point (NFP) or through the Early Warning and Response system of the EU (EWRS). The CIb verifies la- boratory confirmation, and the indication for contact tracing regarding flight duration. The MHS of the airport where the specific flight landed coordinates contact tracing for flight passengers. In case of Schiphol, MHS Kennemerland approaches the involved airline company requesting the passenger list. The air- line provides passenger lists with at least passenger names, seat numbers and booking or contact details. MHS Kennemerland then completes contact details through booking offices or using other search methods. Close contacts living in the Netherlands are traced by the respective Dutch MHS’s. For tracing foreign contacts, the CIb sends a notification with contact details to the NFP of the country of final destination, or through the EWRS system for EU countries.