Page 202 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

200 Chapter 9
Sufficient timely notification is an achievement as it is not reported by any other study describing a country-wide system for all diseases.
Lastly we showed that the average of median per diseases of disease iden- tification delay (D1X), which includes patient, doctor and laboratory test delay, was quite stable over time. This might be related to the fact that legal adjust- ments did not influence the diseases identification time.
We observed that delays of measles, mumps and psittacosis decreased significantly when outbreaks started, which might be the result of RIVM alert services such as ‘(lab)inf@cts’ and signaling reports that were sent to physicians and MHS. Reduction of reporting delay during outbreaks is known to occur, as patients and physicians will be more aware due to media attention and informa- tion provided to health care workers, as has been recently demonstrated during the Ebola outbreak in DRC (25). To what extent the reduction in reporting delay is caused by a reduction of the patient, doctor or laboratory delay cannot be de- termined, as dates of consultation (TC) and initiating laboratory testing (TL) are not routinely collected in the Dutch notification system. Information on these specific delays is important during outbreaks, to determine where disease iden- tification delays can be reduced, and in order to create real time surveillance information on new cases to monitor the impact of interventions.
Having achieved timely notification and reporting, we conclude that re- duction of the disease identification delay is the next step to reduce total lo- cal reporting delay. Insight in patient, doctor and laboratory delay is necessary to decide on interventions to decrease disease identifications, to ensure early warning of emerging diseases, and monitor the effect of control measures.
9.2 Section 2
Research question 4: What defines timely response and which ele- ments in emergency preparedness facilitate timeliness of response
Timeliness of response is related to the effectiveness of an intervention, such as post-exposure prophylaxes and provision of health care, in relation to the de- lay in delivery of the intervention. Emergency preparedness for group A diseas- es, requiring immediate notification at suspicion, is facilitated by standardized guidelines in provision of health care, and coordination of preparedness overar- ching the public health and curative sector. Cost saving elements in response is centralization of care by academic hospitals and ambulances.