Page 204 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan
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202 Chapter 9
whether the high effort of contact tracing is justified, especially for a disease as measles that is endemic is many EU countries.
In our opinion, when performing a risk assessment and deciding on control measures such as contact tracing, delays which might hamper effectiveness of control measures should be taken into account.
Lastly, in our study, passenger locator cards did not shorten the delay until identifying passenger contacts. However, they reduce time investment for pub- lic health officials and airline companies by collecting passenger details.
During the Ebola outbreak in West Africa in 2014-2015, the curative and public health sectors in the Netherlands prepared for potential import cases of Ebola. We used the delay between decision for referral and arrival of the ambulance in the designated hospital as performance indicator for prepared- ness (Chapter 7). The delay of 13 referred suspected Ebola cases was extensive, median 5 hours (range 2.0-7.5), mainly resulting from preparations needed by the ambulance and academic hospital. This is too long when taking into ac- count that half of the patients actually suffered from malaria, which might need immediate treatment. Also, possible Ebola cases can lead to hectic situations especially in an environment open for the public, which needs to be avoided.
By focus group sessions and semi-structured interviews, we studied the experiences and needs for improved preparedness among curative and public health sector. The participants considered the Ebola preparedness extensive in comparison with the actual risk of a patient, but necessary as any risk of trans- mission of this severe infection to healthcare workers and other people needs to be prevented. The respondents expressed the need for national guidelines on infection prevention such as personal protective equipment (PPE), and stan- dardization of regional preparedness, with national coordination by the RIVM. Guidelines for institutional preparedness should be developed, including con- tingency criteria for up- and downscaling. During the Ebola outbreak, the Dutch Inspectorate of Health concluded that the preparedness for patients with Eb- ola was sufficient (34, 35). We add that timeliness of referral of possible cases needs improvement. Better coordination of preparedness overarching the pub- lic health and curative sector for preparedness for emerging infections is nec- essary. The need for this multisector and multilevel approach is encountered by other countries as well. The added value of our study however, is that our evaluation combined quantitative outcomes of timeliness analyses with qualita- tive research among stakeholders, resulting in a shared problem diagnoses and motivation to improve preparedness plans (36-38).





























































































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