Page 224 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

222 Summary
MHS (PIR2), using the disease specific serial interval distribution, the distribu- tion of the incubation period and the range of the reproduction number. Osiris data of notifications to the MHS between July 2003 - January 2012 showed that only hepatitis A and hepatitis B were within this outbreak control timeframe of 17 and 52 days respectively in the Netherlands. The outbreak control time- frames for measles and mumps were within reach, and efforts were considered worthwhile to reduce delays with four days for measles and one day for mumps. For shigellosis and pertussis the outbreak control timeframe hardly could be achieved only by extreme delay reduction.
In Chapter 5, delays of notification to the MHS and reporting to RIVM of a larger group of 20 and 30 diseases respectively were investigated. In total 144,066 cases notified between July 2003 - November 2017 in the Nether- lands, were analyzed to determine timeliness according to the legal timeframe, outbreak control timeframe and incubation periods. The influence of the law change in December 2008, obliging both physicians and laboratories to notify diseases instead of either one of them, was analyzed as well. Also the most actual timeliness of notifications in 2016 and 2017 was determined. Timeliness was considered sufficient when ≥ 80% of cases met the specific timeframe.
The median notification delay decreased from 2 days (range 0-6 days, aver- age across the medians per infectious disease 1.4 day) in 2003-2009 to 0 days (range 0-6, average across the medians 0.4 day) during the period 2013-2017. In the period 2016-2017, 82.3% of notifications were performed within the legal framework of one working day. The median reporting delay from MHS to the RIVM of improved from 1 day (range 0-1, average across the medians 0.5 day) to 0 days (range 0-1, average across the medians 0.1 day) in the study periods. In 2016-2017, 98.4% of reported cases were within the legal timeframe of the specific disease. We concluded that the law change contributed to the substan- tially improved notification and reporting delays. Nevertheless, MHS should pay specific attention to the notification delays for botulism, diphtheria, hantavirus infections, leptospirosis, community acquired MRSA (MRSA CA) and STEC when providing feedback to notifying laboratories and physicians. Disease identifica- tion delay (D1X) did not change substantially during 2003-2017.
Besides hepatitis A and hepatitis B, also measles reached the outbreak con- trol timeframe as median D1 decreased from 9 to 4 days in the period 2013 - 2017. This is related to the national outbreak in 2013-2014 during which doctor delay probably was reduced by increased awareness through RIVM and MHS alerts, and laboratory delay prevented as epidemiologically linked cases did not need laboratory confirmation. Having achieved short notification delays, disease