Page 225 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

identification delay now dominates total local reporting delay. For bacterial gas- tro-enteral diseases with short incubation periods as STEC, shigellosis and typhoid fever, as well as for pertussis, the timeframes of outbreak control or incubation periods are beyond reach. Insight in patient, doctor and laboratory delay is es- sential to decide how to reduce disease identification delay. This is of particular concern during outbreaks when real-time monitoring of new cases is important. We recommend to including dates of physician consultation and initiating labo- ratory testing in each notification. Furthermore, for these diseases, primary pre- vention through e.g. health education, vaccination, and food safety is important.
Section 2 describes elements related to timeliness of response systems in the Netherlands during the pandemic influenza A(H1N1) in 2009; and the Ebola outbreak in West Africa in 2014-2015.
In Chapter 6, we retrospectively investigated delays of 17 contact inves- tigations among flight contacts of laboratory confirmed cases of pandemic in- fluenza A(H1N1). The average delay between flight arrival and contact details identified, a proxy for delivering PEP, was 3.9 days (median 4 days) and in only 3 flights this delay was < 48 hours, the indicated time for effective PEP. In our opinion, contact tracing among passengers was not effective. We recommend health authorities to take delays in disease identification into account when de- ciding to install contact tracing measures.
Chapter 7 describes the evaluation of the Ebola preparedness for an import case in the Netherlands. Referral delays of 13 suspected Ebola cases to a univer- sity medical center were determined and experiences in preparedness among curative and public health stakeholders were evaluated through semi-struc- tured interviews and focus group sessions. The median referral delay was 5 hours (range 2.0-7.5), mainly resulting from preparations by the ambulance and academic hospital. This delay is too long, as half of the patients actually suffered from malaria. Also hectic situations in a public environment should be prevent- ed by swift action. Participants expressed the need for national guidelines on infection prevention (e.g. personal protective equipment, PPE), standardization of regional preparedness with national coordination by the RIVM and guide- lines for institutional preparedness, including contingency criteria. We conclud- ed that better coordination of preparedness overarching the public health and curative sector for preparedness for emerging infections is necessary.
Chapter 8 analyses the costs made by the curative and public health sector for Ebola preparedness in the Netherlands, including the referral of 13 suspect- ed cases and treatment of one confirmed case. The total costs made by these
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