Page 113 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

Exposure Notification
TO: Onset of symptom
TC: Consultation
D1 D1x
diagnosis notified to LHD
diagnosis reported to RHD
Timeliness of infectious disease reporting, the Netherlands, 2003-2017 111
Introduction
Effective communicable disease surveillance systems are a prerequisite to en- sure early detection of health threats and their timely control. Delay in infec- tious disease reporting might hamper timely outbreak control measures, such as prophylaxis for contacts, active case finding or identifying and eliminating a common source. In the Netherlands, earlier studies revealed that up to 42% of infectious diseases reported between June 2003 and December 2008 were not notified within 3 days after laboratory confirmation, and that there were sub- stantial reporting delays for four of six investigated diseases [1,2].
Infectious disease reporting is a process with several steps, the notification and reporting chain (Figure 1) [2]. Reporting delay on local level is the result of (i) the incubation time, (ii) the time until the patient decides to seek medical care, (ii) doctors’ delay in recognising the disease and initiating laboratory test- ing, (iv) delayed laboratory confirmation of the diagnosis and (v) delayed noti- fications by physicians and laboratories to the local health department (LHD) or Municipal Health Services (MHS) in the Netherlands, defined as notification delay. Subsequently, reporting delays from the LHD to regional and national health services (NHS), defined as reporting delay, influence timely detection of multiregional or national outbreaks.
TL: Physician orders
lab test
D2
Tx: Lab
obtains diagnosis
TRL: Positive TRR:
TRN:
Diagnoses reported to NHD
time
Timeline
Incubation period (Dinc)
D3X
D4 D6
D5
Tp: physician D3P obtains
lab result:
Figure 1. Notification and reporting chain
D1: total local delay; D1X: disease identification delay; D2: total testing delay; D3X: lab- oratory notification delay; D3P: physician notification delay; D4: local reporting delay; D5: regional reporting delay; D6: reporting delay; LHD: local health department; RHD: regional health department. NHD: national health department
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