Page 114 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

112 Chapter 5
Public health authorities stimulate early notification and reporting through pro- vision of information and guidance to medical professionals. In addition, many, also European, countries have included timeframes for notification and report- ing in their laws on notifiable diseases [3,4]. These legal requirements, which may even include penalties for non-adherence, are a strong instrument and an important step in the chain through which governments can control early detection and timely public health response. Nevertheless, legal requirements need careful consideration and evaluation, and other facilitating elements such as clear and uniform reporting timeframes, procedures and feedback on notifi- cations are important as well [5].
In the Netherlands, legal adjustments were made to mandatory infectious disease reporting in December 2008 to reduce notification and reporting delays. Under the former Infectious Disease Act from 1998, diseases were notifiable by either physicians (group B notifiable diseases, D3P in Figure 1) or laboratories (group C diseases, D3X). When the new Public Health Act came into force in December 2008, both group B and C diseases became notifiable to the MHS for both physicians and laboratories [6]. The notification timeframe of 1 working day remained unchanged, likewise the timeframe for group A diseases, which require immediate notification upon disease suspicion either by physicians or laboratories. The timeframe for reporting from the MHS to the NHS, the Na- tional Institute for Public Health and the Environment (RIVM); D6 in Figure 1), was reduced for some group B and C diseases: from 7 to 3 days for hepatitis A, Q fever and psittacosis, and from 1 month to 7 days for pertussis and malaria.
In this study, we evaluate whether the legal adjustments resulted in faster reporting and whether legal and outbreak control timeframes were met. In or- der to address earlier steps in the notification and reporting chain such as de- lays in notification by doctors and laboratories, the RIVM raises outbreak aware- ness among MHS, physicians and microbiologists through a weekly signalling report sent by email. Further guidance, e.g. about the availability of laboratory tests and notification criteria, is also provided through an instant alert system, so-called inf@ct and labinf@ct email messages. Our second objective was to evaluate whether these awareness systems reduced reporting delays during outbreaks.