Page 128 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

126 Chapter 5
The gradual decrease since 2003 was probably related to local agreements be- tween MHS, physicians and microbiologists on anonymous pre-notifications for group B diseases by the laboratory. This was recommended under the former law to reduce reporting delay in group B diseases [12]. In our opinion, the va- riety of notification procedures explains why a substantial delay reduction was only achieved in 2011. In 2016–2017, for all six diseases studied by Reijn et al., the percentage of cases notified more than 3 days after laboratory confirmation was substantially reduced, and legal thresholds were achieved forat least80% of cases for D3 (82.3%). Nevertheless, for some diseases, notifications by the involved physicians and laboratories still need to become more timely, namely botulism, diphtheria, hantavirus infections, leptospirosis, malaria, communi- ty-acquired meticillin-resistant Staphylococcus aureus and STEC. These diseases have in common that they are rare and may need additional laboratory tests after initial confirmation, which are performed by specialised reference labora- tories leading to delay in notification. For STEC infections, this delay is of special concern as early identification of a common source is important. We recom- mend that MHS monitor notification delays in their region and identify ways of improvement together with local laboratories and involved physicians.
Although we attribute the shortening of notification delays over time main- ly to the legal adjustment in December 2008, other developments such as faster notification systems probably contributed as well. Laboratories nowadays noti- fy mainly through automated electronic systems which in comparative studies have proven faster than conventional methods [5]. Also, according MHS, most notifications are performed by laboratories nowadays. Another influence may have been the quarterly feedback of notification delays that RIVM has provided to the MHS since 2006 and that can be used by MHS to monitor and evaluate no- tification timeliness and in their communication to health professionals. Never- theless, these developments have only contributed to shorter notification delays since the legal adjustment obliging laboratories to notify in addition to physicians.
Other countries also observed shorter reporting delays after law adjust- ments. In Germany, the median local reporting time to state health depart- ments decreased from 4 to 1 day after adjusting the legal threshold from 1 week to 1 day [3]. In the United Kingdom (UK), after introduction of a new legal obli- gation on laboratories to report a specified list of causative agents, the median notification delay by laboratories (D2) decreased from 10 to 8 days, fulfilling the timeframe of 21 days. However only a minority of laboratories reported more than 90% of cases timely [4].