Page 169 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

Costs of Ebola preparedness and response in the Netherlands 167
Introduction
Between December 2013 and April 2016, the largest epidemic of Ebola virus disease (EVD) ever recorded took place. It included at least 28,616 suspected, probable, and confirmed cases and 11,310 documented deaths, but the real numbers were probably much higher [1]. Most cases occurred in the West-Af- rican countries of Guinea, Liberia, Sierra Leone and, to a lesser extent, in Mali, Nigeria, and Senegal. The rise in EVD cases in July 2014 prompted World Health Organization (WHO) to declare the outbreak a public health event of interna- tional concern [2]. On September 28, 2014, the United States encountered its first patient with symptoms of EVD, who originated from Liberia [3]. Fear of local outbreaks arose in non-African countries because of this patient and cas- es among healthcare workers (HCWs) returning from Africa [4]. Internationally, health systems were urged to prepare for the possibility of an EVD patient pre- senting to hospitals [5-8]. In Western countries, EVD care was required for 27 patients, of whom 22 were healthcare personnel. Of the total, 24 were medical- ly evacuated from West Africa or were infected with Ebola virus in West Africa and had onset of disease in Europe or the United States. The remaining 3 were secondary patients infected in the United States or Europe [9, 10]. The Nether- lands received an infected United Nations (UN) worker in December 2015 [11].
Although technical guidance was provided by WHO [12], European Centre for Disease Prevention and Control [13], and US Centers for Disease Control and Pre- vention [14], this had to be adjusted to the specific circumstances of each country by its own infectious disease control organisations. Country-specific guidelines were developed and included flowcharts and algorithms for identification of patients, isolation precautions, laboratory testing, patient transportation, waste disposal, quarantine procedures, and management of widespread anxiety about EVD [15].
An outbreak of such a highly virulent disease not only results in a disease burden to society, but the containment efforts also have economic consequenc- es. These economic costs include social disruptions in the countries affected, border control, restrictions on international trade, a downturn in travel and tourism income, and additional healthcare costs [16-18]. To date, a few studies have measured the costs of EVD preparedness and treatment of patients in hos- pitals [17, 19-21]. In public health and primary care institutions, such prepared- ness costs in not-affected countries have not been studied, but their evaluation is important for future preparedness of similar outbreaks of highly virulent in- fectious diseases. The aim of this paper is to present the total costs associated with EVD preparedness and response in healthcare in the Netherlands.
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