Page 193 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

to set up covenants with physicians, to authorize laboratories to notify, nomina- tive, both group B and C diseases, to the MHS (2, 3). In December 2008, the new Public Health Law was installed, which legally arranged that both physicians and laboratories need to notify group B and group C diseases to the MHS within one working day (4). The former Infectious Disease Act instructed the MHS to subsequently report notified cases to the Health Inspectorate. The Inspectorate transferred this responsibility to the RIVM in 2005, which is adjusted in the new Public Health Law as well. The timeframe for reporting by MHS to the RIVM was determined in an agreement between MHS/RIVM, as within 1, 3 or 7 days or one month, depending on the specific disease. With the new Law on Public Health, these delays were adjusted to only 1, 3 or 7 days (5). Since July 2003, MHS report cases to the RIVM through an electronic, web-based reporting sys- tem, called ‘Osiris’ (6).
Notification delay
We performed the first study into notification delays on national level in the Netherlands, for six infectious diseases notified between June 2003 and Decem- ber 2008, (Chapter 2). Data were subtracted from Osiris. Even with a broader timeframe of 3 days instead of 1, to include weekend days, a substantial percent- age of notifications were not notified to the MHS within this timeframe, ranging from 12% of meningococcal, up to 42% of shigellosis notifications (Chapter 2, Table 1). As delay in notifications hamper timely outbreak investigation and control measures by the MHS, in our opinion, these findings were alarming. These outcomes were the reason to initiate further research into timeliness of surveillance systems.
In Chapter 5, we investigated the notification delays of a larger group of 19 diseases between 2003-2009. The median delay was 2 days (range 0-6 days), and the average across the medians per infectious disease 1.4 day even with exclusion of weekend days (Chapter 5, Table 1). We concluded that a substan- tial part of notifications in the period 2003-2009 was not made within the legal timeframe, even in a small, highly industrialized country as the Netherlands. In the period 2013-2017, under the new law the median delay was 0 days, range 0-6 days, and the average across the medians per infectious disease had de- creased to 0.4 day. In the period 2016 and 2017, 82.3% of notifications were performed within the legal framework of one working day. The percentage of diseases notified later than 3 days after laboratory confirmation had decreased to 4.6% -16.9% for the same six diseases as calculated in Chapter 2. We conclud- ed that notification time by physicians and laboratories to the MHS improved
General discussion 191
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