Page 209 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

and to enable MHS to implement timely control measures, in this thesis we also investigated the ‘disease identification delay’, between disease onset until lab- oratory confirmation. This delay is disease specific, involves patient, doctor and laboratory delay, and is much longer than the notification or reporting delay. The outbreak control timeframe we developed for six person-to-person trans- missible diseases addresses this disease identification delay. Incubation periods were used for non-person-to-person transmissible diseases.
We showed that nowadays in the Netherlands, thresholds for notification and reporting timeliness are met. However, only medians three out of six dis- eases, hepatitis A, hepatitis B and measles, were within the outbreak control timeframe. Especially bacterial foodborne pathogens are of concern as both shigellosis and STEC will not reach the threshold for outbreak control, or two incubation periods, respectively.
We conclude that the notification, reporting and outbreak control time- frames all three are essential and complementary. For diseases that do not ful- fill the outbreak control timeframe, insight in and extra effort to reduce the dis- ease identification delay is necessary, and public health authorities should focus on primary prevention of these diseases specifically. We recommend to include dates of physician consultation and initiating laboratory testing in a notification, to be able to determine patient, doctor and laboratory delay within the disease identification delay. This enables MHS and RIVM to decide which interventions to decrease this delay are necessary during an outbreak and to monitor the effect interventions as ‘real-time’ as possible.
Timeframes for public health response are related to interventions to pre- vent further transmission. For some diseases, a time indication is provided for the effectiveness of the intervention, preferably evidence based in the disease specific guidelines.(57-59). We evaluated timeliness of two interventions, for only one, provision of PEP, a quantitative timeframe existed. In the other in- tervention, referral time of a possible Ebola patient to an academic hospital, the indicated delay was ‘as soon as possible’ based on the medical treatment necessary. The opinion among respondents, involved ‘experts’, formed another indicator. Analyzing the delay in response contributed to the conclusion that better preparedness and delay reduction was needed and possible through, amongst others, standardized guidelines on infection prevention. We conclude that quantitative timeframes are relevant to evaluate the effectiveness of re- sponses to enhance the preparedness system. Ineffective interventions can be discarded, and discussions about the outcomes lead to better understanding of the causes and to commitment among public health and curative professionals
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