Page 211 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

We have experienced that determining delays of public health measures, as PEP and referral time of possible Ebola patients to the hospital, demonstrates whether a measure was implemented in an effective way in a certain event, which can contribute to commitment among professionals and can function as catalyzer to come to improvements. We therefore recommend including quan- titative performance indicators for evaluation of timeliness of response pro- cesses in AAR. These indicators are disease specific and should be chosen per event, preferably in consultation with the involved professionals.
9.5 Main findings of this thesis
Core findings
Delay of notification and reporting
- In the Netherlands, the median notification delay to MHS is 0 days (range
0-6 days) over the period 2013-2017. As 82.3% of notifications are made within one working day, the threshold for sufficient timely notification is achieved. However, even in a sophisticated notification system fulfilling the legal timeframe, inter-disease variation in notification delay exists. For sev- eral diseases a further reduction of notification time is necessary: botulism, diphtheria, hantavirus, leptospirosis, malaria, MRSA CA, Q-fever and STEC.
- MHS report timely according legal timeframes to the RIVM. After the law change in 2008, they swiftly adjusted their notification procedures to the RIVM. Now only diphtheria and MRSA CA cases need attention to be re- ported sooner.
Timeframes for timeliness of notification
- According to our disease specific timeframe for outbreak control, using to- tal local reporting delay, until 2012, only two out of six person-to-person transmissible diseases, hepatitis A and B, were notified in time to enable MHS to implement timely measures for outbreak control. Since then, also measles reached the outbreak control condition.
- Applying two incubation periods as alternative timeframe, disease identi- fication of bacterial pathogens causing foodborne infections such as STEC and shigellosis, is too slow to prevent secondary cases further transmitting the disease.
- Notification and reporting delay, the ‘administrative part’ of the notification and reporting chain, has now been minimized in the Netherlands. Disease
General discussion 209
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