Page 226 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

224 Summary
sectors were estimated to be € 12.6 million (range € 6.7 - € 22.5 million), or € 17.9 including overhead. Costs for preparedness exceeded costs for response and involved mainly personnel costs for activities such as coordination, devel- oping protocols and training, and expenditure for PPE. In order to reduce costs and increase efficiency, we advised centralization of care through designating one ambulance service for transportation and fewer hospitals for admission of possible patients with a highly infectious disease as Ebola. The outcomes of these evaluations are currently operationalized by the public health and cura- tive sector in the national ‘Platform for Preparedness for Group A diseases’ co- ordinated by the RIVM.
In Chapter 9, we answer the research questions and discuss the results of our studies in light of the thesis aim. The discussions focus on the following topics:
1. Timeframes for notification systems
Timeframes commonly involve legal timeframes for notification and reporting, which only refer to the administrative part of the notification and reporting chain. We developed an additional outbreak control timeframe for six per- son-to-person transmissible diseases, which takes into account the total local reporting delay (D1) including patient, doctor and laboratory confirmation de- lay. This defines the maximum delay which still enables MHS disease control. For non-person-to-person transmissible disease we used two incubation peri- ods as alternative.
As legal timeframes for notification and reporting delay are met nowadays, insight in the longer disease identification delay (D1X) is important, which in- volves patient delay to consult a physician, doctors’ delay to recognize the dis- ease and initiate laboratory test, and laboratory delay. Alert systems as (lab) inf@ct and signaling reports, can reduce doctors and laboratory delays. There- fore, dates of physician consultation and initiating laboratory testing should be included in each notification.
For diseases with total local reporting delays beyond reach of the outbreak control timeframe, or two incubation periods, such as bacterial pathogens caus- ing gastro-enteritis and pertussis, public health interventions should focus on primary prevention, as health education, vaccination and food safety, or alter- native surveillance methods (e.g. typing of pathogens to identify outbreaks).
2. Timeframes for response
Timeframes for public health response are related to the effectiveness of in- terventions to prevent infection or further transmission are disease and event