Page 47 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

Timeliness of infectious disease reporting, the Netherlands, 2003-2009 45
MHS, which received most reports by fax, showed an average improvement in notification time of 3.3 days (p< 0.05; 95% CI 0.5-6.1 days) compared to MHS which received reports by post. E-mail was slower than fax, though not signifi- cantly, and showed no significant improvement compared to post.
Most MHS received about five to ten report cards per week. Only one MHS indicated that it still received 10-20 report cards per week from physicians, and its average Pd of notifications showed a significant delay of 19,1 days compared to the other MHS with an average Pd of 7,3 days. No MHS received more than 20 report cards per week.
No MHS received a majority of notifications by e-mail. Most MHS that used e-mail had encountered problems with the security of their inhouse electronic mail system. Moreover, to protect patient privacy, an e-mail report would often contain a minimum of information, requiring a public health officer to spend time contacting the laboratory or physician to complete the report.
Discussion
This is the first study conducted in the Netherlands on the timeliness of infec- tious disease reporting at the national level. Our key measures were the inter- vals between onset of symptoms and MHS notification, and between laboratory diagnosis and notification.
It is preferable for notification to the MHS to occur within the incubation period to prevent transmission leading to secondary cases. The interval after diagnosis can be influenced by faster reporting procedures.
We found that even in this small and highly industrialised country, during the period studied, a considerable number of infectious disease cases were not reported to the Municipal Health Service (MHS) within the time frame of two incubation periods, and many cases were reported more than three days after laboratory confirmation of diagnosis. This striking delay in reporting leads to considerable delay of response measures by the MHS and the National Institute for Public Health and the Environment (RIVM). Differences in timeliness of re- porting for each disease cannot only be attributed to differences in incubation periods. Cases of measles and typhoid fever, as well as cases of meningococcal disease and EHEC/STEC infections, show different percentages, despite their incubation periods being very similar. We find that each disease has specific attributes that have to be analysed for each step in the surveillance process in order to identify reasons for delays and to find options for improvement [4,7].
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