Abstract
BackgroundTimely notification of infectious diseases is essential for effective disease control and needs regular evaluation.AimOur objective was to evaluate the effects that statutory adjustments in the Netherlands in 2008 and raising awareness during outbreaks had on notification timeliness.MethodsIn a retrospective analyses of routine surveillance data obtained between July 2003 and November 2017, delays between disease onset and laboratory confirmation (disease identification delay), between laboratory confirmation and notification to Municipal Health Services (notification delay) and between notification and reporting to the National Institute for Public Health and the Environment (reporting delay) were analysed for 28 notifiable diseases. Delays before (period 1) and after the law change (periods 2 and 3) were compared with legal timeframes. We studied the effect of outbreak awareness in 10 outbreaks and the effect of specific guidance messages on disease identification delay for two diseases.ResultsWe included 144,066 notifications. Average notification delay decreased from 1.4 to 0.4 days across the three periods (six diseases; p < 0.05), reporting delay decreased mainly in period 2 (from 0.5 to 0.1 days, six diseases; p < 0.05). In 2016–2017, legal timeframes were met overall. Awareness resulted in decreased disease identification delay for three diseases: measles and rubella (outbreaks) and psittacosis (specific guidance messages).ConclusionsLegal adjustments decreased notification and reporting delays, increased awareness reduced identification delays. As disease identification delay dominates the notification chain, insight in patient, doctor and laboratory delay is necessary to further improve timeliness and monitor the impact of control measures during outbreaks.
Highlights
Effective communicable disease surveillance systems are a prerequisite to ensure early detection of health threats and their timely control
The disease identification delay was the longest delay and showed most variation between diseases, with medians ranging between 2 days and 55 days
We observed that legal adjustments for mandatory notification to the MunicipalHealth Services (MHS) and reporting to the RIVM led to shorter delays
Summary
Effective communicable disease surveillance systems are a prerequisite to ensure early detection of health threats and their timely control. Reporting delay on local level is the result of (i) the incubation time, (ii) the time until the patient decides to seek medical care, (ii) doctors’ delay in recognising the disease and initiating laboratory testing, (iv) delayed laboratory confirmation of the diagnosis and (v) delayed notifications by physicians and laboratories to the local health department (LHD) or Municipal. Health Services (MHS) in the Netherlands, defined as notification delay. Reporting delays from the LHD to regional and national health services (NHS), defined as reporting delay, influence timely detection of multiregional or national outbreaks. Notification of infectious diseases is essential for effective disease control and needs regular evaluation.
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