Date Published: June 14, 2018
Publisher: Public Library of Science
Author(s): Corien Swaan, Anouk van den Broek, Mirjam Kretzschmar, Jan Hendrik Richardus, Eric HY Lau.
Timely notification of infectious diseases is crucial for prompt response by public health services. Adequate notification systems facilitate timely notification. A systematic literature review was performed to assess outcomes of studies on notification timeliness and to determine which aspects of notification systems are associated with timely notification.
Articles reviewing timeliness of notifications published between 2000 and 2017 were searched in Pubmed and Scopus. Using a standardized notification chain, timeliness of reporting system for each article was defined as either sufficient (≥ 80% notifications in time), partly sufficient (≥ 50–80%), or insufficient (< 50%) according to the article’s predefined timeframe, a standardized timeframe for all articles, and a disease specific timeframe. Electronic notification systems were compared with conventional methods (postal mail, fax, telephone, email) and mobile phone reporting. 48 articles were identified. In almost one third of the studies with a predefined timeframe (39), timeliness of notification systems was either sufficient or insufficient (11/39, 28% and 12/39, 31% resp.). Applying the standardized timeframe (45 studies) revealed similar outcomes (13/45, 29%, sufficient notification timeframe, vs 15/45, 33%, insufficient). The disease specific timeframe was not met by any study. Systems involving reporting by laboratories most often complied sufficiently with predefined or standardized timeframes. Outcomes were not related to electronic, conventional notification systems or mobile phone reporting. Electronic systems were faster in comparative studies (10/13); this hardly resulted in sufficient timeliness, neither according to predefined nor to standardized timeframes. A minority of notification systems meets either predefined, standardized or disease specific timeframes. Systems including laboratory reporting are associated with timely notification. Electronic systems reduce reporting delay, but implementation needs considerable effort to comply with notification timeframes. During outbreak threats, patient, doctors and laboratory testing delays need to be reduced to achieve timely detection and notification. Public health authorities should incorporate procedures for this in their preparedness plans.
Monitoring infectious diseases is essential for detecting outbreaks that demand public health response and control measures. Therefore, efficient and reliable surveillance and notification systems are vital for monitoring public health trends and early detection of disease outbreaks . Timeliness is an important indicator for evaluation of surveillance systems, and defined as ‘reflecting the speed between steps in a public health surveillance system’ .
An overview of the search process is depicted in the flowchart in Fig 3. In total 48 articles were included in the review [3, 9–11, 13, 15, 16, 18–58]. An overview of study characteristics and results is shown in Table 1. The articles involve notification systems in 17 countries, mainly Northern America (United States 20 studies), Europe (14 studies) and East Asia (6). The majority of the studies (27 studies) analyze the timeliness of notification of one specific infectious disease, either in a disease specific notification system (13) or a generic notification system (14). Groups of infectious diseases were analyzed in 21 studies, one study analyzed timeliness of reporting of several syndromes.
To our knowledge, this is the first systematic review assessing timeliness of notification systems. Thirty-nine out of 48 identified studies from 17 different countries provided quantitative data including a predefined timeframe. Timeliness of almost one third of the systems was sufficient, one third insufficient and the others partly sufficient, both for the predefined as the standardized timeframes. Reporting delay by laboratories, either combined with by physicians, was timelier than other delays in the notification chain in both timeframes. Outcomes were not related to notification systems. Although electronic systems were faster in comparative studies (10/13), this hardly resulted in sufficient scorings for theirs systems, neither according predefined nor standardized timeframes. The disease specific timeframe for optimal outbreak control was not met by any study.
This systematic review shows that a minority of notification systems meet either predefined, standardized or disease specific timeframes. Systems which include laboratory reporting, either combined with reporting by physicians, are more often associated with timely notification. Electronic reporting systems are not associated with sufficient timeliness of notifications, while they need a considerable investment. And, even when fully implemented, they will only reduce a part of the notification chain, excluding D1-D2. Therefore, during outbreak threats, patient, doctors and laboratory testing delays need to be reduced to achieve timely detection and notification. Conventional reporting methods, like phone calls, and mobile phone texting, still can play an important role, besides alerting potential patients, physicians, and provision of appropriate laboratory test. Public health authorities should be aware of these aspects and incorporate contingency systems for enhanced notification in their preparedness plans.