Swaan Corien M, Öry Alexander V, Schol Lianne G C, Jacobi André, Richardus Jan Hendrik, Timen Aura
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (Drs Swaan, Öry, and Timen and Mss Schol and Jacobi); and Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (Dr Richardus).
J Public Health Manag Pract. 2018 Jan/Feb;24(1):18-25. doi: 10.1097/PHH.0000000000000573.
During the Ebola outbreak in West Africa in 2014-2015, close cooperation between the curative sector and the public health sector in the Netherlands was necessary for timely identification, referral, and investigation of patients with suspected Ebola virus disease (EVD).
In this study, we evaluated experiences in preparedness among stakeholders of both curative and public health sectors to formulate recommendations for optimizing preparedness protocols. Timeliness of referred patients with suspected EVD was used as indicator for preparedness.
In focus group sessions and semistructured interviews, experiences of curative and public health stakeholders about the regional and national process of preparedness and response were listed. Timeliness recordings of all referred patients with suspected EVD (13) were collected from first date of illness until arrival in the referral academic hospital.
Ebola preparedness was considered extensive compared with the risk of an actual patient, however necessary. Regional coordination varied between regions. More standardization of regional preparation and operational guidelines was requested, as well as nationally standardized contingency criteria, and the National Centre for Infectious Disease Control was expected to coordinate the development of these guidelines. For the timeliness of referred patients with suspected EVD, the median delay between first date of illness until triage was 2.0 days (range: 0-10 days), and between triage and arrival in the referral hospital, it was 5.0 hours (range: 2-7.5 hours). In none of these patients Ebola infection was confirmed.
Coordination between the public health sector and the curative sector needs improvement to reduce delay in patient management in emerging infectious diseases. Standardization of preparedness and response practices, through guidelines for institutional preparedness and blueprints for regional and national coordination, is necessary, as preparedness for emerging infectious diseases needs a multidisciplinary approach overarching both the public health sector and the curative sector. In the Netherlands a national platform for preparedness is established, in which both the curative sector and public health sector participate, in order to implement the outcomes of this study.
在2014 - 2015年西非埃博拉疫情期间，荷兰的治疗部门与公共卫生部门之间密切合作对于及时识别、转诊和调查疑似埃博拉病毒病（EVD）患者至关重要。
在本研究中，我们评估了治疗部门和公共卫生部门利益相关者的防范经验，以制定优化防范方案的建议。将疑似埃博拉病毒病患者转诊的及时性用作防范指标。
在焦点小组会议和半结构化访谈中，列出了治疗部门和公共卫生部门利益相关者关于区域和国家防范及应对过程的经验。收集了所有疑似埃博拉病毒病转诊患者（13例）从发病首日至抵达转诊学术医院的及时性记录。
与实际出现患者的风险相比，埃博拉防范措施虽被认为广泛，但很有必要。各地区之间的区域协调情况各不相同。要求对区域准备和操作指南进行更多标准化，以及制定全国标准化的应急标准，并且期望国家传染病控制中心协调这些指南的制定。对于疑似埃博拉病毒病转诊患者的及时性，从发病首日至分诊的中位延迟时间为2.0天（范围：0 - 10天），从分诊至抵达转诊医院的中位延迟时间为5.0小时（范围：2 - 7.5小时）。这些患者中均未确诊感染埃博拉病毒。
公共卫生部门与治疗部门之间的协调需要改进，以减少新发传染病患者管理中的延迟。通过机构防范指南以及区域和国家协调蓝图来实现防范和应对措施的标准化是必要的，因为新发传染病的防范需要一种涵盖公共卫生部门和治疗部门的多学科方法。在荷兰，已建立了一个由治疗部门和公共卫生部门共同参与的国家防范平台，以落实本研究的成果。
