Direct Laboratory Notification of Communicable Diseases

1 Introduction

1.1 Background

Communicable diseases remain a significant public health priority, both in New Zealand and internationally. The problems facing New Zealand in this area today are diverse, and include food-borne diseases, the emergence of antimicrobial-resistant bacteria, sexually transmitted diseases, vector-borne diseases, and vaccine-preventable diseases. New and emerging diseases such as pneumococcal disease and sudden acute respiratory syndrome (SARS), as well as the threat of an intentional release of a biological agent, pose potential threats to public health.
Surveillance is fundamental to the prevention and control of communicable diseases. A key surveillance instrument for the monitoring and management of communicable disease (and some non-communicable issues) is notification. Under the Health Act 1956 there are 49 diseases and conditions that are required to be notified (including on suspicion) to a Medical Officer of Health (and territorial local authority for some conditions). The primary purpose of notification is to trigger an appropriate public health response so that further illness can be prevented. The secondary purpose is for surveillance; that is, to predict, observe, and minimise the harm caused by outbreak, epidemic and pandemic situations.
In 2003 the Ministry of Health initiated a review of the current system of notifiable diseases and conditions. This review was undertaken by the consultancy group Allen & Clarke, regulatory and policy specialists. The review identified a need to improve the effectiveness of the current system, especially in relation to data accuracy and timeliness. A major recommendation was to create a legal framework that would allow the direct laboratory notification of notifiable diseases.
The Health Amendment Act 2006 was passed in December 2006. As well as improving the Government’s ability to respond to an outbreak of pandemic flu or a similar highly infectious disease, this new legislation also provided for direct laboratory notification of notifiable diseases.
The old legislation (prior to 18 December 2007) saw considerable variations in reporting rates and some under-reporting. The new legislative requirements will improve the old system, including an improvement to the rates of reporting. This new legislation requires laboratories to directly report the results of positive tests that indicate the possibility of a notifiable disease to Medical Officers of Health. This is expected to support reporting by clinicians and result in more comprehensive and faster overall reporting of communicable diseases to Medical Officers of Health. Accurate and timely data is essential if we are to promptly identify and respond to important public health events such as pandemic influenza, or a similar emergent infectious agent with epidemic or pandemic potential.

1.2 Purpose of the guidelines

In July 2007 the Ministry of Health established a project team and a sector advisory group to help facilitate the introduction of the new legislation. This document is one of the outcomes of that work.
The main purpose of these guidelines is to inform the health sector about what is involved in meeting the new legislative requirements, and to present a set of national minimum requirements for those parties that are required to comply with the legislation.
The preferred method of notification is through a national electronic system that builds on existing systems, including EpiSurv – the national notifiable diseases database maintained by Environmental Science and Research (ESR). The development and implementation of the national electronic system for direct laboratory notification requires a phased approach to ensure the implementation of electronic notification is co-ordinated with other IT projects involving laboratories. This will ensure there is efficient and effective use of IT resources and systems, and will help minimise the compliance costs for all parties involved.
The national electronic system provides a base set of functions and tools for:

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  electronic and manual data capture
  
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  recording of cases of notifiable diseases and subsequent investigation details
  
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  recording of contact tracing information and linking of cases
  
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  data analysis and reporting.
  

Sections 6.3 and 6.4 of this document discuss in more detail the functions provided by the national electronic system.

The national electronic system is intended to be able to coexist with local public health unit (PHU) systems that are used to support more advanced requirements for notifiable disease case management, contact tracing and management, and outbreak and emergency response. It provides interfaces through which data can be exchanged electronically. Section 6.9 discusses integration in more detail.
There are also other legislative changes in the near future that will have an impact on direct laboratory notifications. The Government is looking to add additional communicable diseases to the notification schedule around March 2008. In addition, new public health legislation was introduced into the House in November 2007. This will see further changes to what clinicians are required to do under the Act, and will stipulate more clearly what information is required within a notification to a Medical Officer of Health.
For these reasons, it is important to note that this is only version 1 of the national guidelines, and that these are expected to change over the coming year. Updates of the national guidelines will be posted on the Ministry of Health website. If you are unsure of what version to use, please contact:

Team Leader

Communicable Diseases
Communicable Disease & Environmental Health Policy
Population Health Directorate
Ministry of Health
Ph: [phone]

1.3 Structure of the guidelines

These guidelines begin with an overview of the existing processes, and then outline what high-level changes will occur after 18 December 2007 with the move to direct laboratory notifications.
Following this overview of process changes, the guidelines focus on specific areas, including:

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  commonly asked legal questions
  
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  the set of laboratory notification flowcharts that establish the trigger points for notifying a test result
  
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  more detail on business processes
  
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  the high-level technical specifications relating to the national electronic notification system.
  

At the end of the guidelines there is a set of appendices that contain detailed technical information. There is also a companion document to these national guidelines that sets out the technical details for implementing the national electronic solution. The Electronic Notifiable Disease Messaging System (ENDMS) Implementation Guide is available on the Ministry of Health website in the publications and resources section.