title: Ebola Preparedness in the Netherlands: The Need for Coordination Between the Public Health and the Curative Sector.
abstract: 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.
authors.affiliation: 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).
authors.forename: Corien M
authors.initials: CM
authors.lastname: Swaan
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Öry
authors.forename: Lianne G C
authors.initials: LGC
authors.lastname: Schol
authors.forename: André
authors.initials: A
authors.lastname: Jacobi
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.forename: Aura
authors.initials: A
authors.lastname: Timen
mesh_terms: D000354:Africa, Western; D002959:Civil Defense / Q000379:methods / Q000592:standards*; D017144:Focus Groups; D019142:Hemorrhagic Fever, Ebola / Q000628:therapy*; D006801:Humans; D009426:Netherlands / Q000208:ethnology; D011634:Public Health / Q000379:methods / Q000592:standards*; D036301:Qualitative Research