Web system will track outbreaks of disease

A new electronic system for reporting infectious diseases in the capital is launched by the Health Authority-Abu Dhabi.

ABU DHABI // A new electronic system for reporting infectious diseases in the capital has been launched by the Health Authority-Abu Dhabi. Officials said yesterday that the move would have a dramatic effect on tracking and managing outbreaks. After launching the e-notification system the HAAD will turn its attention to "encouraging, enabling and enforcing" stricter regulations on reporting infectious diseases. It hopes that by eliminating the paper trail it will be able to collect more accurate, real-time information and better track the spread of diseases in the emirate.

There are 53 contagious diseases on the HAAD's list and the law requires every case to be reported to the authority. Each disease has a case definition and it may be that certain diseases, depending on how contagious or dangerous they are, need to be reported when first suspected. The list includes tuberculosis, hepatitis, HIV, rabies, meningitis, measles, chickenpox and salmonella. Healthcare workers can now register cases on a web-based system rather than sending paper notification to the HAAD headquarters in Abu Dhabi city. The system will eventually be tied to the licensing of healthcare professionals to ensure they are following the rules.

Dr Oliver Harrison, the director of public health at the HAAD, said that based on international standards and the demographics of the Abu Dhabi population, the authority received notification of less than half of reportable cases. It currently receives about 1,000 notifications every month and has a response time of 24 hours, partly because the system is entirely paper-based. The turnaround time would decrease to two hours with the new system, he said.

The authority is now focusing on encouraging and enabling reporting by holding training sessions for physicians, he said. "We need the data for three reasons," Dr Harrison said. "Firstly to drive patient care. As the doctor notifies us we will provide them with feedback about how to manage the case. Secondly, we will also share appropriate anonymous data with other agencies such as education authorities if there is a threat of an outbreak in a school, or the municipality if there is a food-borne disease outbreak."

The data would also be used to drive research and policy innovation. It would be of interest on a global level because it provided a sample base of many nationalities, he added. Zaid al Siksek, the chief executive of the HAAD, said improved reporting would also shorten the response time if the authority needed to act on a notification. Dr Harrison said the UAE was exposed to a substantial risk of imported diseases by immigrant workers, who come from 161 countries.

Over time the authority will concentrate on stricter enforcement to ensure its records are accurate. It will compare its own data with international benchmarks of incident rates to look for possible gaps. "If we expect to see 2,000 cases of something and we only see 1,000, we will know something is wrong," Dr Harrison said. "We also analyse data on electronic claims submitted to insurance companies so we will know if someone is being treated for a reportable infectious disease but has not reported it to us."

Then it became "either a fraudulent claim or a failure to notify". He added that the authority would not withdraw a licence based on one case but it had the "regulatory authority" to call an organisation to account for not complying with the regulations. The new system was piloted in three hospitals in the emirate: Tawam Hospital in Al Ain, Sheikh Khalifa Medical City and Lifeline Hospital in Abu Dhabi city.

Dr Riad Abdelkarim, the director of medical affairs at Tawam, said he thought the under-reporting of infectious diseases was linked to heavy workloads and a lack of awareness. "With education and awareness there will be a gradual increase in utilisation. Part of it is getting people educated to the point where they realise the potential for tremendous community benefits from the information," he said.

Dr Rayhan Hashmey, the chief of infectious diseases and the chairman of the infection control committee at the hospital, said increased and improved reporting could also have a big impact on the way the UAE handled infectious disease cases. "When you don't have information, the easiest thing to do is to think 'we are going to deport everybody'. Maybe now the UAE can make more evidence-based and informed decisions. Maybe this could lead to a review of the policy."

Everyone seeking residence in the UAE must undergo a medical examination in which they will be screened for HIV and tuberculosis. Positive results lead to immediate deportation. Only Emiratis can be treated for these diseases. The Ministry of Health, which sets the list of deportable infectious diseases, has previously come under fire from international bodies such as the UN for its blanket rules on deportation.

In June last year the health minister at the time said the policy was under review, but he later withdrew the statement. However, "good data could make the argument that it would be better to keep these people here and treat them, rather than deporting them", Dr Hashmey said He also stressed the importance of good reporting in terms of building a comprehensive preventive medicine system in the UAE for preventive health care, so "that we know about the current states of communicable disease, particularly when it comes to things like chickenpox or typhoid".

Tuberculosis, for example, could lie dormant and would not be picked up in a chest x-ray. If symptoms develop while a person is in the UAE, it is important to be able to track and trace any potential outbreak, especially with the number of people coming from affected places, he added. [e-mail]