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2.2.5: Calculate the three timeliness metrics and determine if the 7-1-7 target was met

The value of determining the dates of emergence, detection, notification, and early response completion is to calculate intervals between these events, referred to as timeliness metrics. The calculation of key timeliness metrics allows public health officials and other stakeholders to identify whether the processes for detection, notification, and early response were timely, and whether the event met the 7-1-7 target. These timeliness metrics allow for an assessment of the
performance of the systems for surveillance and early response, and for bottlenecks and enablers to be identified for future planning and action (see Steps 3 and 4).

Calculation of the 7-1-7 timeliness metrics
  1. Time to detect = Date of detection – Date of emergence [Target: 7 days]
  2. Time to notify = Date of notification – Date of detection [Target: 1 day]
  3. Time to complete early response = Date of early response completion – Date of notification [Target: 7 days]

Nipah virus in India

On Aug 29, 2021, the family of a 12-year-old boy who lived near a farm frequented by Pteropus fruit bats brought him to a local clinic in the Kozhikode district of Kerala State with a headache and low-grade fever. Over the next three days, the boy was transferred to one hospital and then another as his condition rapidly deteriorated; he developed serious symptoms including disorientation and loss of consciousness.

With four previous outbreaks of Nipah virus disease reported in India since its emergence—one of which took place in the very same district of Kozhikode, Kerala—district doctors were prepared. Although the boy was much younger than previous cases of Nipah and fell sick outside the typical season for infection, his tell-tale presentation with encephalitis and the clear reporting protocols for symptoms meant that samples were immediately sent to the National Institute of Virology in Pune for testing on Sept 3. The sample was confirmed to contain Nipah antibodies the following day. Tragically, the boy succumbed to the virus on Sept 5.

As soon as Nipah was confirmed on Sept 4, health authorities were alerted and senior health officials across local, district, state and national bodies convened in the Kozhikode district to plan and implement response measures, releasing a detailed action plan and practice manual for all stakeholders on September 5. The group would meet every day—twice a day, at first—establishing a 24-hour Emergency Operations Center in a local guesthouse where they worked together around the clock.

With the help of a multi-disciplinary team from the Indian Government’s National Centre for Disease Control, rapid and exhaustive epidemiological investigations quickly identified 240 of the index case’s contacts and other potential cases in nearby districts; officials also conducted extensive sampling and testing of the fruit bats near his home—all by Sept 6. The district had learned from previous outbreaks how important contact tracing and case investigation would be to containment efforts, as well as establishing triage centers and isolation facilities to control transmission, a field laboratory for faster test results, and risk communication activities targeting health literacy and behavior change.

The public was informed about Nipah virus transmission and prevention measures through daily press briefings and a “No Nipah” media campaign, and neighboring states were quickly alerted to the potential threat. After a conservative waiting period of 42 days with no new cases detected (twice the length of the potential incubation period of 21 days), India’s Health Minister announced the end of the outbreak on Oct 17, 2021.

  • Date of Emergence Aug 29:  The first known case developed a fever and the family sought care.
  • Date of Detection Sept 3:  The clinician determined that the patient might have Nipah virus, completed a specimen requisition form, and sent the specimen for testing.
  • Date of Notification Sept 4:  Public health officials were notified of the case.
  • Date of Early Response Completion Sept 6:  The investigation had been initiated, risk had been assessed, contacts were placed under quarantine, Nipah virus was confirmed, the public had been informed of the outbreak, and a coordination structure had been established.
  • Time to detect: “Sept 3” – “Aug 29” = 5 days
  • Time to notify: “Sept 4” – “Sept 3” = 1 day
  • Time to initiate early response: “Sept 4” – “Sept 4” = 0 days (coordination initiated on the same day as notification)
  • Time to complete early response: “Sept 6” – “Sept 4” = 2 days

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