Changes in the statutory notification system for communicable
disease in Norway
A new, revised statutory notification system came into
force in Norway on 1 July 2003 (1). This is the third major revision since
the Norwegian Surveillance System for Communicable Diseases (Meldingssystem
for smittsomme sykdommer, MSIS) was implemented nationwide in 1975. The notification
system is administered by the Department of Infectious Disease Epidemiology
at the Norwegian Institute of Public Health (Nasjonalt folkehelseinstitutt,
NIPH) in Oslo.
The reason for this latest revision was the introduction of the new Health
Register Act of 2001(2), which made it necessary to base the statutory notification
system on this Act and not as previously on the Communicable Disease Control
Act of 1994. The other registers covered by the new Health Register Act
are the Medical Birth Register, the Death Register, the Vaccination Register,
and the Cancer Register. The Central Tuberculosis Register was established
in 1964 and has, mostly for historical reasons, until recently been a separate
body outside the NIPH. As a consequence of the Government Health Authorities
reorganisation in 2002, the National Tuberculosis Register is now a part
of NIPH and is administrated by the Department of Infectious Disease Epidemiology.
A separate Tuberculosis Register has, however, been retained within the
new statutory notification system.
The new statutory notification system is based on the traditional reporting
of selected notifiable diseases. As a supplement to this reporting and as
a response to new challenges in infectious disease control, a whole range
of early warning systems has been introduced in the new legislation. This
constitutes a major change from the old system.
Reporting of notifiable diseases
The number of notifiable disease has now been reduced from 68 to 58. Infections
such as amoebic dysentery, HTLV-infections, hepatitis D and E, and rare
sexually transmitted infections (STIs) such as chancroid and lymphogranuloma
are among the infections that are no longer notifiable. New notifiable diseases
are echinococcosis, severe acute respiratory syndrome (SARS), and smallpox.
Echinococcosis has been included as a result of recent findings of Echinococcus
multilocularis in mice, polar foxes, and domestic cats and dogs on
Svalbard archipelago outside mainland Norway (3).
The notifiable diseases are now divided into three main categories: group
A covers most of the infections; group B covers HIV infection, gonorrhoea,
and syphilis; and group C covers influenza and genital chlamydial infections.
Group A and group B diseases are notified, case by case, by both clinicians
and laboratories, while group C diseases are reported as aggregated data
from laboratories (chlamydia) and as sentinel data from selected clinicians
(influenza). Group A diseases are reported with full patient identification,
while the STIs in group B are reported anonymously using a non-unique identifier
linking reports from clinicians and laboratories. At the moment, all notifications
are sent by ordinary post, but it is hoped that electronic reporting from
laboratories will be introduced before the end of 2003. All doctors and
all the laboratories in the country are obliged to report notifiable diseases.
Case definitions are in use for all notifiable diseases and will soon be
revised to comply with common European case definitions (4).
Patient consent is not necessary for reporting a notifiable disease, but
the reporting clinicians are obliged to inform the patient of the reporting
system and what the data will be used for. The patient also has the right
to be given information on the use of his/her own data in the register.
Early warning systems
Early warning is defined in the new legislation as immediate reporting (usually
by telephone) to local, regional, or central health authorities on clinical
suspicion of a number of selected diseases, outbreaks, etc. In the following
situations, health personnel are obliged to give such an early warning:
||A suspected or confirmed case of selected notifiable diseases. The
Department of Health can at any time decide which diseases should be
included. From July 2003 the following diseases are included; anthrax,
botulism, cholera, diphtheria, epidemic typhus, haemorrhagic fevers,
legionellosis, measles, meningococcal disease, plague, poliomyelitis,
rabies, rubella, SARS, smallpox, and trichinosis. In addition to
giving an early warning, the clinician also must report the infection
in the ordinary way as a notifiable disease. The clinician, nurse, or
midwife must inform the local health authorities in the municipality,
which in turn has to inform the Department of Infectious Disease Epidemiology
at the NIPH and regional health authorities. A special 24 hour telephone
hotline has been set up at the NIPH.
|| Suspected or confirmed outbreak of a notifiable disease,
all food- and waterborne outbreaks or other serious outbreaks of a communicable
|| Suspected or confirmed outbreak in a health institution regardless
of causative organism.
|| A suspected or confirmed case of transmission through food or water
|| A suspected or confirmed case of transmission from live animals
||A suspected or confirmed case of transmission through medical equipment,
cosmetics, medical products, blood or blood products
|| Suspected or confirmed deliberate release of an infectious disease
|| Laboratories and clinicians diagnosing an infection in a blood donor
that can be transmitted by blood or blood products must inform the local
blood transfusion services.
||Clinicians in health institutions responsible for transferring a patient
with certain infections, for example methicillin resistant Staphylococcus
aureus, to another health institution should inform that institution.