For these outbreaks, the duration between the first clinical appearance of BT and the first outbreak notification are presented in Figure 2 B (for cattle herds) and Figure 2 D (for sheep flocks).
For cattle during the two week periods after the first BT notifications, no significant spatial difference between the first clinical appearance of BT and the first outbreak notification was observed in the eastern part of the province of Liège (Welch' test; P>0.50); which means the difference is about 10 days in all parts of the area under consideration.
The second was the duration between the first clinical appearance of BT and the first outbreak notification to the authorities and the third was the spatio-temporal distribution of quantification cycle (Cq) values of the RTqPCRs performed in cattle during the two week periods after the first BT notifications (N = 32).
In December 2006, after the outbreak, notification criteria were changed to include all D+HUS cases, based solely on clinical presentation.
In the participating hospital, outbreak notification thresholds for C. difficile are employed and consist of the following [ 10]: For units with ≥ 20 beds: 3 cases of CDI identified on one unit within a 7 day period or 5 cases within a 4 week period.
Although legally not considered an outbreak, single case notifications of rare diseases with strong public health implications (e.g., anthrax) will of course be captured through the SurvNet system as single case records and will result in immediate investigation and action by local authorities.
Prior to the implementation of control measures we obtained estimates of 1.1 (95% CI 0.9 1.5) in the Gelderse Vallei and 1.9, (95% CI 1.0 3.0) in Limburg which are significantly lower than those previously reported for the same outbreak prior to notification (6.5 (95% CI 3.1 9.9) for the epidemic in the Gelderse Vallei).
Prior to the Norwegian outbreak in 2006, notification was only required for HUS cases with laboratory-confirmed STEC infection.
The results confirmed many of the epidemiological features of this outbreak as shown by notification and hospitalisation data.
Outbreaks detected through informal notifications appeared to feature the longest detection delays.
Outbreaks resulting in notification were restricted to households or community settings [ 8].
