During an infectious disease crisis, it is important to implement appropriate measures in good time. The mayor, chair of the security region, or government minister is responsible for deciding that. The medical specialists in infectious disease control at the Municipal Public Health Services (GGDs) and the National Institute of Public Health and the Environment (RIVM) advise these decision-makers about possible measures. Advisory opinions based on the latest professional knowledge in medicine and epidemiology are urgently needed in this context. The Centre for Infectious Disease Control plays a key role in compiling relevant knowledge. To streamline this process, the CIb has a structure for scaling up response. 

Weekly meeting to identify signals

The CIb receives daily reports from Municipal Public Health Services (GGDs) and hospitals throughout the Netherlands about which infectious diseases are observed there. Doctors and researchers at the CIb discuss these reports in a weekly meeting to identify signals of a possible outbreak. In that context, they also review which infectious diseases are currently circulating in the Netherlands and elsewhere. Sometimes signals of infectious disease are identified that require more information to assess the situation and monitor developments or take appropriate measures. In such cases, a coordination meeting is held or a response team is formed.

Coordination meeting

At a coordination meeting, experts from within RIVM discuss a specific infectious disease and how it spreads. These meetings are sometimes also attended by doctors from a Municipal Public Health Service (GGD), or other experts. Coordination meetings often take place in a series of several gatherings. This allows experts to closely monitor an outbreak over time. In addition, research is sometimes initiated to gather additional information about the disease and the outbreak. If necessary to gain a better overview of the situation or coordinate measures, the CIb may organise a response team.

Response team

A response team is formed in the event of a current or impending outbreak of an infectious disease that requires national coordination.  This often applies if there is an outbreak in more than one region of the Netherlands. In such situations, it is important to achieve central coordination with the various parties involved. A response team includes doctors and researchers from RIVM, as well as external experts. The team members from outside RIVM are generally professionals from the Municipal Public Health Services (GGDs) in the affected regions or doctors or researchers from universities, academic medical centres or hospitals. The response team assesses the severity of the outbreak and determines the need for additional measures. In addition to informing the parties involved and arranging harmonisation between them, the response team also coordinates control efforts. A response team may be convened only once or on multiple occasions, depending on the severity and scope of an outbreak.

Outbreak Management Team

In exceptional cases, the Centre for Infectious Disease Control will convene an Outbreak Management Team (OMT).

An OMT is generally convened in response to an impending crisis that could potentially have severe consequences. This often happens after a signal indicating an outbreak has been provided by a coordination meeting or response team. The OMT consists of experts from RIVM as well as from hospitals and academic centres or other relevant institutions. The director of the CIb convenes the OMT and invites experts to join based on their expertise and knowledge of the infectious disease. Through the Administrative Coordination Consultation (BAO), the OMT advises the Minister of Health, Welfare and Sport (VWS) about measures to curb or control the spread of infectious diseases. The Health Minister can also request an OMT. An OMT generally only meets once or twice.

Council of experts

A council of experts is usually consulted for situations that are not immediately urgent. This happens at times when there is a need for an advisory opinion from experts based on current developments in the field of infectious disease. Consulting a council of experts offers a space for pooling new, topical scientific knowledge about a specific topic and compiling current or new research questions. Sometimes a council of experts may be consulted for advisory opinions on preventing the spread of specific diseases. The Centre for Infectious Disease Control, government ministries or other experts may request an advisory opinion.

Outbreaks of zoonotic diseases

In the event of outbreaks of zoonoses – diseases that can be transmitted from animals to people – it may be necessary to implement measures for humans and for animals. In addition to the CIb structure for scaling up responses to infectious disease outbreaks among humans, a similar structure is in place for zoonotic diseases. The zoonotic response structure consists of a signalling meeting, a coordination meeting, a zoonosis response team, a council of experts on zoonotic diseases, and an outbreak management team for zoonotic diseases. The approach is identical to the structure used for infectious diseases in humans, but additional experts are invited from the fields of veterinary medicine and animal health.

Measures applicable to animals

The legal framework for infectious disease control to protect public health is laid down in the Public Health Act (Wet Publieke Gezondheid - WPG). Measures applicable to animals can be implemented on the basis of the Animal Health and Welfare Act (Gezondheids- en welzijnswet voor dieren - GWWD). The Minister of Health, Welfare and Sport (VWS) and the Minister of Agriculture, Nature and Food Quality take joint action in response to outbreaks of zoonoses (diseases that can be transmitted to humans from animals).