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In Italy, the current communicable disease notification system is organised as follows: in each region, Local Health Units (LHU) fill in and forward case report forms (CRF) to the Regional Health Authority, which send aggregated and individual notifications to several central-level institutions. In most regions, all data are recorded manually on hard-copy. Although most relevant data from CRFs are eventually entered into a computerised database at the National Institute of Statistics (ISTAT), the national database is only available 3–4 years later and no data-quality control is performed at that time. To improve the quality and timeliness of notification, in 1994, the Istituto Superiore di Sanità (the National Institute of Health) began to develop an experimental computerised surveillance network for communicable diseases (referred to as ‘SIMI’). Specifically, a software was created and distributed to the LHUs and the Regional Health Authorities; staff training was performed; and feedback and analyses of collected data was promoted. SIMI was evaluated in the 13 regions that were participating in 1997 (out of a total of 20 regions in Italy), using criteria commonly used for surveillance systems (i.e., completeness and coherence of data, case definitions, costs, timeliness, and feedback). SIMI was implemented at a limited cost and the data collected were observed to have had a high degree of completeness and internal consistency. The SIMI system has since been adopted for the routine notification of communicable diseases in nearly all regions. Similar evaluations will be necessary for assessing the performance of the various notification systems used across Europe and to include them in a European network. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate completeness of tuberculosis notification in Bichat Claude-Bernard University Hospital and to evaluate whether misclassification of atypical mycobacterial infection could have contributed to the inaccuracy of tuberculosis notification. Data from Microbiology Laboratory of the hospital and statutory notifications were compared. From 1 January 1994 to 31 December 1995, 299 tuberculosis cases were diagnosed in the Microbiology Laboratory and 316 cases were notified as tuberculosis. Notification rate for laboratory-documented tuberculosis was 57.5%, was significantly higher in cases with positive acid fast bacilli smear (75%) than without this feature (45%) and was similar in HIV-positive (59.4%) and HIV-negative (63.5%) patients. Among notified cases, diagnosis was established by laboratory proofs in only 54.4% and by clinical signs in 45.6%. Three cases with positive smear and culture growing atypical mycobacteria were wrongly notified. Notification of laboratory-documented tuberculosis was higher than that observed in a previous study in the same hospital, suggesting that the rise of tuberculosis incidence reported in our country could be partially artificial. Nevertheless, extent of notification remains insufficient and needs to be improved by combining microbiological data with current system of notification. [ABSTRACT FROM AUTHOR]