{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:11:30Z","timestamp":1789017090132,"version":"build-2803163510"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T00:00:00Z","timestamp":1575331200000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Norway, Legionnaires\u2019 disease is reportable upon clinical suspicion to public health authorities and mandatorily notifiable through the Norwegian surveillance system for communicable diseases (MSIS) for both clinicians and laboratories. In the summer of 2017, several European countries reported high notification rates for Legionnaires\u2019 disease, which was not observed in Norway. We evaluated MSIS to assess if it meets its objectives of detecting cases and trends in incidence of Legionnaires\u2019 disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrieved MSIS data from 2008 to 2017 and calculated timeliness as days from sampling to notification, and internal completeness for key variables as the proportion of observations with a value. Where possible, we assessed internal validity on the presence of a plausible value. To estimate external completeness and validity we linked MSIS with hospital reimbursement claims in the Norwegian Patient Registry. To assess acceptability and representativeness, we surveyed doctors in 39 hospitals on their units\u2019 diagnostic and notification procedures, and their use of MSIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 438 notified cases. Internal completeness and internal validity were high for key variables (\u226595%). The median delay from sampling to notification was 4\u2009days.<\/jats:p>\n                    <jats:p>There were 73 patients in MSIS only, 70 in the Norwegian Patient Registry only, and 351 in both registers. The external completeness of MSIS was 83% (95% CI 80\u201386%). For external validity, the positive predictive value of MSIS was 83% (95% CI 79\u201386%).<\/jats:p>\n                    <jats:p>Forty-seven respondents from 28 hospitals described testing procedures. These were inconsistent: 29 (62%) reported no systematic application of criteria for requesting legionella testing. Eighteen (38%) reported testing all patients with suspected pneumonia and a travel history. Thirty-one (66%) found the notification criteria clear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results suggest that the surveillance in MSIS can detect incidence changes for Legionnaires\u2019 disease over time, by place and person, but likely does not detect every case diagnosed in Norway.<\/jats:p>\n                    <jats:p>We recommend wider investigation of diagnostic procedures in order to improve representativeness and awareness of MSIS notification criteria among clinicians in order to improve acceptability of the surveillance. We also recommend a more comprehensive assessment of whether patients only registered in the Norwegian Patient Registry were true Legionnaires\u2019 disease cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-019-7981-9","type":"journal-article","created":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T05:00:01Z","timestamp":1576472401000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Evaluation of the national surveillance of Legionnaires' disease in Norway, 2008-2017"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8661-901X","authenticated-orcid":false,"given":"Cecilia","family":"Wolff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siri","family":"Feruglio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Line","family":"Vold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,3]]},"reference":[{"issue":"10016","key":"7981_CR1","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/S0140-6736(15)60078-2","volume":"387","author":"BA Cunha","year":"2016","unstructured":"Cunha BA, Burillo A, Bouza E. Legionnaires' disease. Lancet. 2016;387(10016):376\u201385.","journal-title":"Lancet"},{"issue":"8","key":"7981_CR2","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1017\/S0950268811000975","volume":"140","author":"FF Graham","year":"2012","unstructured":"Graham FF, White PS, Harte DJG, Kingham SP. Changing epidemiological trends of legionellosis in New Zealand, 1979-2009. Epidemiol Infect. 2012;140(8):1481\u201396.","journal-title":"Epidemiol Infect"},{"issue":"10","key":"7981_CR3","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1016\/S1473-3099(14)70713-3","volume":"14","author":"N Phin","year":"2014","unstructured":"Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K, et al. Epidemiology and clinical management of Legionnaires' disease. Lancet Infect Dis. 2014;14(10):1011\u201321.","journal-title":"Lancet Infect Dis"},{"key":"7981_CR4","unstructured":"WHO. Legionellosis fact sheet 2018. https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/legionellosis. Accessed 12 July 2019."},{"issue":"3","key":"7981_CR5","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1128\/CMR.15.3.506-526.2002","volume":"15","author":"BS Fields","year":"2002","unstructured":"Fields BS, Benson RF, Besser RE. Legionella and legionnaires\u2019 disease: 25 years of investigation. Clin Microbiol Rev. 2002;15(3):506.","journal-title":"Clin Microbiol Rev"},{"key":"7981_CR6","doi-asserted-by":"crossref","unstructured":"Jespersen S, Sogaard OS, Schonheyder HC, Fine MJ, Ostergaard L. Clinical features and predictors of mortality in admitted patients with community- and hospital-acquired legionellosis: a Danish historical cohort study. BMC Infect Dis. 2010;10.","DOI":"10.1186\/1471-2334-10-124"},{"issue":"1","key":"7981_CR7","first-page":"49","volume":"56","author":"TW Steele","year":"1990","unstructured":"Steele TW, Lanser J, Sangster N. 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Provision for compilation of data from MSIS and NPR for the purposes of quality control can be found in the MSIS Regulations (Section 8, \u00a72\u20136, second paragraph) and the Norwegian Patient Register Regulations (\u00a72\u20134, first paragraph and \u00a73\u20131, 2nd paragraph). Participation in the survey of clinicians was voluntary and submission of the completed questionnaire was considered consent to participate. The confidentiality of participant identity was maintained and all data was aggregated to ensure the responses from specific hospitals could not be identified.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1624"}}