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Russcher A, van Boven M, Benincà E, Verweij EJTJ, Molenaar-de Backer MWA, Zaaijer HL, Vossen ACTM, Kroes ACM. Changing epidemiology of parvovirus B19 in the Netherlands since 1990, including its re-emergence after the COVID-19 pandemic. Sci Rep 2024; 14:9630. [PMID: 38671058 PMCID: PMC11053065 DOI: 10.1038/s41598-024-59582-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Parvovirus B19V (B19V) infection during pregnancy can be complicated by potentially life-threatening fetal hydrops, which can be managed by intrauterine transfusion (IUT). This study investigates the long-term temporal patterns in the epidemiology of B19V and evaluates the impact on fetal hydrops, by combining data on B19V infections from the Dutch Sentinel Surveillance system in the period 1990 to 2023, Dutch blood banking data and hospital data on fetal hydrops. Using wavelet analysis, we identified annual epidemic cycles in the Netherlands in the period 1990-2019 and we identified superimposed multiannual cycles in the period 1990-2009. After 2009, no multiannual cycle could be identified, although the incidence fluctuated and correlates with number of IUT performed. As of 2020, weekly reports of B19V infection demonstrated a historically low incidence and B19V-DNA positive blood donors were nearly absent. From May 2020 to May 2023, no IUT for B19V-related hydrops was performed. In the spring of 2023, B19V infections re-emerged, reaching pre-pandemic epidemic levels. Due to the changes in B19V epidemiology over the last 30 years and the near-absence of B19V during the COVID-19 pandemic, the resulting low immunity levels may lead to rebound outbreaks. Alertness to severe complications such as fetal hydrops is warranted.
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Affiliation(s)
- Anne Russcher
- LUCID Medical Microbiology and Infection Control, Leiden University Medical Center, Leiden, The Netherlands.
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisa Benincà
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - E J T Joanne Verweij
- Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijke W A Molenaar-de Backer
- Department of Blood-Borne Infections, Donor Medicine Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Blood-Borne Infections, Donor Medicine Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Ann C T M Vossen
- LUCID Medical Microbiology and Infection Control, Leiden University Medical Center, Leiden, The Netherlands
| | - Aloys C M Kroes
- LUCID Medical Microbiology and Infection Control, Leiden University Medical Center, Leiden, The Netherlands
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van Boven M, Backer JA, Veldhuijzen I, Gomme J, van Binnendijk R, Kaaijk P. Estimation of the infection attack rate of mumps in an outbreak among college students using paired serology. Epidemics 2024; 46:100751. [PMID: 38442537 DOI: 10.1016/j.epidem.2024.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/07/2023] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Mumps virus is a highly transmissible pathogen that is effectively controlled in countries with high vaccination coverage. Nevertheless, outbreaks have occurred worldwide over the past decades in vaccinated populations. Here we analyse an outbreak of mumps virus genotype G among college students in the Netherlands over the period 2009-2012 using paired serological data. To identify infections in the presence of preexisting antibodies we compared mumps specific serum IgG concentrations in two consecutive samples (n=746), whereby the first sample was taken when students started their study prior to the outbreaks, and the second sample was taken 2-5 years later. We fit a binary mixture model to the data. The two mixing distributions represent uninfected and infected classes. Throughout we assume that the infection probability increases with the ratio of antibody concentrations of the second to first sample. The estimated infection attack rate in this study is higher than reported earlier (0.095 versus 0.042). The analyses yield probabilistic classifications of participants, which are mostly quite precise owing to the high intraclass correlation of samples in uninfected participants (0.85, 95%CrI: 0.82-0.87). The estimated probability of infection increases with decreasing antibody concentration in the pre-outbreak sample, such that the probability of infection is 0.12 (95%CrI: 0.10-0.13) for the lowest quartile of the pre-outbreak samples and 0.056 (95%CrI: 0.044-0.068) for the highest quartile. We discuss the implications of these insights for the design of booster vaccination strategies.
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Affiliation(s)
- Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Jantien A Backer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Irene Veldhuijzen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Justin Gomme
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium; NHS Scotland, Edinburgh, Scotland, United Kingdom
| | - Rob van Binnendijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Patricia Kaaijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Deng S, Guo L, Cohen C, Meijer A, Moyes J, Pasittungkul S, Poovorawan Y, Teirlinck A, van Boven M, Wanlapakorn N, Wolter N, Paget J, Nair H, Li Y. Impact of Subgroup Distribution on Seasonality of Human Respiratory Syncytial Virus: A Global Systematic Analysis. J Infect Dis 2024; 229:S25-S33. [PMID: 37249267 DOI: 10.1093/infdis/jiad192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Previous studies reported inconsistent findings regarding the association between respiratory syncytial virus (RSV) subgroup distribution and timing of RSV season. We aimed to further understand the association by conducting a global-level systematic analysis. METHODS We compiled published data on RSV seasonality through a systematic literature review, and unpublished data shared by international collaborators. Using annual cumulative proportion (ACP) of RSV-positive cases, we defined RSV season onset and offset as ACP reaching 10% and 90%, respectively. Linear regression models accounting for meteorological factors were constructed to analyze the association of proportion of RSV-A with the corresponding RSV season onset and offset. RESULTS We included 36 study sites from 20 countries, providing data for 179 study-years in 1995-2019. Globally, RSV subgroup distribution was not significantly associated with RSV season onset or offset globally, except for RSV season offset in the tropics in 1 model, possibly by chance. Models that included RSV subgroup distribution and meteorological factors explained only 2%-4% of the variations in timing of RSV season. CONCLUSIONS Year-on-year variations in RSV season onset and offset are not well explained by RSV subgroup distribution or meteorological factors. Factors including population susceptibility, mobility, and viral interference should be examined in future studies.
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Affiliation(s)
- Shuyu Deng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ling Guo
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam Meijer
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Siripat Pasittungkul
- Centre of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Centre of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anne Teirlinck
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Michiel van Boven
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Nasamon Wanlapakorn
- Centre of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John Paget
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - You Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Hetebrij WA, de Roda Husman AM, Nagelkerke E, van der Beek RFHJ, van Iersel SCJL, Breuning TGV, Lodder WJ, van Boven M. Inferring hospital admissions from SARS-CoV-2 virus loads in wastewater in The Netherlands, August 2020 - February 2022. Sci Total Environ 2024; 912:168703. [PMID: 37992845 DOI: 10.1016/j.scitotenv.2023.168703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/15/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
Wastewater-based surveillance enables tracking of SARS-CoV-2 circulation at a local scale in near-real time. Here we investigate the relation between virus loads and the number of hospital admissions in the Netherlands. Inferred virus loads from August 2020 until February 2022 in each of the 344 Dutch municipalities are analysed in a Bayesian multilevel Poisson regression to relate virus loads to daily age-stratified (in groups of 20 years) hospital admissions. Covariates include municipal vaccination coverages stratified by age and dose (first, second, and booster) and prevalence of the circulating coronavirus variants (wildtype, Alpha, Delta, and Omicron (BA.1 and BA.2)). Our model captures the relation between hospital admissions and virus loads well. Estimated hospitalisation rates per 1,000,000 persons per day at a virus load of 1013 particles range from 0.18 (95 % Prediction Interval (PI): 0.046-0.48) in children (0-19 years) to 20.1 (95 % PI: 9.46-36.8) in the oldest age group (80 years and older) in an unvaccinated population with only wildtype SARS-CoV-2 circulation. The analyses indicate a nearly twofold (1.92 (95 % PI: 1.78-2.05)) decrease in the expected number of hospitalisations at a given virus load between the Alpha and the Omicron variant. Our analyses show that virus load estimates in wastewater are closely related to the expected number of hospitalisations and provide an attractive tool to detect increased SARS-CoV-2 circulation at a local scale, even when there are few hospital admissions. Our analyses enable integration of data at the municipality level into meaningful conversion rates to translate virus loads at a local level into expected numbers of hospital admissions, which would allow for a better interpretation of virus loads detected in wastewater.
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Affiliation(s)
- Wouter A Hetebrij
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Ana Maria de Roda Husman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Erwin Nagelkerke
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Rudolf F H J van der Beek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Senna C J L van Iersel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Titus G V Breuning
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Willemijn J Lodder
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Miyazawa S, Wong TS, Ito G, Iwamoto R, Watanabe K, van Boven M, Wallinga J, Miura F. Wastewater-based reproduction numbers and projections of COVID-19 cases in three areas in Japan, November 2021 to December 2022. Euro Surveill 2024; 29:2300277. [PMID: 38390648 PMCID: PMC10899819 DOI: 10.2807/1560-7917.es.2024.29.8.2300277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/20/2023] [Indexed: 02/24/2024] Open
Abstract
BackgroundWastewater surveillance has expanded globally as a means to monitor spread of infectious diseases. An inherent challenge is substantial noise and bias in wastewater data because of the sampling and quantification process, limiting the applicability of wastewater surveillance as a monitoring tool.AimTo present an analytical framework for capturing the growth trend of circulating infections from wastewater data and conducting scenario analyses to guide policy decisions.MethodsWe developed a mathematical model for translating the observed SARS-CoV-2 viral load in wastewater into effective reproduction numbers. We used an extended Kalman filter to infer underlying transmissions by smoothing out observational noise. We also illustrated the impact of different countermeasures such as expanded vaccinations and non-pharmaceutical interventions on the projected number of cases using three study areas in Japan during 2021-22 as an example.ResultsObserved notified cases were matched with the range of cases estimated by our approach with wastewater data only, across different study areas and virus quantification methods, especially when the disease prevalence was high. Estimated reproduction numbers derived from wastewater data were consistent with notification-based reproduction numbers. Our projections showed that a 10-20% increase in vaccination coverage or a 10% reduction in contact rate may suffice to initiate a declining trend in study areas.ConclusionOur study demonstrates how wastewater data can be used to track reproduction numbers and perform scenario modelling to inform policy decisions. The proposed framework complements conventional clinical surveillance, especially when reliable and timely epidemiological data are not available.
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Affiliation(s)
- Shogo Miyazawa
- Data Science Department, Shionogi and Co, Ltd, Osaka, Japan
| | - Ting Sam Wong
- SHIMADZU Corporation, Kyoto, Japan
- AdvanSentinel Inc., Osaka, Japan
| | - Genta Ito
- Data Science Department, Shionogi and Co, Ltd, Osaka, Japan
| | - Ryo Iwamoto
- Integrated Disease Care Division, Shionogi and Co, Ltd, Osaka, Japan
- Data Science Department, Shionogi and Co, Ltd, Osaka, Japan
| | - Kozo Watanabe
- Center for Marine Environmental Studies (CMES), Ehime University, Ehime, Japan
| | - Michiel van Boven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jacco Wallinga
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Fuminari Miura
- Center for Marine Environmental Studies (CMES), Ehime University, Ehime, Japan
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van Boven M, van Dorp CH, Westerhof I, Jaddoe V, Heuvelman V, Duijts L, Fourie E, Sluiter-Post J, van Houten MA, Badoux P, Euser S, Herpers B, Eggink D, de Hoog M, Boom T, Wildenbeest J, Bont L, Rozhnova G, Bonten MJ, Kretzschmar ME, Bruijning-Verhagen P. Estimation of introduction and transmission rates of SARS-CoV-2 in a prospective household study. PLoS Comput Biol 2024; 20:e1011832. [PMID: 38285727 PMCID: PMC10852262 DOI: 10.1371/journal.pcbi.1011832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/08/2024] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
Household studies provide an efficient means to study transmission of infectious diseases, enabling estimation of susceptibility and infectivity by person-type. A main inclusion criterion in such studies is usually the presence of an infected person. This precludes estimation of the hazards of pathogen introduction into the household. Here we estimate age- and time-dependent household introduction hazards together with within household transmission rates using data from a prospective household-based study in the Netherlands. A total of 307 households containing 1,209 persons were included from August 2020 until March 2021. Follow-up of households took place between August 2020 and August 2021 with maximal follow-up per household mostly limited to 161 days. Almost 1 out of 5 households (59/307) had evidence of an introduction of SARS-CoV-2. We estimate introduction hazards and within-household transmission rates in our study population with penalized splines and stochastic epidemic models, respectively. The estimated hazard of introduction of SARS-CoV-2 in the households was lower for children (0-12 years) than for adults (relative hazard: 0.62; 95%CrI: 0.34-1.0). Estimated introduction hazards peaked in mid October 2020, mid December 2020, and mid April 2021, preceding peaks in hospital admissions by 1-2 weeks. Best fitting transmission models included increased infectivity of children relative to adults and adolescents, such that the estimated child-to-child transmission probability (0.62; 95%CrI: 0.40-0.81) was considerably higher than the adult-to-adult transmission probability (0.12; 95%CrI: 0.057-0.19). Scenario analyses indicate that vaccination of adults can strongly reduce household infection attack rates and that adding adolescent vaccination offers limited added benefit.
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Affiliation(s)
- Michiel van Boven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
| | - Christiaan H. van Dorp
- Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, United States of America
| | - Ilse Westerhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | | | | | | | | | - Paul Badoux
- Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Sjoerd Euser
- Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Bjorn Herpers
- Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Dirk Eggink
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marieke de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Trisja Boom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joanne Wildenbeest
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s hospital, University Medical Center Utrecht, the Netherlands
| | - Louis Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s hospital, University Medical Center Utrecht, the Netherlands
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
- BioISI—Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Marc J. Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mirjam E. Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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7
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Osei-Yeboah R, Spreeuwenberg P, Del Riccio M, Fischer TK, Egeskov-Cavling AM, Bøås H, van Boven M, Wang X, Lehtonen T, Bangert M, Campbell H, Paget J. Estimation of the Number of Respiratory Syncytial Virus-Associated Hospitalizations in Adults in the European Union. J Infect Dis 2023; 228:1539-1548. [PMID: 37246742 PMCID: PMC10681866 DOI: 10.1093/infdis/jiad189] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in adults that can result in hospitalizations. Estimating RSV-associated hospitalization is critical for planning RSV-related healthcare across Europe. METHODS We gathered RSV-associated hospitalization estimates from the RSV Consortium in Europe (RESCEU) for adults in Denmark, England, Finland, Norway, Netherlands, and Scotland from 2006 to 2017. We extrapolated these estimates to 28 European Union (EU) countries using nearest-neighbor matching, multiple imputations, and 2 sets of 10 indicators. RESULTS On average, 158 229 (95% confidence interval [CI], 140 865-175 592) RSV-associated hospitalizations occur annually among adults in the EU (≥18 years); 92% of these hospitalizations occur in adults ≥65 years. Among 75-84 years, the annual average is estimated at 74 519 (95% CI, 69 923-79 115) at a rate of 2.24 (95% CI, 2.10-2.38) per 1000. Among ≥85 years, the annual average is estimated at 37 904 (95% CI, 32 444-43 363) at a rate of 2.99 (95% CI, 2.56-3.42). CONCLUSIONS Our estimates of RSV-associated hospitalizations in adults are the first analysis integrating available data to provide the disease burden across the EU. Importantly, for a condition considered in the past to be primarily a disease of young children, the average annual hospitalization estimate in adults was lower but of a similar magnitude to the estimate in young children (0-4 years): 158 229 (95% CI, 140 865-175 592) versus 245 244 (95% CI, 224 688-265 799).
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Affiliation(s)
- Richard Osei-Yeboah
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Marco Del Riccio
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Postgraduate Medical School in Public Health, University of Florence, Italy
| | - Thea K Fischer
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed and Public Health, University of Copenhagen, Denmark
| | - Amanda Marie Egeskov-Cavling
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed and Public Health, University of Copenhagen, Denmark
| | - Håkon Bøås
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Xin Wang
- School of Public Health, Nanjing Medical University, China
| | - Toni Lehtonen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki
| | | | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, United Kingdom
| | - John Paget
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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8
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Boppana SB, van Boven M, Britt WJ, Gantt S, Griffiths PD, Grosse SD, Hyde TB, Lanzieri TM, Mussi-Pinhata MM, Pallas SE, Pinninti SG, Rawlinson WD, Ross SA, Vossen ACTM, Fowler KB. Vaccine value profile for cytomegalovirus. Vaccine 2023; 41 Suppl 2:S53-S75. [PMID: 37806805 DOI: 10.1016/j.vaccine.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/28/2023] [Accepted: 06/02/2023] [Indexed: 10/10/2023]
Abstract
Cytomegalovirus (CMV) is the most common infectious cause of congenital malformation and a leading cause of developmental disabilities such as sensorineural hearing loss (SNHL), motor and cognitive deficits. The significant disease burden from congenital CMV infection (cCMV) led the US National Institute of Medicine to rank CMV vaccine development as the highest priority. An average of 6.7/1000 live births are affected by cCMV, but the prevalence varies across and within countries. In contrast to other congenital infections such as rubella and toxoplasmosis, the prevalence of cCMV increases with CMV seroprevalence rates in the population. The true global burden of cCMV disease is likely underestimated because most infected infants (85-90 %) have asymptomatic infection and are not identified. However, about 7-11 % of those with asymptomatic infection will develop SNHL throughout early childhood. Although no licensed CMV vaccine exists, several candidate vaccines are in development, including one currently in phase 3 trials. Licensure of one or more vaccine candidates is feasible within the next five years. Various models of CMV vaccine strategies employing different target populations have shown to provide substantial benefit in reducing cCMV. Although CMV can cause end-organ disease with significant morbidity and mortality in immunocompromised individuals, the focus of this vaccine value profile (VVP) is on preventing or reducing the cCMV disease burden. This CMV VVP provides a high-level, comprehensive assessment of the currently available data to inform the potential public health, economic, and societal value of CMV vaccines. The CMV VVP was developed by a working group of subject matter experts from academia, public health groups, policy organizations, and non-profit organizations. All contributors have extensive expertise on various elements of the CMV VVP and have described the state of knowledge and identified the current gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Suresh B Boppana
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, and Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - William J Britt
- Departments of Pediatrics, Microbiology, and Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, USA
| | - Soren Gantt
- Centre de recherche du CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Paul D Griffiths
- Emeritus Professor of Virology, University College London, United Kingdom
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tatiana M Lanzieri
- Measles, Rubella, and Cytomegalovirus Epidemiology Team, Viral Vaccine Preventable Diseases Branch / Division of Viral Diseases. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Sarah E Pallas
- Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Swetha G Pinninti
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William D Rawlinson
- Serology and Virology Division, NSW Health Pathology Randwick, Prince of Wales Hospital, Sydney, Australia; School of Biotechnology and Biomolecular Sciences, and School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Shannon A Ross
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Karen B Fowler
- Departments of Pediatrics and Epidemiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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9
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van Boven M, van Dorp CH, Westerhof I, Jaddoe V, Heuvelman V, Duijts L, Fourie E, Sluiter-Post J, van Houten MA, Badoux P, Euser S, Herpers B, Eggink D, de Hoog M, Boom T, Wildenbeest J, Bont L, Rozhnov G, Bonten MJ, Kretzschmar ME, Bruijning-Verhagen P. Estimation of introduction and transmission rates of SARS-CoV-2 in a prospective household study. medRxiv 2023:2023.06.02.23290879. [PMID: 37333399 PMCID: PMC10275010 DOI: 10.1101/2023.06.02.23290879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Household studies provide an efficient means to study transmission of infectious diseases, enabling estimation of individual susceptibility and infectivity. A main inclusion criterion in such studies is often the presence of an infected person. This precludes estimation of the hazards of pathogen introduction into the household. Here we use data from a prospective household-based study to estimate SARS-CoV-2 age- and time-dependent household introduction hazards together with within household transmission rates in the Netherlands from August 2020 to August 2021. Introduction hazards and within-household transmission rates are estimated with penalized splines and stochastic epidemic models, respectively. The estimated hazard of introduction of SARS-CoV-2 in the households was lower for children (0-12 years) than for adults (relative hazard: 0.62; 95%CrI: 0.34-1.0). Estimated introduction hazards peaked in mid October 2020, mid December 2020, and mid April 2021, preceding peaks in hospital admissions by 1-2 weeks. The best fitting transmission models include increased infectivity of children relative to adults and adolescents, such that the estimated child-to-child transmission probability (0.62; 95%CrI: 0.40-0.81) was considerably higher than the adult-to-adult transmission probability (0.12; 95%CrI: 0.057-0.19). Scenario analyses show that vaccination of adults could have strongly reduced infection attack rates in households and that adding adolescent vaccination would have offered limited added benefit.
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Affiliation(s)
- Michiel van Boven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
| | - Christiaan H van Dorp
- Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, United States
| | - Ilse Westerhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | | | | | | | | | - Paul Badoux
- Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Sjoerd Euser
- Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Bjorn Herpers
- Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Dirk Eggink
- National Institute for Public Health, and the Environment, Bilthoven, the Netherlands
| | - Marieke de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Trisja Boom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joanne Wildenbeest
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's hospital, University Medical Center Utrecht, the Netherlands
| | - Louis Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's hospital, University Medical Center Utrecht, the Netherlands
| | - Ganna Rozhnov
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
- BioISI-Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Marc J Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht, The Netherlands
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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10
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van Boven M, Hetebrij WA, Swart A, Nagelkerke E, van der Beek RF, Stouten S, Hoogeveen RT, Miura F, Kloosterman A, van der Drift AMR, Welling A, Lodder WJ, de Roda Husman AM. Patterns of SARS-CoV-2 circulation revealed by a nationwide sewage surveillance programme, the Netherlands, August 2020 to February 2022. Euro Surveill 2023; 28:2200700. [PMID: 37347416 PMCID: PMC10288829 DOI: 10.2807/1560-7917.es.2023.28.25.2200700] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/16/2023] [Indexed: 06/23/2023] Open
Abstract
BackgroundSurveillance of SARS-CoV-2 in wastewater offers a near real-time tool to track circulation of SARS-CoV-2 at a local scale. However, individual measurements of SARS-CoV-2 in sewage are noisy, inherently variable and can be left-censored.AimWe aimed to infer latent virus loads in a comprehensive sewage surveillance programme that includes all sewage treatment plants (STPs) in the Netherlands and covers 99.6% of the Dutch population.MethodsWe applied a multilevel Bayesian penalised spline model to estimate time- and STP-specific virus loads based on water flow-adjusted SARS-CoV-2 qRT-PCR data for one to four sewage samples per week for each of the more than 300 STPs.ResultsThe model captured the epidemic upsurges and downturns in the Netherlands, despite substantial day-to-day variation in the measurements. Estimated STP virus loads varied by more than two orders of magnitude, from ca 1012 virus particles per 100,000 persons per day in the epidemic trough in August 2020 to almost 1015 per 100,000 in many STPs in January 2022. The timing of epidemics at the local level was slightly shifted between STPs and municipalities, which resulted in less pronounced peaks and troughs at the national level.ConclusionAlthough substantial day-to-day variation is observed in virus load measurements, wastewater-based surveillance of SARS-CoV-2 that is performed at high sampling frequency can track long-term progression of an epidemic at a local scale in near real time.
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Affiliation(s)
- Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wouter A Hetebrij
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Arno Swart
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Erwin Nagelkerke
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Rudolf Fhj van der Beek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sjors Stouten
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Rudolf T Hoogeveen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Fuminari Miura
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Center for Marine Environmental Studies (CMES), Ehime University, Ehime, Japan
| | - Astrid Kloosterman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Centre for Environmental Safety and Security, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Anne-Merel R van der Drift
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Anne Welling
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Willemijn J Lodder
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ana Maria de Roda Husman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Institute for Risk Assessment Science (IRAS), Utrecht University, Utrecht, the Netherlands
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11
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van den Hoogen LL, Verheul MK, Vos ERA, van Hagen CCE, van Boven M, Wong D, Wijmenga-Monsuur AJ, Smits G, Kuijer M, van Rooijen D, Bogaard-van Maurik M, Zutt I, van Vliet J, Wolf J, van der Klis FRM, de Melker HE, van Binnendijk RS, den Hartog G. SARS-CoV-2 Spike S1-specific IgG kinetic profiles following mRNA or vector-based vaccination in the general Dutch population show distinct kinetics. Sci Rep 2022; 12:5935. [PMID: 35396570 PMCID: PMC8990276 DOI: 10.1038/s41598-022-10020-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/30/2022] [Indexed: 12/21/2022] Open
Abstract
mRNA- and vector-based vaccines are used at a large scale to prevent COVID-19. We compared Spike S1-specific (S1) IgG antibodies after vaccination with mRNA-based (Comirnaty, Spikevax) or vector-based (Janssen, Vaxzevria) vaccines, using samples from a Dutch nationwide cohort. In adults 18-64 years old (n = 2412), the median vaccination interval between the two doses was 77 days for Vaxzevria (interquartile range, IQR: 69-77), 35 days (28-35) for Comirnaty and 33 days (28-35) for Spikevax. mRNA vaccines induced faster inclines and higher S1 antibodies compared to vector-based vaccines. For all vaccines, one dose resulted in boosting of S1 antibodies in adults with a history of SARS-CoV-2 infection. For Comirnaty, two to four months following the second dose (n = 196), S1 antibodies in adults aged 18-64 years old (436 BAU/mL, IQR: 328-891) were less variable and median concentrations higher compared to those in persons ≥ 80 years old (366, 177-743), but differences were not statistically significant (p > 0.100). Nearly all participants seroconverted following COVID-19 vaccination, including the aging population. These data confirm results from controlled vaccine trials in a general population, including vulnerable groups.
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Affiliation(s)
- Lotus L van den Hoogen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Marije K Verheul
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Eric R A Vos
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Cheyenne C E van Hagen
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Denise Wong
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Alienke J Wijmenga-Monsuur
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Gaby Smits
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Marjan Kuijer
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Debbie van Rooijen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Marjan Bogaard-van Maurik
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Ilse Zutt
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Jeffrey van Vliet
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Janine Wolf
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Fiona R M van der Klis
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Robert S van Binnendijk
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Gerco den Hartog
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands.
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12
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van den Hoogen LL, Smits G, van Hagen CC, Wong D, Vos ER, van Boven M, de Melker HE, van Vliet J, Kuijer M, Woudstra L, Wijmenga-Monsuur AJ, GeurtsvanKessel CH, Stoof SP, Reukers D, Wijsman LA, Meijer A, Reusken CB, Rots NY, van der Klis FR, van Binnendijk RS, den Hartog G. Seropositivity to Nucleoprotein to detect mild and asymptomatic SARS-CoV-2 infections: A complementary tool to detect breakthrough infections after COVID-19 vaccination? Vaccine 2022; 40:2251-2257. [PMID: 35287986 PMCID: PMC8904156 DOI: 10.1016/j.vaccine.2022.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/14/2022] [Accepted: 03/03/2022] [Indexed: 12/17/2022]
Abstract
Background Methods Results Conclusions
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13
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Wang X, Li Y, Vazquez Fernandez L, Teirlinck AC, Lehtonen T, van Wijhe M, Stona L, Bangert M, Reeves RM, Bøås H, van Boven M, Heikkinen T, Klint Johannesen C, Baraldi E, Donà D, Tong S, Campbell H. Respiratory Syncytial Virus-Associated Hospital Admissions and Bed Days in Children <5 Years of Age in 7 European Countries. J Infect Dis 2022; 226:S22-S28. [PMID: 35023567 DOI: 10.1093/infdis/jiab560] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of respiratory tract infections (RTIs) in young children. High-quality country-specific estimates of bed days and length of stay (LOS) show the population burden of RSV-RTI on secondary care services and the burden among patients, and can be used to inform RSV immunization implementation decisions. METHODS We estimated the hospital burden of RSV-associated RTI (RSV-RTI) in children under 5 years in 7 European countries (Finland, Denmark, Norway, Scotland, England, the Netherlands, and Italy) using routinely collected hospital databases during 2001-2018. We described RSV-RTI admission rates during the first year of life by birth month and assessed their correlation with RSV seasonality in 5 of the countries (except for England and Italy). We estimated average annual numbers and rates of bed days for RSV-RTI and other-pathogen RTI, as well as the hospital LOS. RESULTS We found that infants born 2 months before the peak month of RSV epidemics more frequently had the highest RSV-RTI hospital admission rate. RSV-RTI hospital episodes accounted for 9.9-21.2 bed days per 1000 children aged <5 years annually, with the median (interquartile range) LOS ranging from 2 days (0.5-4 days) to 4 days (2-6 days) between countries. Between 70% and 89% of these bed days were in infants aged <1 year, representing 40.3 (95% confidence interval [CI], 40.1-40.4) to 91.2 (95% CI, 90.6-91.8) bed days per 1000 infants annually. The number of bed days for RSV-RTI was higher than that for RTIs associated with other pathogens in infants aged <1 year, especially in those <6 months. CONCLUSIONS RSV disease prevention therapies (monoclonal antibodies and maternal vaccines) for infants could help prevent a substantial number of bed days due to RSV-RTI. "High-risk" birth months should be considered when developing RSV immunization schedules. Variation in LOS between countries might reflect differences in hospital care practices.
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Affiliation(s)
- Xin Wang
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom.,School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - You Li
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom.,School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | | | - Anne C Teirlinck
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Toni Lehtonen
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Turku University Hospital, Turku, Finland
| | - Maarten van Wijhe
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Rachel M Reeves
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Håkon Bøås
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Terho Heikkinen
- Turku University Hospital, Turku, Finland.,University of Turku, Turku, Finland
| | | | - Eugenio Baraldi
- Dipartimento di Salute della Donna e del Bambino, Università di Padova, Padova, Italy
| | - Daniele Donà
- Dipartimento di Salute della Donna e del Bambino, Università di Padova, Padova, Italy
| | | | - Harry Campbell
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
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14
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Reukers DFM, van Boven M, Meijer A, Rots N, Reusken C, Roof I, van Gageldonk-Lafeber AB, van der Hoek W, van den Hof S. High Infection Secondary Attack Rates of Severe Acute Respiratory Syndrome Coronavirus 2 in Dutch Households Revealed by Dense Sampling. Clin Infect Dis 2022; 74:52-58. [PMID: 33822007 PMCID: PMC8083540 DOI: 10.1093/cid/ciab237] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Indoor environments are considered one of the main settings for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Households in particular represent a close-contact environment with high probability of transmission between persons of different ages and roles in society. METHODS Households with a laboratory-confirmed SARS-CoV-2 positive case in the Netherlands (March-May 2020) were included. At least 3 home visits were performed during 4-6 weeks of follow-up, collecting naso- and oropharyngeal swabs, oral fluid, feces and blood samples from all household members for molecular and serological analyses. Symptoms were recorded from 2 weeks before the first visit through to the final visit. Infection secondary attack rates (SAR) were estimated with logistic regression. A transmission model was used to assess household transmission routes. RESULTS A total of 55 households with 187 household contacts were included. In 17 households no transmission took place; in 11 households all persons were infected. Estimated infection SARs were high, ranging from 35% (95% confidence interval [CI], 24%-46%) in children to 51% (95% CI, 39%-63%) in adults. Estimated transmission rates in the household were high, with reduced susceptibility of children compared with adolescents and adults (0.67; 95% CI, .40-1.1). CONCLUSION Estimated infection SARs were higher than reported in earlier household studies, presumably owing to our dense sampling protocol. Children were shown to be less susceptible than adults, but the estimated infection SAR in children was still high. Our results reinforce the role of households as one of the main multipliers of SARS-CoV-2 infection in the population.
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Affiliation(s)
- Daphne F M Reukers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Adam Meijer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Nynke Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Chantal Reusken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Inge Roof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Wim van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Susan van den Hof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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15
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Vos ERA, van Boven M, den Hartog G, Backer JA, Klinkenberg D, van Hagen CCE, Boshuizen H, van Binnendijk RS, Mollema L, van der Klis FRM, de Melker HE. Associations Between Measures of Social Distancing and Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity: A Nationwide Population-based Study in the Netherlands. Clin Infect Dis 2021. [PMID: 33772265 DOI: 10.1093/cid/ciab264.pmid:33772265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
UNLABELLED This large, nationwide, population-based, seroepidemiological study provides evidence of the effectiveness of physical distancing (>1.5 m) and indoor group size reductions in reducing severe acute respiratory syndrome coronavirus 2 infection. Additionally, young adults may play an important role in viral spread, contrary to children up until age 12 years with whom close contact is permitted. CLINICAL TRIALS REGISTRATION NTR8473.
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Affiliation(s)
- Eric R A Vos
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Michiel van Boven
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Gerco den Hartog
- Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jantien A Backer
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Don Klinkenberg
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Cheyenne C E van Hagen
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hendriek Boshuizen
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Robert S van Binnendijk
- Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Liesbeth Mollema
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Fiona R M van der Klis
- Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hester E de Melker
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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16
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den Hartog G, Vos ERA, van den Hoogen LL, van Boven M, Schepp RM, Smits G, van Vliet J, Woudstra L, Wijmenga-Monsuur AJ, van Hagen CCE, Sanders EAM, de Melker HE, van der Klis FRM, van Binnendijk RS. Persistence of Antibodies to Severe Acute Respiratory Syndrome Coronavirus 2 in Relation to Symptoms in a Nationwide Prospective Study. Clin Infect Dis 2021; 73:2155-2162. [PMID: 33624751 PMCID: PMC7929058 DOI: 10.1093/cid/ciab172] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Assessing the duration of immunity following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a first priority to gauge the degree of protection following infection. Such knowledge is lacking, especially in the general population. Here, we studied changes in immunoglobulin isotype seropositivity and immunoglobulin G (IgG) binding strength of SARS-CoV-2-specific serum antibodies up to 7 months following onset of symptoms in a nationwide sample. METHODS Participants from a prospective representative serological study in the Netherlands were included based on IgG seroconversion to the spike S1 protein of SARS-CoV-2 (N = 353), with up to 3 consecutive serum samples per seroconverted participant (N = 738). Immunoglobulin M (IgM), immunoglobulin A (IgA), and IgG antibody concentrations to S1, and increase in IgG avidity in relation to time since onset of disease symptoms, were determined. RESULTS While SARS-CoV-2-specific IgM and IgA antibodies declined rapidly after the first month after disease onset, specific IgG was still present in 92% (95% confidence interval [CI], 89%-95%) of the participants after 7 months. The estimated 2-fold decrease of IgG antibodies was 158 days (95% CI, 136-189 days). Concentrations were sustained better in persons reporting significant symptoms compared to asymptomatic persons or those with mild upper respiratory complaints only. Similarly, avidity of IgG antibodies for symptomatic persons showed a steeper increase over time compared with persons with mild or no symptoms (P = .022). CONCLUSIONS SARS-CoV-2-specific IgG antibodies persist and show increasing avidity over time, indicative of underlying immune maturation. These data support development of immune memory against SARS-CoV-2, providing insight into protection of the general unvaccinated part of the population. CLINICAL TRIALS REGISTRATION NL8473 (the Dutch trial registry).
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Affiliation(s)
- Gerco den Hartog
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Eric R A Vos
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Lotus L van den Hoogen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Rutger M Schepp
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Gaby Smits
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jeffrey van Vliet
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Linde Woudstra
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Alienke J Wijmenga-Monsuur
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Cheyenne C E van Hagen
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Fiona R M van der Klis
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Robert S van Binnendijk
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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17
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Linssen RS, Teirlinck AC, van Boven M, Biarent D, Stona L, Amigoni A, Comoretto RI, Leteurtre S, Bruandet A, Bentsen GK, Drage IM, Wang X, Campbell H, van Woensel JBM, Bont L, Bem RA. Increasing burden of viral bronchiolitis in the pediatric intensive care unit; an observational study. J Crit Care 2021; 68:165-168. [PMID: 34304966 DOI: 10.1016/j.jcrc.2021.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Viral bronchiolitis is a major cause of pediatric intensive care unit (PICU) admission. Insight in the trends of bronchiolitis-associated PICU admissions is limited, but imperative for future PICU resource and capacity planning. MATERIALS AND METHODS We retrospectively studied trends in PICU admissions for bronchiolitis in six European sites, including three full national registries, between 2000 and 2019 and calculated population-based estimates per 100,000 children where appropriate. Information concerning risk factors for severe disease and use of invasive mechanical ventilation was also collected when available. RESULTS In total, there were 15,606 PICU admissions for bronchiolitis. We observed an increase in the annual number, rate and estimates per 100,000 children of PICU admissions for bronchiolitis at all sites over the last two decades, while the proportion of patients at high risk for severe disease remained relatively stable. CONCLUSIONS The international increased burden of bronchiolitis for the PICU is concerning, and warrants further international attention and investigation.
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Affiliation(s)
- Rosalie S Linssen
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands.
| | - Anne C Teirlinck
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Dominique Biarent
- Pediatric Intensive Care and Emergency Department, Hospital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Belgium
| | - Luca Stona
- Fondazione Penta Child Health Research ONLUS, Padova, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's, Health, University Hospital of Padova, Padova, Italy
| | - Rosanna I Comoretto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Stephane Leteurtre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Groupe Francophone de Réanimation et d'Urgences pédiatriques - GFRUP-, Paris, France
| | - Amélie Bruandet
- Medical Information Department, Lille University Hospital, Lille, France
| | - Gunnar K Bentsen
- Division of Emergencies and Critical Care, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Inger Marie Drage
- Division of Emergencies and Critical Care, Oslo University Hospital - Ullevaal, Oslo, Norway
| | - Xin Wang
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Job B M van Woensel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - Louis Bont
- UMCU Laboratory of Translational Immunology, Wilhelmina Children's Hospital, University Medical Center of Utrecht, Utrecht, the Netherlands; Respiratory Syncytial Virus Network (ReSViNET) Foundation, Zeist, the Netherlands
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
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18
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Viana J, van Dorp CH, Nunes A, Gomes MC, van Boven M, Kretzschmar ME, Veldhoen M, Rozhnova G. Controlling the pandemic during the SARS-CoV-2 vaccination rollout. Nat Commun 2021; 12:3674. [PMID: 34135335 PMCID: PMC8209021 DOI: 10.1038/s41467-021-23938-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023] Open
Abstract
There is a consensus that mass vaccination against SARS-CoV-2 will ultimately end the COVID-19 pandemic. However, it is not clear when and which control measures can be relaxed during the rollout of vaccination programmes. We investigate relaxation scenarios using an age-structured transmission model that has been fitted to age-specific seroprevalence data, hospital admissions, and projected vaccination coverage for Portugal. Our analyses suggest that the pressing need to restart socioeconomic activities could lead to new pandemic waves, and that substantial control efforts prove necessary throughout 2021. Using knowledge on control measures introduced in 2020, we anticipate that relaxing measures completely or to the extent as in autumn 2020 could launch a wave starting in April 2021. Additional waves could be prevented altogether if measures are relaxed as in summer 2020 or in a step-wise manner throughout 2021. We discuss at which point the control of COVID-19 would be achieved for each scenario.
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Affiliation(s)
- João Viana
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Christiaan H van Dorp
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Ana Nunes
- Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- BioISI-Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Manuel C Gomes
- Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Michiel van Boven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marc Veldhoen
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- BioISI-Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.
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19
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Andeweg SP, Schepp RM, van de Kassteele J, Mollema L, Berbers GAM, van Boven M. Population-based serology reveals risk factors for RSV infection in children younger than 5 years. Sci Rep 2021; 11:8953. [PMID: 33903695 PMCID: PMC8076290 DOI: 10.1038/s41598-021-88524-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/08/2021] [Indexed: 12/02/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection is a leading cause of hospitalization in infants. Underlying risk factors for RSV infection in the general population are not well understood, as previous work has focused on severe outcomes of infection in a clinical setting. Here we use RSV-specific IgG and IgA antibody measurements from two population-based cross-sectional serosurveys carried out in the Netherlands (n = 682) to classify children up to 5 years as seronegative or seropositive. We employ a generalized additive model to estimate the probability of prior RSV infection as function of age, date of birth within the year, and other risk factors. The analyses show that the majority of children have experienced a RSV infection before the age of 2 years. Age and birthdate are strong predictors of RSV infection in the first years of life, and children born in summer have higher estimated probability of infection than those born in winter [e.g., 0.56 (95% CI 0.45–0.66) vs. 0.32 (0.21–0.45) at age 1 year]. Our analyses reveal that the mean age at infection depends on date of birth, which has implications for the design of vaccination programmes and prioritisation schemes for the prophylactic use of monoclonal antibodies.
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Affiliation(s)
- Stijn P Andeweg
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands.
| | - Rutger M Schepp
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands
| | - Jan van de Kassteele
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands
| | - Liesbeth Mollema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands
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20
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Vos ERA, van Boven M, den Hartog G, Backer JA, Klinkenberg D, van Hagen CCE, Boshuizen H, van Binnendijk RS, Mollema L, van der Klis FRM, de Melker HE. Associations between measures of social distancing and SARS-CoV-2 seropositivity: a nationwide population-based study in the Netherlands. Clin Infect Dis 2021; 73:2318-2321. [PMID: 33772265 PMCID: PMC8083720 DOI: 10.1093/cid/ciab264] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
This large nationwide population-based seroepidemiological study provides evidence on the effectiveness of physical distancing (>1.5m) and indoor group size reductions on SARS-CoV-2 infection. Additionally, young adults may play an important role in viral spread, opposed to children up until 12 years of age with whom close contact is permitted.
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Affiliation(s)
- Eric R A Vos
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Gerco den Hartog
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Jantien A Backer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Don Klinkenberg
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Cheyenne C E van Hagen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Hendriek Boshuizen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Robert S van Binnendijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Liesbeth Mollema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, MA Bilthoven, the Netherlands
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21
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Reeves RM, van Wijhe M, Tong S, Lehtonen T, Stona L, Teirlinck AC, Fernandez LV, Li Y, Giaquinto C, Fischer TK, Demont C, Heikkinen T, Speltra I, van Boven M, Bøås H, Campbell H. Respiratory Syncytial Virus-Associated Hospital Admissions in Children Younger Than 5 Years in 7 European Countries Using Routinely Collected Datasets. J Infect Dis 2021; 222:S599-S605. [PMID: 32815542 DOI: 10.1093/infdis/jiaa360] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of respiratory tract infection (RTI) in young children. Registries provide opportunities to explore RSV epidemiology and burden. METHODS We explored routinely collected hospital data on RSV in children aged < 5 years in 7 European countries. We compare RSV-associated admission rates, age, seasonality, and time trends between countries. RESULTS We found similar age distributions of RSV-associated hospital admissions in each country, with the highest burden in children < 1 years old and peak at age 1 month. Average annual rates of RTI admission were 41.3-112.0 per 1000 children aged < 1 year and 8.6-22.3 per 1000 children aged < 1 year. In children aged < 5 years, 57%-72% of RTI admissions with specified causal pathogen were coded as RSV, with 62%-87% of pathogen-coded admissions in children < 1 year coded as RSV. CONCLUSIONS Our results demonstrate the benefits and limitations of using linked routinely collected data to explore epidemiology and burden of RSV. Our future work will use these data to generate estimates of RSV burden using time-series modelling methodology, to inform policymaking and regulatory decisions regarding RSV immunization strategy and monitor the impact of future vaccines.
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Affiliation(s)
- Rachel M Reeves
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Maarten van Wijhe
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | | | - Toni Lehtonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Turku University Hospital, Turku, Finland
| | | | - Anne C Teirlinck
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Liliana Vazquez Fernandez
- Department of Infectious Diseases, Epidemiology, and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - You Li
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Thea Kølsen Fischer
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Nordsjælland Hospital Hilleroed and University of Southern Denmark, Odense, Denmark
| | - Clarisse Demont
- Global Vaccine Epidemiology and Modelling Department, Sanofi Pasteur, Lyon, France
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Håkon Bøås
- Department of Infectious Diseases, Epidemiology, and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Harry Campbell
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
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22
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Vos ERA, den Hartog G, Schepp RM, Kaaijk P, van Vliet J, Helm K, Smits G, Wijmenga-Monsuur A, Verberk JDM, van Boven M, van Binnendijk RS, de Melker HE, Mollema L, van der Klis FRM. Nationwide seroprevalence of SARS-CoV-2 and identification of risk factors in the general population of the Netherlands during the first epidemic wave. J Epidemiol Community Health 2020; 75:jech-2020-215678. [PMID: 33249407 PMCID: PMC8142429 DOI: 10.1136/jech-2020-215678] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND We aimed to detect SARS-CoV-2 serum antibodies in the general population of the Netherlands and identify risk factors for seropositivity amidst the first COVID-19 epidemic wave. METHODS Participants (n=3207, aged 2-90 years), enrolled from a previously established nationwide serosurveillance study, provided a self-collected fingerstick blood sample and completed a questionnaire (median inclusion date 3 April 2020). IgG antibodies targeted against the spike S1-protein of SARS-CoV-2 were quantified using a validated multiplex-immunoassay. Seroprevalence was estimated controlling for survey design, individual pre-pandemic concentration, and test performance. Random-effects logistic regression identified risk factors for seropositivity. RESULTS Overall seroprevalence in the Netherlands was 2.8% (95% CI 2.1 to 3.7), with no differences between sexes or ethnic background, and regionally ranging between 1.3 and 4.0%. Estimates were highest among 18-39 year-olds (4.9%), and lowest in children 2-17 years (1.7%). Multivariable analysis revealed that persons taking immunosuppressants and those from the Orthodox-Reformed Protestant community had over four times higher odds of being seropositive compared to others. Anosmia/ageusia was the most discriminative symptom between seropositive (53%) and seronegative persons (4%, p<0.0001). Antibody concentrations in seropositive persons were significantly higher in those with fever or dyspnoea in contrast to those without (p=0.01 and p=0.04, respectively). CONCLUSIONS In the midst of the first epidemic wave, 2.8% of the Dutch population was estimated to be infected with SARS-CoV-2, that is, 30 times higher than reported. This study identified independent groups with increased odds for seropositivity that may require specific surveillance measures to guide future protective interventions internationally, including vaccination once available.
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Affiliation(s)
- Eric R A Vos
- Centre for Infectious Disease Control, RIVM, Bilthoven, Netherlands
| | - Gerco den Hartog
- Centre for Infectious Disease Control, RIVM, Bilthoven, Netherlands
| | - Rutger M Schepp
- Centre for Infectious Disease Control, RIVM, Bilthoven, Netherlands
| | - Patricia Kaaijk
- Centre for Infectious Disease Control, RIVM, Bilthoven, Netherlands
| | | | - Kina Helm
- Centre for Infectious Disease Control, RIVM, Bilthoven, Netherlands
| | - Gaby Smits
- Centre for Infectious Disease Control, RIVM, Bilthoven, Netherlands
| | | | | | | | | | | | - Liesbeth Mollema
- Centre for Infectious Disease Control, RIVM, Bilthoven, Netherlands
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23
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van Boven M, Teirlinck AC, Meijer A, Hooiveld M, van Dorp CH, Reeves RM, Campbell H, van der Hoek W. Estimating Transmission Parameters for Respiratory Syncytial Virus and Predicting the Impact of Maternal and Pediatric Vaccination. J Infect Dis 2020; 222:S688-S694. [PMID: 32821916 PMCID: PMC7751153 DOI: 10.1093/infdis/jiaa424] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of respiratory tract illness in young children and a major cause of hospital admissions globally. METHODS Here we fit age-structured transmission models with immunity propagation to data from the Netherlands (2012-2017). Data included nationwide hospitalizations with confirmed RSV, general practitioner (GP) data on attendance for care from acute respiratory infection, and virological testing of acute respiratory infections at the GP. The transmission models, equipped with key parameter estimates, were used to predict the impact of maternal and pediatric vaccination. RESULTS Estimates of the basic reproduction number were generally high (R0 > 10 in scenarios with high statistical support), while susceptibility was estimated to be low in nonelderly adults (<10% in persons 20-64 years) and was higher in older adults (≥65 years). Scenario analyses predicted that maternal vaccination reduces the incidence of infection in vulnerable infants (<1 year) and shifts the age of first infection from infants to young children. CONCLUSIONS Pediatric vaccination is expected to reduce the incidence of infection in infants and young children (0-5 years), slightly increase incidence in 5 to 9-year-old children, and have minor indirect benefits.
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Affiliation(s)
- Michiel van Boven
- Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Anne C Teirlinck
- Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Adam Meijer
- Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Christiaan H van Dorp
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Rachel M Reeves
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Wim van der Hoek
- Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
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24
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Benincà E, Hagenaars T, Boender GJ, van de Kassteele J, van Boven M. Trade-off between local transmission and long-range dispersal drives infectious disease outbreak size in spatially structured populations. PLoS Comput Biol 2020; 16:e1008009. [PMID: 32628659 PMCID: PMC7365471 DOI: 10.1371/journal.pcbi.1008009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 07/16/2020] [Accepted: 06/02/2020] [Indexed: 01/25/2023] Open
Abstract
Transmission of infectious diseases between immobile hosts (e.g., plants, farms) is strongly dependent on the spatial distribution of hosts and the distance-dependent probability of transmission. As the interplay between these factors is poorly understood, we use spatial process and transmission modelling to investigate how epidemic size is shaped by host clustering and spatial range of transmission. We find that for a given degree of clustering and individual-level infectivity, the probability that an epidemic occurs after an introduction is generally higher if transmission is predominantly local. However, local transmission also impedes transfer of the infection to new clusters. A consequence is that the total number of infections is maximal if the range of transmission is intermediate. In highly clustered populations, the infection dynamics is strongly determined by the probability of transmission between clusters of hosts, whereby local clusters act as multiplier of infection. We show that in such populations, a metapopulation model sometimes provides a good approximation of the total epidemic size, using probabilities of local extinction, the final size of infections in local clusters, and probabilities of cluster-to-cluster transmission. As a real-world example we analyse the case of avian influenza transmission between poultry farms in the Netherlands. Transmission of infectious diseases between immobile hosts depends on the transmission characteristics of the infection and on the spatial distribution of hosts. Examples include infectious diseases of plants that are spread by wind or via vectors (e.g., Asiatic citrus canker spread between citrus trees), diseases that are transmitted between local host populations (e.g., sylvatic plague transmitted between rodents living in burrows), diseases of production animals that are spread between farms (e.g., avian influenza in poultry transmitted from farm to farm). We use spatial transmission modelling to investigate how the total number of infections over the course of an epidemic is determined by host clustering and spatial range of transmission. We find that for a given degree of clustering and infectivity of hosts, the number of infections is maximal if the spatial range of transmission is intermediate. In highly clustered populations we show that epidemic size can be approximated by a metapopulation model, illustrating that in such populations the transmission dynamics is dominated by transmission between clusters of hosts.
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Affiliation(s)
- Elisa Benincà
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands
- * E-mail:
| | - Thomas Hagenaars
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Gert Jan Boender
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Jan van de Kassteele
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands
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Rozhnova G, E Kretzschmar M, van der Klis F, van Baarle D, Korndewal M, C Vossen A, van Boven M. Short- and long-term impact of vaccination against cytomegalovirus: a modeling study. BMC Med 2020; 18:174. [PMID: 32611419 PMCID: PMC7331215 DOI: 10.1186/s12916-020-01629-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Infection with cytomegalovirus (CMV) is highly prevalent worldwide and can cause severe disease in immunocompromised persons and congenitally infected infants. The disease burden caused by congenital CMV infection is high, especially in resource-limited countries. Vaccines are currently under development for various target groups. METHODS We evaluated the impact of vaccination strategies and hygiene intervention using transmission models. Model parameters were estimated from a cross-sectional serological population study (n=5179) and a retrospective birth cohort (n=31,484), providing information on the age- and sex-specific CMV prevalence and on the birth prevalence of congenital CMV (cCMV). RESULTS The analyses show that vertical transmission and infectious reactivation are the main drivers of transmission. Vaccination strategies aimed at reducing transmission from mother to child (vaccinating pregnant women or women of reproductive age) can yield substantial reductions of cCMV in 20 years (31.7-71.4% if 70% of women are effectively vaccinated). Alternatively, hygiene intervention aimed at preventing CMV infection and re-infection of women of reproductive age from young children is expected to reduce cCMV by less than 2%. The effects of large-scale vaccination on CMV prevalence can be substantial, owing to the moderate transmissibility of CMV at the population level. However, as CMV causes lifelong infection, the timescale on which reductions in CMV prevalence are expected is in the order of several decades. Elimination of CMV infection in the long run is only feasible for a vaccine with a long duration of protection and high vaccination coverage. CONCLUSIONS Vaccination is an effective intervention to reduce the birth prevalence of cCMV. Population-level reductions in CMV prevalence can only be achieved on a long timescale. Our results stress the value of vaccinating pregnant women and women of childbearing age and provide support for the development of CMV vaccines and early planning of vaccination scenarios and rollouts.
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Affiliation(s)
- Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
| | - Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Fiona van der Klis
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Debbie van Baarle
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Marjolein Korndewal
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Ann C Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel van Boven
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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Vos RA, Mollema L, van Boven M, van Lier A, Smits G, Janga-Jansen AVA, Baboe-Kalpoe S, Hulshof K, Stienstra Y, van der Klis FRM, de Melker HE. High varicella zoster virus susceptibility in Caribbean island populations: Implications for vaccination. Int J Infect Dis 2020; 94:16-24. [PMID: 32112964 DOI: 10.1016/j.ijid.2020.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Varicella zoster virus (VZV) infection is reported regularly among adolescents and adults in Caribbean island populations. The disease more often runs a severe course among these populations, causing a substantial burden. The aim of this sero-epidemiological study was to obtain an insight into VZV susceptibility and its determinants in island populations of the Caribbean Netherlands (CN). METHODS Participants from Bonaire, St. Eustatius, and Saba (n = 1829, aged 0-90 years) donated a blood sample and completed a questionnaire. VZV-specific IgG antibodies were determined using a bead-based multiplex immunoassay. Risk factors were analysed using a logistic regression model. RESULTS Overall seroprevalence in CN was 78%, being lowest on St. Eustatius (73%) and highest on Bonaire and Saba (79%). Seropositivity increased gradually with age, with 60% and 80% at ages 10 years and 30 years, respectively, and ranging between 80% and 90% thereafter. Higher odds for VZV seronegativity were seen among persons who were born in CN or had resided there since early childhood, and among single-person households. CONCLUSIONS VZV susceptibility is relatively high among adolescents and adults in CN. In order to reduce the burden of VZV-related disease in these populations, routine varicella vaccination is recommended. As data are scarce, the study findings can serve as a blueprint for the epidemiology in tropical regions.
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Affiliation(s)
- Regnerus A Vos
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 MA Bilthoven, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Centre/University of Groningen, Groningen, The Netherlands.
| | - Liesbeth Mollema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 MA Bilthoven, The Netherlands.
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 MA Bilthoven, The Netherlands.
| | - Alies van Lier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 MA Bilthoven, The Netherlands.
| | - Gaby Smits
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 MA Bilthoven, The Netherlands.
| | - Alcira V A Janga-Jansen
- Department of Public Health, Public Entity Bonaire, Kaya Neerlandia 41, Kralendijk, Bonaire, Caribbean Netherlands, The Netherlands.
| | - Sharda Baboe-Kalpoe
- Department of Public Health, Public Entity St. Eustatius, Cottageroad z/n, Oranjestad, St. Eustatius, Caribbean Netherlands, The Netherlands.
| | - Koen Hulshof
- Department of Public Health, Public Entity Saba, The Bottom, Saba, Caribbean Netherlands, The Netherlands.
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University Medical Centre/University of Groningen, Groningen, The Netherlands.
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 MA Bilthoven, The Netherlands.
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3720 MA Bilthoven, The Netherlands.
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27
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Meijer A, Swaan CM, Voerknecht M, Jusic E, van den Brink S, Wijsman LA, Voordouw BC, Donker GA, Sleven J, Dorigo-Zetsma WW, Svraka S, van Boven M, Haverkate MR, Timen A, van Dissel JT, Koopmans MP, Bestebroer TM, Fouchier RA. Case of seasonal reassortant A(H1N2) influenza virus infection, the Netherlands, March 2018. ACTA ACUST UNITED AC 2019; 23. [PMID: 29667576 PMCID: PMC6836195 DOI: 10.2807/1560-7917.es.2018.23.15.18-00160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A seasonal reassortant A(H1N2) influenza virus harbouring genome segments from seasonal influenza viruses A(H1N1)pdm09 (HA and NS) and A(H3N2) (PB2, PB1, PA, NP, NA and M) was identified in March 2018 in a 19-months-old patient with influenza-like illness (ILI) who presented to a general practitioner participating in the routine sentinel surveillance of ILI in the Netherlands. The patient recovered fully. Further epidemiological and virological investigation did not reveal additional cases.
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Affiliation(s)
- Adam Meijer
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Corien M Swaan
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Martin Voerknecht
- General practitioner participating in the Primary Care Database sentinel surveillance coordinated by NIVEL Netherlands institute for health services research, Utrecht, the Netherlands
| | - Edin Jusic
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Sharon van den Brink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Lisa A Wijsman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bettie Cg Voordouw
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Gé A Donker
- Coordinator NIVEL Primary Care Database sentinel surveillance, NIVEL Netherlands institute for health services research, Utrecht, the Netherlands
| | - Jacqueline Sleven
- Municipal Health Services 'Gooi en Vechtstreek', Bussum, the Netherlands
| | | | - Sanela Svraka
- Central Bacteriology and Serology Laboratory, Tergooi Hospitals, Hilversum, the Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Manon R Haverkate
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Aura Timen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jaap T van Dissel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marion Pg Koopmans
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Theo M Bestebroer
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ron Am Fouchier
- Department Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
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28
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van Boven M, van de Kassteele J, Korndewal MJ, van Dorp CH, Kretzschmar M, van der Klis F, de Melker HE, Vossen AC, van Baarle D. Infectious reactivation of cytomegalovirus explaining age- and sex-specific patterns of seroprevalence. PLoS Comput Biol 2017; 13:e1005719. [PMID: 28949962 PMCID: PMC5630159 DOI: 10.1371/journal.pcbi.1005719] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 10/06/2017] [Accepted: 08/02/2017] [Indexed: 01/01/2023] Open
Abstract
Human cytomegalovirus (CMV) is a herpes virus with poorly understood transmission dynamics. Person-to-person transmission is thought to occur primarily through transfer of saliva or urine, but no quantitative estimates are available for the contribution of different infection routes. Using data from a large population-based serological study (n = 5,179), we provide quantitative estimates of key epidemiological parameters, including the transmissibility of primary infection, reactivation, and re-infection. Mixture models are fitted to age- and sex-specific antibody response data from the Netherlands, showing that the data can be described by a model with three distributions of antibody measurements, i.e. uninfected, infected, and infected with increased antibody concentration. Estimates of seroprevalence increase gradually with age, such that at 80 years 73% (95%CrI: 64%-78%) of females and 62% (95%CrI: 55%-68%) of males are infected, while 57% (95%CrI: 47%-67%) of females and 37% (95%CrI: 28%-46%) of males have increased antibody concentration. Merging the statistical analyses with transmission models, we find that models with infectious reactivation (i.e. reactivation that can lead to the virus being transmitted to a novel host) fit the data significantly better than models without infectious reactivation. Estimated reactivation rates increase from low values in children to 2%-4% per year in women older than 50 years. The results advance a hypothesis in which transmission from adults after infectious reactivation is a key driver of transmission. We discuss the implications for control strategies aimed at reducing CMV infection in vulnerable groups. Human cytomegalovirus (CMV) is a herpes virus causing lifelong infection. In high-income countries, the probability of infection increases gradually with age such that at old age up to 100% of the population is infected. CMV is thought to be transmitted mainly by transfer of saliva or urine, but little quantitative evidence is available about the transmission dynamics. We analyze serological data to estimate age- and sex-specific rates of infection, re-infection, and reactivation. The analyses show that infectious reactivation (i.e. reactivation of the virus in an infected person that is sufficient for it to be transmitted to another person) is essential to explain the data. We propose that infectious reactivation in adults is an important driver of transmission of CMV.
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Affiliation(s)
- Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- * E-mail:
| | - Jan van de Kassteele
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marjolein J. Korndewal
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Leiden University Medical Center, Department of Medical Microbiology, Leiden, the Netherlands
| | - Christiaan H. van Dorp
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Theoretical Biology and Bioinformatics, Utrecht University, Utrecht, the Netherlands
| | - Mirjam Kretzschmar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Fiona van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hester E. de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Ann C. Vossen
- Leiden University Medical Center, Department of Medical Microbiology, Leiden, the Netherlands
| | - Debbie van Baarle
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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29
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Woolthuis RG, Wallinga J, van Boven M. Variation in loss of immunity shapes influenza epidemics and the impact of vaccination. BMC Infect Dis 2017; 17:632. [PMID: 28927373 PMCID: PMC5606000 DOI: 10.1186/s12879-017-2716-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 09/05/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Protective antibody immunity against the influenza A virus wanes in 2-7 years due to antigenic drift of the virus' surface proteins. The duration of immune protection is highly variable because antigenic evolution of the virus is irregular. Currently, the variable nature of the duration of immunity has had little attention in analyses of the impact of vaccination, including cost-effectiveness studies. METHODS We developed a range of mathematical transmission models to investigate the effect of variable duration of immunity on the size of seasonal epidemics. The models range from simple conceptual to more realistic, by distinguishing between infection- versus vaccination-induced immunity, by inclusion of primary vaccine failure, by assuming a leaky vaccine, and by the inclusion of age-dependent contact patterns. RESULTS We show that annual variation in the duration of immunity causes large variation in the size of epidemics, and affects the effectiveness of vaccination. Accumulation of susceptible individuals in one or more mild seasons results in a disproportionately large outbreak in a subsequent season. Importantly, variation in the duration of immunity increases the average infection attack rate when the vaccination coverage is around the outbreak threshold. Specifically, in a tailored age-stratified model with a realistic reproduction number (R 0 = 1.4) and vaccination coverage of 25%, we find that the attack rate in unvaccinated children (<10 years old) is negligible if the duration of immunity is constant, while on average 2.8% (2.5-97.5% percentiles: 1.8-4.1%) of the children are infected if the duration of immunity is variable. These findings stem from the buildup of susceptibility over multiple seasons by waning of immunity, and the nonlinear relation between susceptibility and infection attack rates. CONCLUSIONS The models illustrate that variation in the duration of immunity impacts the long-term effectiveness of vaccination, and that vaccine effectiveness cannot be judged for each year in isolation. Our findings have implications for vaccination strategies that aim to maximize the vaccination coverage while extending the age range of persons eligible for vaccination.
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Affiliation(s)
- Rutger G Woolthuis
- Theoretical Biology, Utrecht University, Padualaan 8, Utrecht, 3584 CH, The Netherlands. .,National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands.
| | - Jacco Wallinga
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands
| | - Michiel van Boven
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands
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30
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te Beest DE, de Bruin E, Imholz S, Koopmans M, van Boven M. Heterosubtypic cross-reactivity of HA1 antibodies to influenza A, with emphasis on nonhuman subtypes (H5N1, H7N7, H9N2). PLoS One 2017; 12:e0181093. [PMID: 28715468 PMCID: PMC5513445 DOI: 10.1371/journal.pone.0181093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/25/2017] [Indexed: 11/26/2022] Open
Abstract
Epidemics of influenza A vary greatly in size and age distribution of cases, and this variation is attributed to varying levels of pre-existing immunity. Recent studies have shown that antibody-mediated immune responses are more cross-reactive than previously believed, and shape patterns of humoral immunity to influenza A viruses over long periods. Here we quantify antibody responses to the hemagglutinin subunit 1 (HA1) across a range of subtypes using protein microarray analysis of cross-sectional serological surveys carried out in the Netherlands before and after the A/2009 (H1N1) pandemic. We find significant associations of responses, both within and between subtypes. Interestingly, substantial overall reactivity is observed to HA1 of avian H7N7 and H9N2 viruses. Seroprevalence of H7N7 correlates with antibody titers to A/1968 (H3N2), and is highest in persons born between 1954 and 1969. Seroprevalence of H9N2 is high across all ages, and correlates strongly with A/1957 (H2N2). This correlation is most pronounced in A/2009 (H1N1) infected persons born after 1968 who have never encountered A/1957 (H2N2)-like viruses. We conclude that heterosubtypic antibody cross-reactivity, both between human subtypes and between human and nonhuman subtypes, is common in the human population.
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MESH Headings
- Adolescent
- Adult
- Aged
- Animals
- Antibodies, Viral/immunology
- Birds
- Child
- Child, Preschool
- Cross Reactions
- Humans
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H5N1 Subtype/immunology
- Influenza A Virus, H5N1 Subtype/isolation & purification
- Influenza A Virus, H7N7 Subtype/immunology
- Influenza A Virus, H7N7 Subtype/isolation & purification
- Influenza A Virus, H9N2 Subtype/immunology
- Influenza A Virus, H9N2 Subtype/isolation & purification
- Influenza in Birds/pathology
- Influenza in Birds/virology
- Influenza, Human/pathology
- Influenza, Human/virology
- Middle Aged
- Young Adult
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Affiliation(s)
- Dennis E. te Beest
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Erwin de Bruin
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sandra Imholz
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marion Koopmans
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- * E-mail:
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31
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Benincà E, van Boven M, Hagenaars T, van der Hoek W. Space-time analysis of pneumonia hospitalisations in the Netherlands. PLoS One 2017; 12:e0180797. [PMID: 28704495 PMCID: PMC5509219 DOI: 10.1371/journal.pone.0180797] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 06/21/2017] [Indexed: 11/21/2022] Open
Abstract
Community acquired pneumonia is a major global public health problem. In the Netherlands there are 40,000-50,000 hospital admissions for pneumonia per year. In the large majority of these hospital admissions the etiologic agent is not determined and a real-time surveillance system is lacking. Localised and temporal increases in hospital admissions for pneumonia are therefore only detected retrospectively and the etiologic agents remain unknown. Here, we perform spatio-temporal analyses of pneumonia hospital admission data in the Netherlands. To this end, we scanned for spatial clusters on yearly and seasonal basis, and applied wavelet cluster analysis on the time series of five main regions. The pneumonia hospital admissions show strong clustering in space and time superimposed on a regular yearly cycle with high incidence in winter and low incidence in summer. Cluster analysis reveals a heterogeneous pattern, with most significant clusters occurring in the western, highly urbanised, and in the eastern, intensively farmed, part of the Netherlands. Quantitatively, the relative risk (RR) of the significant clusters for the age-standardised incidence varies from a minimum of 1.2 to a maximum of 2.2. We discuss possible underlying causes for the patterns observed, such as variations in air pollution.
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Affiliation(s)
- Elisa Benincà
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Thomas Hagenaars
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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32
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Marinelli I, van Lier A, de Melker H, Pugliese A, van Boven M. Estimation of age-specific rates of reactivation and immune boosting of the varicella zoster virus. Epidemics 2017; 19:1-12. [DOI: 10.1016/j.epidem.2016.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022] Open
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33
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van Boven M, van Lier A. Global trends in vaccination coverage. The Lancet Global Health 2016; 4:e670-1. [DOI: 10.1016/s2214-109x(16)30185-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/20/2016] [Indexed: 11/28/2022]
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34
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Vink MA, Berkhof J, van de Kassteele J, van Boven M, Bogaards JA. A Bivariate Mixture Model for Natural Antibody Levels to Human Papillomavirus Types 16 and 18: Baseline Estimates for Monitoring the Herd Effects of Immunization. PLoS One 2016; 11:e0161109. [PMID: 27537200 PMCID: PMC4990197 DOI: 10.1371/journal.pone.0161109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022] Open
Abstract
Post-vaccine monitoring programs for human papillomavirus (HPV) have been introduced in many countries, but HPV serology is still an underutilized tool, partly owing to the weak antibody response to HPV infection. Changes in antibody levels among non-vaccinated individuals could be employed to monitor herd effects of immunization against HPV vaccine types 16 and 18, but inference requires an appropriate statistical model. The authors developed a four-component bivariate mixture model for jointly estimating vaccine-type seroprevalence from correlated antibody responses against HPV16 and -18 infections. This model takes account of the correlation between HPV16 and -18 antibody concentrations within subjects, caused e.g. by heterogeneity in exposure level and immune response. The model was fitted to HPV16 and -18 antibody concentrations as measured by a multiplex immunoassay in a large serological survey (3,875 females) carried out in the Netherlands in 2006/2007, before the introduction of mass immunization. Parameters were estimated by Bayesian analysis. We used the deviance information criterion for model selection; performance of the preferred model was assessed through simulation. Our analysis uncovered elevated antibody concentrations in doubly as compared to singly seropositive individuals, and a strong clustering of HPV16 and -18 seropositivity, particularly around the age of sexual debut. The bivariate model resulted in a more reliable classification of singly and doubly seropositive individuals than achieved by a combination of two univariate models, and suggested a higher pre-vaccine HPV16 seroprevalence than previously estimated. The bivariate mixture model provides valuable baseline estimates of vaccine-type seroprevalence and may prove useful in seroepidemiologic assessment of the herd effects of HPV vaccination.
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Affiliation(s)
- Margaretha A. Vink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Jan van de Kassteele
- Department of Statistics, Informatics and Modelling, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Johannes A. Bogaards
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- * E-mail:
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35
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Te Beest DE, Birrell PJ, Wallinga J, De Angelis D, van Boven M. Joint modelling of serological and hospitalization data reveals that high levels of pre-existing immunity and school holidays shaped the influenza A pandemic of 2009 in the Netherlands. J R Soc Interface 2015; 12:rsif.2014.1244. [PMID: 25540241 PMCID: PMC4305427 DOI: 10.1098/rsif.2014.1244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Obtaining a quantitative understanding of the transmission dynamics of influenza A is important for predicting healthcare demand and assessing the likely impact of intervention measures. The pandemic of 2009 provides an ideal platform for developing integrative analyses as it has been studied intensively, and a wealth of data sources is available. Here, we analyse two complementary datasets in a disease transmission framework: cross-sectional serological surveys providing data on infection attack rates, and hospitalization data that convey information on the timing and duration of the pandemic. We estimate key epidemic determinants such as infection and hospitalization rates, and the impact of a school holiday. In contrast to previous approaches, our novel modelling of serological data with mixture distributions provides a probabilistic classification of individual samples (susceptible, immune and infected), propagating classification uncertainties to the transmission model and enabling serological classifications to be informed by hospitalization data. The analyses show that high levels of immunity among persons 20 years and older provide a consistent explanation of the skewed attack rates observed during the pandemic and yield precise estimates of the probability of hospitalization per infection (1–4 years: 0.00096 (95%CrI: 0.00078–0.0012); 5–19 years: 0.00036 (0.00031–0.0044); 20–64 years: 0.0015 (0.00091–0.0020); 65+ years: 0.0084 (0.0028–0.016)). The analyses suggest that in The Netherlands, the school holiday period reduced the number of infectious contacts between 5- and 9-year-old children substantially (estimated reduction: 54%; 95%CrI: 29–82%), thereby delaying the unfolding of the pandemic in The Netherlands by approximately a week.
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Affiliation(s)
- Dennis E Te Beest
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, Bilthoven 3720AB, The Netherlands
| | - Paul J Birrell
- MRC Biostatistics Unit, Cambridge Institute of Public Health, CB2 0SR
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, Bilthoven 3720AB, The Netherlands
| | | | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, Bilthoven 3720AB, The Netherlands
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van Lier A, Lugnér A, Opstelten W, Jochemsen P, Wallinga J, Schellevis F, Sanders E, de Melker H, van Boven M. Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster. EBioMedicine 2015; 2:1494-9. [PMID: 26629544 PMCID: PMC4634630 DOI: 10.1016/j.ebiom.2015.08.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
Introduction Varicella zoster virus (VZV) is the etiological agent of varicella and herpes zoster (HZ). It has been hypothesised that immune boosting of latently infected persons by contact with varicella reduces the probability of HZ. If true, universal varicella vaccination may increase HZ incidence due to reduced VZV circulation. To inform decision-making, we conduct cost-effectiveness analyses of varicella vaccination, including effects on HZ. Methods Effects of varicella vaccination are simulated with a dynamic transmission model, parameterised with Dutch VZV seroprevalence and HZ incidence data, and linked to an economic model. We consider vaccination scenarios that differ by whether or not they include immune boosting, and reactivation of vaccine virus. Results Varicella incidence decreases after introduction of vaccination, while HZ incidence may increase or decrease depending on whether or not immune boosting is present. Without immune boosting, vaccination is expected to be cost-effective or even cost-saving. With immune boosting, vaccination at 95% coverage is not expected to be cost-effective, and may even cause net health losses. Conclusions Cost-effectiveness of varicella vaccination depends strongly on the impact on HZ and the economic time horizon. Our findings reveal ethical dilemmas as varicella vaccination may result in unequal distribution of health effects between generations. Cost-effectiveness of varicella vaccination depends strongly on the impact on herpes zoster and the economic time horizon. Varicella vaccination may result in profound trans-generational differences in distribution of health benefits and losses. Ethical dilemmas could arise, as unvaccinated groups may be exposed to a substantially increased health hazard.
We study the impact of universal childhood varicella vaccination by dynamic transmission modelling and cost-effectiveness analyses. Scenarios that are considered differ by whether or not immune boosting is included, and whether or not reactivation of vaccine virus is possible. Health effects of varicella vaccination in scenarios with immune boosting are unevenly distributed: cohorts born just before introduction of vaccination and persons who refuse vaccination may pay the price for health gains in vaccinated cohorts by an increased lifetime risk of herpes zoster. These results uncover an ethical dilemma, as varicella vaccination could result in significant trans-generational inequalities of health effects.
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Affiliation(s)
- Alies van Lier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Anna Lugnér
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Wim Opstelten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Petra Jochemsen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - François Schellevis
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands ; Department of General Practice & Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, v/d Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Elisabeth Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands ; Department of Paediatric Immunology and Infectious Diseases, Wilhelmina's Children Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Hester de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
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van Dorp CH, van Boven M, de Boer RJ. Immuno-epidemiological modeling of HIV-1 predicts high heritability of the set-point virus load, while selection for CTL escape dominates virulence evolution. PLoS Comput Biol 2014; 10:e1003899. [PMID: 25522184 PMCID: PMC4270429 DOI: 10.1371/journal.pcbi.1003899] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 09/07/2014] [Indexed: 02/07/2023] Open
Abstract
It has been suggested that HIV-1 has evolved its set-point virus load to be optimized for transmission. Previous epidemiological models and studies into the heritability of set-point virus load confirm that this mode of adaptation within the human population is feasible. However, during the many cycles of replication between infection of a host and transmission to the next host, HIV-1 is under selection for escape from immune responses, and not transmission. Here we investigate with computational and mathematical models how these two levels of selection, within-host and between-host, are intertwined. We find that when the rate of immune escape is comparable to what has been observed in patients, immune selection within hosts is dominant over selection for transmission. Surprisingly, we do find high values for set-point virus load heritability, and argue that high heritability estimates can be caused by the 'footprints' left by differing hosts' immune systems on the virus.
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Affiliation(s)
- Christiaan H. van Dorp
- Theoretical Biology and Bioinformatics, Universiteit Utrecht, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- * E-mail:
| | - Michiel van Boven
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Rob J. de Boer
- Theoretical Biology and Bioinformatics, Universiteit Utrecht, Utrecht, The Netherlands
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te Beest D, de Bruin E, Imholz S, Wallinga J, Teunis P, Koopmans M, van Boven M. Discrimination of influenza infection (A/2009 H1N1) from prior exposure by antibody protein microarray analysis. PLoS One 2014; 9:e113021. [PMID: 25405997 PMCID: PMC4236143 DOI: 10.1371/journal.pone.0113021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/19/2014] [Indexed: 11/17/2022] Open
Abstract
Reliable discrimination of recent influenza A infection from previous exposure using hemagglutination inhibition (HI) or virus neutralization tests is currently not feasible. This is due to low sensitivity of the tests and the interference of antibody responses generated by previous infections. Here we investigate the diagnostic characteristics of a newly developed antibody (HA1) protein microarray using data from cross-sectional serological studies carried out before and after the pandemic of 2009. The data are analysed by mixture models, providing a probabilistic classification of sera (susceptible, prior-exposed, recently infected). Estimated sensitivity and specificity for identifying A/2009 infections are low using HI (66% and 51%), and high when using A/2009 microarray data alone or together with A/1918 microarray data (96% and 95%). As a heuristic, a high A/2009 to A/1918 antibody ratio (>1.05) is indicative of recent infection, while a low ratio is indicative of a pre-existing response, even if the A/2009 titer is high. We conclude that highly sensitive and specific classification of individual sera is possible using the protein microarray, thereby enabling precise estimation of age-specific infection attack rates in the population even if sample sizes are small.
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Affiliation(s)
- Dennis te Beest
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Erwin de Bruin
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Sandra Imholz
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Peter Teunis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Marion Koopmans
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Viroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Te Beest DE, Henderson D, van der Maas NAT, de Greeff SC, Wallinga J, Mooi FR, van Boven M. Estimation of the serial interval of pertussis in Dutch households. Epidemics 2014; 7:1-6. [PMID: 24928663 DOI: 10.1016/j.epidem.2014.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/10/2014] [Accepted: 02/06/2014] [Indexed: 11/29/2022] Open
Abstract
Increasing incidence has led to the re-appearance of pertussis as a public health problem in developed countries. Pertussis infection is usually mild in vaccinated children and adults, but it can be fatal in infants who are too young for effective vaccination (≤3 months). Tailoring of control strategies to prevent infection of the infant hinges on the availability of estimates of key epidemiological quantities. Here we estimate the serial interval of pertussis, i.e., the time between symptoms onset in a case and its infector, using data from a household-based study carried out in the Netherlands in 2007-2009. We use statistical methodology to tie infected persons to probable infector persons, and obtain statistically supported stratifications of the data by person-type (infant, mother, father, sibling). The analyses show that the mean serial interval is 20 days (95% CI: 16-23 days) when the mother is the infector of the infant, and 28 days (95% CI: 23-33 days) when the infector is the father or a sibling. These time frames offer opportunities for early mitigation of the consequences of infection of an infant once a case has been detected in a household. If preventive measures such as social distancing or antimicrobial treatment are taken promptly they could decrease the probability of infection of the infant.
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Affiliation(s)
- Dennis E Te Beest
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands
| | | | - Nicoline A T van der Maas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands
| | - Frits R Mooi
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands.
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Abstract
Influenza epidemics in temperate regions show a characteristic seasonal pattern with peak incidence occurring in winter. Previous research has shown that low absolute humidity and school holidays can both affect influenza transmission. During an epidemic, transmission is strongly influenced by the depletion of susceptibles (i.e., increase in the number of those immune). To assess how much variability in influenza transmission intensity is due to each of these driving factors, we used a long time series of the number of weekly visits to general practitioners for influenzalike illness in the Netherlands from 1970-2011 and transformed this into a time series of weekly influenza reproduction numbers, which are a measure of transmission intensity. We used statistical regression techniques to quantify how the reproduction numbers were affected by each driving factor. We found a clear ranking of importance of driving factors in explaining the variation in transmission intensity. Most of the variation (30%) was explained by the depletion of susceptibles during the season, 27% was explained by between-season effects, and 3% was explained by absolute humidity. School holidays at the Christmas period did not have a statistically significant effect on influenza transmission. Although the influence of absolute humidity was small, its seasonal fluctuations may determine when sustained influenza transmission is possible and may thus drive influenza seasonality.
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Lugnér AK, van der Maas N, van Boven M, Mooi FR, de Melker HE. Cost-effectiveness of targeted vaccination to protect new-borns against pertussis: comparing neonatal, maternal, and cocooning vaccination strategies. Vaccine 2013; 31:5392-7. [PMID: 24075918 DOI: 10.1016/j.vaccine.2013.09.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 09/03/2013] [Accepted: 09/13/2013] [Indexed: 11/19/2022]
Abstract
Pertussis (whooping cough) is a severe infectious disease in infants less than 6 months old. Mass vaccination programmes have been unable to halt transmission effectively. Strategies to protect new-borns against infection include vaccination of the neonate or the mother directly after birth (cocooning), or the mother during pregnancy (maternal). Here we investigate the cost-effectiveness of these three strategies in the Netherlands. Costs for health care utilization and productivity losses, as well as impact on quality of life were calculated for a 10-year vaccination programme, assuming that vaccine-induced immunity lasts 5 years. Cocooning was the most attractive option from a cost-effectiveness viewpoint (€89,000/QALY). However, both cocooning and maternal vaccination would reduce the disease burden in infants and mothers vaccinated (about 17-20 QALY/year). Specifically, with a persistent epidemic as seen in 2012, there is need for reconsidering the vaccination schedules against pertussis in order to increase protection of the vulnerable new-borns.
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Affiliation(s)
- Anna K Lugnér
- Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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van Boven M, Ruijs WLM, Wallinga J, O'Neill PD, Hahné S. Estimation of vaccine efficacy and critical vaccination coverage in partially observed outbreaks. PLoS Comput Biol 2013; 9:e1003061. [PMID: 23658512 PMCID: PMC3642050 DOI: 10.1371/journal.pcbi.1003061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 03/28/2013] [Indexed: 11/18/2022] Open
Abstract
Classical approaches to estimate vaccine efficacy are based on the assumption that a person's risk of infection does not depend on the infection status of others. This assumption is untenable for infectious disease data where such dependencies abound. We present a novel approach to estimating vaccine efficacy in a Bayesian framework using disease transmission models. The methodology is applied to outbreaks of mumps in primary schools in the Netherlands. The total study population consisted of 2,493 children in ten primary schools, of which 510 (20%) were known to have been infected, and 832 (33%) had unknown infection status. The apparent vaccination coverage ranged from 12% to 93%, and the apparent infection attack rate varied from 1% to 76%. Our analyses show that vaccination reduces the probability of infection per contact substantially but not perfectly ([Formula: see text] = 0.933; 95CrI: 0.908-0.954). Mumps virus appears to be moderately transmissible in the school setting, with each case yielding an estimated 2.5 secondary cases in an unvaccinated population ([Formula: see text] = 2.49; 95%CrI: 2.36-2.63), resulting in moderate estimates of the critical vaccination coverage (64.2%; 95%CrI: 61.7-66.7%). The indirect benefits of vaccination are highest in populations with vaccination coverage just below the critical vaccination coverage. In these populations, it is estimated that almost two infections can be prevented per vaccination. We discuss the implications for the optimal control of mumps in heterogeneously vaccinated populations.
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Affiliation(s)
- Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Ypma RJF, Jonges M, Bataille A, Stegeman A, Koch G, van Boven M, Koopmans M, van Ballegooijen WM, Wallinga J. Genetic data provide evidence for wind-mediated transmission of highly pathogenic avian influenza. J Infect Dis 2012; 207:730-5. [PMID: 23230058 DOI: 10.1093/infdis/jis757] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Outbreaks of highly pathogenic avian influenza in poultry can cause severe economic damage and represent a public health threat. Development of efficient containment measures requires an understanding of how these influenza viruses are transmitted between farms. However, the actual mechanisms of interfarm transmission are largely unknown. Dispersal of infectious material by wind has been suggested, but never demonstrated, as a possible cause of transmission between farms. Here we provide statistical evidence that the direction of spread of avian influenza A(H7N7) is correlated with the direction of wind at date of infection. Using detailed genetic and epidemiological data, we found the direction of spread by reconstructing the transmission tree for a large outbreak in the Netherlands in 2003. We conservatively estimate the contribution of a possible wind-mediated mechanism to the total amount of spread during this outbreak to be around 18%.
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Affiliation(s)
- Rolf J F Ypma
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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Döpfer D, Holzhauer M, Boven MV. The dynamics of digital dermatitis in populations of dairy cattle: model-based estimates of transition rates and implications for control. Vet J 2012; 193:648-53. [PMID: 22878094 DOI: 10.1016/j.tvjl.2012.06.047] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Five groups of dairy cows affected by digital dermatitis were subjected to five different footbath strategies and evaluated at regular 3-weekly intervals. A standard protocol was used to record five different stages of disease from early (M1), acute ulcerative (M2), healing (M3) and chronic lesions (M4) in addition to the negative stage of disease (M0). The effect of the footbathing was evaluated using mathematical modelling for the transmission dynamics of infections and summarized using the reproduction ratio R(0). Sensitivity analysis for a range of parameters in the mathematical model showed that the speed of detecting acute lesions and the efficiency with which those lesions were treated were the key parameters which determined whether lesions became more severe or whether they healed.
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Affiliation(s)
- Dörte Döpfer
- Central Veterinary Institute, Animal Sciences Group of Wageningen University and Research, P.O. Box 65, 8200 AB Lelystad, The Netherlands.
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Lugnér AK, van Boven M, de Vries R, Postma MJ, Wallinga J. Cost effectiveness of vaccination against pandemic influenza in European countries: mathematical modelling analysis. BMJ 2012; 345:e4445. [PMID: 22791791 PMCID: PMC3395306 DOI: 10.1136/bmj.e4445] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether a single optimal vaccination strategy exists across countries to deal with a future influenza pandemic by comparing the cost effectiveness of different strategies in various pandemic scenarios for three European countries. DESIGN Economic and epidemic modelling study. SETTINGS General populations in Germany, the Netherlands, and the United Kingdom. DATA SOURCES Country specific patterns of social contact and demographic data. MODEL An age structured susceptible-exposed-infected-recovered transmission model that describes how an influenza A virus will spread in the populations of Germany, the Netherlands, and the United Kingdom. INTERVENTIONS Comparison of four vaccination strategies: no vaccination, blanket vaccination, vaccination of elderly people (≥ 65 years), and vaccination of high transmitters (5-19 years). The four strategies were evaluated for scenarios in which a vaccine became available early or at the peak of the pandemic, and in which either everyone was initially susceptible or older age groups had pre-existing immunity. MAIN OUTCOME MEASURE Cost per quality adjusted life years (QALYs) gained. RESULTS All vaccination strategies were cost effective (incremental cost per QALY gained, comparing intervention with non-intervention). In scenarios where the vaccine became available at the peak of the pandemic and there was pre-existing immunity among elderly people the incremental cost effectiveness ratios for vaccinating high transmitters were €7325 (£5815; $10,470) per QALY gained for Germany, €10,216 per QALY gained for the Netherlands, and €7280 per QALY gained for the United Kingdom. The most cost effective strategy not only differed across the pandemic scenarios but also between countries. Specifically, when the vaccine was available early in the pandemic and there was no pre-existing immunity, in Germany it would be most cost effective to vaccinate elderly people ( €940 per QALY gained), whereas it would be most cost effective to vaccinate high transmitters in both the Netherlands (€525 per QALY gained) and the United Kingdom (€163 per QALY gained). This difference in optimal strategies was due to differences in the demographic characteristics of the countries: Germany has a significantly higher proportion of elderly people compared with the Netherlands and the United Kingdom. CONCLUSIONS No single vaccination strategy was most cost effective across countries. With aging populations, pre-existing immunity in particular could be of crucial importance for the cost effectiveness of options to mitigate a future influenza pandemic.
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Affiliation(s)
- Anna K Lugnér
- Centre for Infectious Disease Control Netherlands, Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands.
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Steens A, Waaijenborg S, Teunis PFM, Reimerink JHJ, Meijer A, van der Lubben M, Koopmans M, van der Sande MAB, Wallinga J, van Boven M. Age-dependent patterns of infection and severity explaining the low impact of 2009 influenza A (H1N1): evidence from serial serologic surveys in the Netherlands. Am J Epidemiol 2011; 174:1307-15. [PMID: 22025354 DOI: 10.1093/aje/kwr245] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite considerable research efforts in specific subpopulations, reliable estimates of the infection attack rates and severity of 2009 influenza A (H1N1) in the general population remain scarce. Such estimates are essential to the tailoring of future control strategies. Therefore, 2 serial population-based serologic surveys were conducted, before and after the 2009 influenza A (H1N1) epidemic, in the Netherlands. Random age-stratified samples were obtained using a 2-stage cluster design. Participants donated blood and completed a questionnaire. Data on sentinel general practitioner-attended influenza-like illness and nationwide hospitalization and mortality were used to assess the severity of infection. The estimated infection attack rates were low in the general population (7.6%, 95% confidence interval: 3.6, 11) but high in children aged 5-19 years (35%, 95% confidence interval: 25, 45). The estimated hospitalization and mortality rates per infection increased significantly with age (5-19 years: 0.042% and 0.00094%, respectively; 20-39 years: 0.12% and 0.0025%; 40-59 years: 0.68% and 0.032%; 60-75 years: >0.81% and >0.068%). The high infection attack rate in children and the very low attack rate in older adults, together with the low severity of illness per infection in children but substantial severity in older adults, produced an epidemic with a low overall impact.
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Affiliation(s)
- Anneke Steens
- Centre for Infectious Disease Control, National Institute for Public Health and theEnvironment (RIVM), the Netherlands
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te Beest DE, Hagenaars TJ, Stegeman JA, Koopmans MPG, van Boven M. Risk based culling for highly infectious diseases of livestock. Vet Res 2011; 42:81. [PMID: 21714865 PMCID: PMC3160900 DOI: 10.1186/1297-9716-42-81] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 06/29/2011] [Indexed: 11/29/2022] Open
Abstract
The control of highly infectious diseases of livestock such as classical swine fever, foot-and-mouth disease, and avian influenza is fraught with ethical, economic, and public health dilemmas. Attempts to control outbreaks of these pathogens rely on massive culling of infected farms, and farms deemed to be at risk of infection. Conventional approaches usually involve the preventive culling of all farms within a certain radius of an infected farm. Here we propose a novel culling strategy that is based on the idea that farms that have the highest expected number of secondary infections should be culled first. We show that, in comparison with conventional approaches (ring culling), our new method of risk based culling can reduce the total number of farms that need to be culled, the number of culled infected farms (and thus the expected number of human infections in case of a zoonosis), and the duration of the epidemic. Our novel risk based culling strategy requires three pieces of information, viz. the location of all farms in the area at risk, the moments when infected farms are detected, and an estimate of the distance-dependent probability of transmission.
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Affiliation(s)
- Dennis E te Beest
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584 CL, Utrecht, The Netherlands.
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Poetri O, Bouma A, Claassen I, Koch G, Soejoedono R, Stegeman A, van Boven M. A single vaccination of commercial broilers does not reduce transmission of H5N1 highly pathogenic avian influenza. Vet Res 2011; 42:74. [PMID: 21635732 PMCID: PMC3132710 DOI: 10.1186/1297-9716-42-74] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 06/02/2011] [Indexed: 11/24/2022] Open
Abstract
Vaccination of chickens has become routine practice in Asian countries in which H5N1 highly pathogenic avian influenza (HPAI) is endemically present. This mainly applies to layer and breeder flocks, but broilers are usually left unvaccinated. Here we investigate whether vaccination is able to reduce HPAI H5N1 virus transmission among broiler chickens. Four sets of experiments were carried out, each consisting of 22 replicate trials containing a pair of birds. Experiments 1-3 were carried out with four-week-old birds that were unvaccinated, and vaccinated at day 1 or at day 10 of age. Experiment 4 was carried out with unvaccinated day-old broiler chicks. One chicken in each trial was inoculated with H5N1 HPAI virus. One chicken in each trial was inoculated with virus. The course of the infection chain was monitored by serological analysis, and by virus isolation performed on tracheal and cloacal swabs. The analyses were based on a stochastic SEIR model using a Bayesian inferential framework. When inoculation was carried out at the 28th day of life, transmission was efficient in unvaccinated birds, and in birds vaccinated at first or tenth day of life. In these experiments estimates of the latent period (~1.0 day), infectious period (~3.3 days), and transmission rate parameter (~1.4 per day) were similar, as were estimates of the reproduction number (~4) and generation interval (~1.4 day). Transmission was significantly less efficient in unvaccinated chickens when inoculation was carried out on the first day of life. These results show that vaccination of broiler chickens does not reduce transmission, and suggest that this may be due to the interference of maternal immunity.
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Affiliation(s)
- Okti Poetri
- Faculty of Veterinary Medicine, Department of Farm Animal Health, Utrecht, The Netherlands.
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Donker T, van Boven M, van Ballegooijen WM, Van't Klooster TM, Wielders CC, Wallinga J. Nowcasting pandemic influenza A/H1N1 2009 hospitalizations in the Netherlands. Eur J Epidemiol 2011; 26:195-201. [PMID: 21416274 PMCID: PMC3079092 DOI: 10.1007/s10654-011-9566-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 03/07/2011] [Indexed: 11/28/2022]
Abstract
During emerging epidemics of infectious diseases, it is vital to have up-to-date information on epidemic trends, such as incidence or health care demand, because hospitals and intensive care units have limited excess capacity. However, real-time tracking of epidemics is difficult, because of the inherent delay between onset of symptoms or hospitalizations, and reporting. We propose a robust algorithm to correct for reporting delays, using the observed distribution of reporting delays. We apply the algorithm to pandemic influenza A/H1N1 2009 hospitalizations as reported in the Netherlands. We show that the proposed algorithm is able to provide unbiased predictions of the actual number of hospitalizations in real-time during the ascent and descent of the epidemic. The real-time predictions of admissions are useful to adjust planning in hospitals to avoid exceeding their capacity.
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Affiliation(s)
- Tjibbe Donker
- National Institute for Public Health and Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands.
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te Beest DE, van Boven M, Bos MEH, Stegeman A, Koopmans MPG. Effectiveness of personal protective equipment and oseltamivir prophylaxis during avian influenza A (H7N7) epidemic, the Netherlands, 2003. Emerg Infect Dis 2011; 16:1562-8. [PMID: 20875281 PMCID: PMC3294382 DOI: 10.3201/eid1610.091412] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We analyzed the effectiveness of personal protective equipment and oseltamivir use during the 2003 avian influenza A (H7N7) epidemic in the Netherlands by linking databases containing information about farm visits, human infections, and use of oseltamivir and personal protective equipment. Using a stringent case definition, based on self-reported conjunctivitis combined with a positive hemagglutination-inhibition assay, we found that prophylactic treatment with oseltamivir significantly reduced the risk for infection per farm visit from 0.145 (95% confidence interval [CI] 0.078-0.233) to 0.031 (95% CI 0.008-0.073). The protective effect was ≈79% (95% CI 40%-97%). These results are comparable with the reported effect of prophylactic treatment with oseltamivir on human seasonal influenza. No significant protective effect was found for use of respirators or safety glasses, possibly because of limitations of the data.
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