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van Gemert JP, Ravensbergen SJ, Verschuuren EAM, Kerstjens HAM, Willemse BWM, van Ingen J, Hoefsloot W, Gan T, Akkerman OW. Non-tuberculous mycobacteria disease pre-lung transplantation: A systematic review of the treatment regimens and duration pre- and post-transplant. Transplant Rev (Orlando) 2023; 37:100800. [PMID: 37832509 DOI: 10.1016/j.trre.2023.100800] [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: 03/19/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND There is lack of consensus on non-tuberculous mycobacteria pulmonary disease (NTM-PD) treatment regimen and duration in patient listed for lung transplantation (LTx). We conducted a systematic review on treatment regimen and duration pre- and directly post-LTx, for patients with known NTM-PD pre-LTx. Additionally, we searched for risk factors for NTM disease development post-LTx and for mortality. METHODS Literature was reviewed on PubMed, Embase and the Cochrane Library, for articles published from inception to January 2022. Individual patient data were sought. RESULTS Sixteen studies were included reporting 92 patients. Most frequent used agents were aminoglycosides and macrolides for Mycobacterium abscessus (M. abscessus) and macrolides and tuberculostatic agents for Mycobacterium avium complex (M. avium complex). The median treatment duration pre-LTx was 10 months (IQR 6-17) and 2 months (IQR 2-8) directly post-LTx. Longer treatment duration pre-LTx was observed in children and in patients with M. abscessus. 46% of the patients with NTM-PD pre-LTx developed NTM disease post-LTx, related mortality rate was 10%. Longer treatment duration pre-LTx (p < 0.001) and sputum non-conversion pre-LTx (p = 0.003) were significantly associated with development of NTM-disease post-LTx. Longer treatment duration pre-LTx (p = 0.004), younger age (p < 0.001) and sputum non-conversion (p = 0.044) were risk factors for NTM related death. CONCLUSIONS The median treatment duration pre-LTx was 10 months (IQR 6-17) and 2 months (IQR 2-8) directly post-LTx. Patients with longer treatment duration for NTM-PD pre-LTx and with sputum non-conversion are at risk for NTM disease post-LTx and for NTM-related death. Children were particularly at risk for NTM related death.
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Affiliation(s)
- Johanna P van Gemert
- Department of pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Sofanne J Ravensbergen
- Department of pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Erik A M Verschuuren
- Department of pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Huib A M Kerstjens
- Department of pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Brigitte W M Willemse
- Department of Pediatric Pulmonology and Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jakko van Ingen
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wouter Hoefsloot
- Radboud Center of Infectious Diseases, Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tji Gan
- Department of pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Onno W Akkerman
- Department of pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, the Netherlands
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2
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Bouter DC, Ravensbergen SJ, Lakerveld J, Hoogendijk WJG, Grootendorst-van Mil NH. Associations between the urban environment and psychotic experiences in adolescents. Schizophr Res 2023; 260:123-131. [PMID: 37639836 DOI: 10.1016/j.schres.2023.08.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE In 2050 two-thirds of the world's population is predicted to live in cities, which asks for a better understanding of how the urban environment affects mental health. Urbanicity has repeatedly been found to be a risk factor, in particular for psychosis. Here, we explored what factors of the urban exposome underlie the association between urban characteristics and psychotic experiences (PE) in adolescents. METHODS Participants were 815 adolescents (mean age 14.84 years, SD 0.78) from an at-risk cohort (greater Rotterdam area, the Netherlands) oversampled on their self-reported emotional and behavioral problems. We used linear regression analysis to examine the association with detailed geodata on urbanicity (surrounding address density), green space density (high and low vegetation), and mixed noise levels (road, rail, air, industry, and wind power) with PE in adolescents. Analyses were adjusted for multiple socio-economic and parental confounders. Furthermore, we explored sex-interaction effects. RESULTS Higher surrounding address density and low greenspace density were each independently associated with more PE (B = 0.18, 95 % CI 0.02; 0.34 and B = 0.17, 95 % CI 0.01; 0.32, respectively). High mixed noise levels were only associated with more PE in boys (B = 0.23, 95 % CI 0.01; 0.46). A sex-interaction effect was found for high urbanicity (B = -0.46, 95 % CI -0.77; -0.14) and low greenspace density (B = -0.49, 95 % CI -0.73; -0.11), illustrating that these associations with PE were specific for boys. CONCLUSION Multiple characteristics of living in an urban area are associated with more PE in adolescent boys. Our observations provide leads for prevention of mental health problems via urban designing.
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Affiliation(s)
- D C Bouter
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - S J Ravensbergen
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - J Lakerveld
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands
| | - W J G Hoogendijk
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - N H Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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Aglanu LM, Amuasi JH, Prokesh E, Beyuo A, Dari CD, Ravensbergen SJ, Agbogbatey MK, Adobasom-Anane AG, Abass KM, Lalloo DG, Blessmann J, Kreuels B, Stienstra Y. Community members and healthcare workers' priorities for the control and prevention of snakebite envenoming in Ghana. PLoS Negl Trop Dis 2023; 17:e0011504. [PMID: 37478151 PMCID: PMC10395900 DOI: 10.1371/journal.pntd.0011504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/30/2023] [Revised: 08/02/2023] [Accepted: 07/05/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Snakebite is one of the most neglected tropical diseases. In Ghana, there has been a limited interest in snakebite envenoming research despite evidence of high human-snake conflicts. In an effort to meet the World Health Organisation's (WHO) 2030 snakebite targets, the need for research evidence to guide policy interventions is evident. However, in setting the research agenda, community and healthcare workers' priorities are rarely considered. METHODS Three categories of focus groups were formed in the Ashanti and Upper West regions of Ghana, comprising of community members with and without a history of snakebite and healthcare workers who manage snakebite patients. Two separate focus group discussions were conducted with each group in each region. Using the thematic content analysis approach, the framework method was adopted for the data analysis. A predefined 15-item list of potential snakebite-associated difficulties and the WHO's 2030 snakebite strategic key activities were ranked in order of priority based on the participants' individual assessment. RESULTS Both acute and chronic effects of snakebite such as bite site management, rehabilitation and mental health were prioritised by the community members. Health system challenges including training, local standard treatment protocols and clinical investigations on the efficacy of available antivenoms were identified as priorities by the healthcare workers. Notably, all the participant groups highlighted the need for research into the efficacy of traditional medicines and how to promote collaborative strategies between traditional and allopathic treatment practices. CONCLUSION The prioritisation of chronic snakebite envenoming challenges by community members and how to live and cope with such conditions accentuate the lack of post-hospital treatment follow-ups for both mental and physical rehabilitation. To improve the quality of life of patients, it is essential to involve grassroots stakeholders in the process of developing and prioritising future research agenda.
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Affiliation(s)
- Leslie Mawuli Aglanu
- University Medical Centre Groningen, Department of Internal Medicine/Infectious Diseases, University of Groningen, Groningen, The Netherlands
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - John Humphrey Amuasi
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
- Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Evie Prokesh
- University Medical Centre Groningen, Department of Internal Medicine/Infectious Diseases, University of Groningen, Groningen, The Netherlands
| | - Alexis Beyuo
- Department of Development Studies, Simon Diedong Dombo University of Business and Integrated Development Studies, Upper West Region, Wa, Ghana
| | | | - Sofanne J. Ravensbergen
- University Medical Centre Groningen, Department of Internal Medicine/Infectious Diseases, University of Groningen, Groningen, The Netherlands
| | - Melvin Katey Agbogbatey
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Austin Gideon Adobasom-Anane
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
- Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - David G. Lalloo
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jörg Blessmann
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Benno Kreuels
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Division for Tropical Medicine, Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ymkje Stienstra
- University Medical Centre Groningen, Department of Internal Medicine/Infectious Diseases, University of Groningen, Groningen, The Netherlands
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Remmelzwaal PC, Ravensbergen SJ, Vos A. [A female patient with acute pain in the right flank]. Ned Tijdschr Geneeskd 2021; 165:D6227. [PMID: 34854636] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This case concerns a 60-years-old female patient with recurrent urinary tract infections, who developed acute abdominal pain. CT scanning revealed a hydronephrosis based on obstruction caused by the indwelling catheter tip, which had advanced into the distal ureter. By pulling the catheter 2 cm outwards, the complaints were relieved instantaneously.
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Affiliation(s)
| | - Sofanne J Ravensbergen
- Universitair Medisch Centrum Groningen (tevensTreantZorggroep, Scheper ziekenhuis, Emmen)
| | - Anja Vos
- TreantZorggroep, Scheper ziekenhuis, Emmen
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5
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Louka C, Ravensbergen SJ, Ott A, Zhou X, García-Cobos S, Friedrich AW, Pournaras S, Rosema S, Rossen JW, Stienstra Y, Bathoorn E. Predominance of CTX-M-15-producing ST131 strains among ESBL-producing Escherichia coli isolated from asylum seekers in the Netherlands. J Antimicrob Chemother 2021; 76:70-76. [PMID: 33009805 PMCID: PMC7729386 DOI: 10.1093/jac/dkaa395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/04/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Numerous studies show increased prevalence of MDR bacteria amongst asylum seekers, but data on the molecular profiles of such strains are limited. We aimed to evaluate the molecular profiles of ESBL-producing Escherichia coli (ESBL-E. coli) strains isolated from asylum seekers and investigate their phylogenetic relatedness. Methods WGS data of ESBL-E. coli isolates from asylum seekers, retrieved from 1 January to 31 December 2016, were analysed to assess MLST STs, fim types, phylogroups and resistance genes. Fifty-two ESBL-E. coli isolates from the Dutch–German border region were used for genome comparison purposes as a control group. Results Among 112 ESBL-E. coli isolates from asylum seekers, originating mostly from Syria (n = 40) and Iraq (n = 15), the majority belonged to ST131 (21.4%) and ST10 (17.0%). The predominant gene for β-lactam resistance was blaCTX-M-15 (67.9%), followed by the often co-detected blaTEM-1B (39.3%). No mcr or carbapenemase genes were detected. The majority of the strains belonged to phylogroups B2 (38.4%) and A (32.1%), carrying fimH27 (25%) and fimH30 (19.6%). A core genome MLST minimum spanning tree did not reveal clusters containing strains from the asylum seekers and the control group. Five clusters were formed within the asylum seeker group, by strains isolated from people originating from different countries. Conclusions The most frequently isolated clones in this study were isolated on a regular basis within the Dutch population before the increase in the asylum seeker population. No mcr- or carbapenemase-producing clones were detected among the asylum seeker population. Minor clustering was observed amongst the asylum seeker strains.
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Affiliation(s)
- Christina Louka
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.,ESCMID Study Group for Infections in Travellers and Migrants, Basel, Switzerland
| | - Sofanne J Ravensbergen
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.,ESCMID Study Group for Infections in Travellers and Migrants, Basel, Switzerland
| | - Alewijn Ott
- Department of Medical Microbiology and Infection Prevention, Certe, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands
| | - Xuewei Zhou
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands
| | - Silvia García-Cobos
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands
| | - Alexander W Friedrich
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands
| | - Spyros Pournaras
- Department of Medical Microbiology, 'ATTIKON' University Hospital of Athens, Athens, Greece
| | - Sigrid Rosema
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands
| | - John W Rossen
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands
| | - Ymkje Stienstra
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.,ESCMID Study Group for Infections in Travellers and Migrants, Basel, Switzerland
| | - Erik Bathoorn
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands
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6
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Louka C, Chandler E, Ranchor AV, Broer H, Pournaras S, Ravensbergen SJ, Stienstra Y. Asylum seekers' perspectives on vaccination and screening policies after their arrival in Greece and The Netherlands. PLoS One 2019; 14:e0226948. [PMID: 31877563 PMCID: PMC6932865 DOI: 10.1371/journal.pone.0226948] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/10/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction Europe has been dealing with an increasing number of refugees during the past 5 years. The timing of screening and vaccination of refugees is debated by many professionals, however refugees’ perspectives on health issues are infrequently taken into account. In this study, we aimed to investigate asylum seekers’ perspectives on infectious diseases screening and vaccination policies. Materials and methods Interviews were conducted in Greece and the Netherlands. Asylum seekers and recently arrived refugees were approached and informed with the help of interpreters; consent forms were acquired. The survey focused on demographic data, vaccination status, screening policies and prevention of infectious diseases. Results A total of 61 (43 male, 70.5%) refugees (30 Afghanis, 16 Syrian, 7 Erithrean) were interviewed. Mean age was 35.2 years (SD 13.5) and 50% had received primary or secondary education, while 24.6% received none. Median time after arrival in Greece and the Netherlands was 24 months (IQR 8.5–28). 44 out of 61 (72.1) participants were willing to be vaccinated after arrival in Europe, 26 preferred vaccination and screening to be performed at the point of entry. The need for screening and vaccination was perceived higher amongst participants in Greece (100% vs 43.3%) due to living conditions leading to increased risk of outbreaks. Conclusion Participants were willing to communicate their perspectives and concerns. Screening and vaccination programs could be more effective when implemented shortly after arrival and by involving asylum seekers and refugees when developing screening and vaccination interventions.
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Affiliation(s)
- Christina Louka
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- ESCMID study group for infections in travelers and migrants, Basel, Switzerland
- * E-mail:
| | - Elizabeth Chandler
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Adelita V. Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Spyros Pournaras
- Laboratory of Clinical Microbiology, ‘ATTIKON’ University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofanne J. Ravensbergen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- ESCMID study group for infections in travelers and migrants, Basel, Switzerland
| | - Ymkje Stienstra
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- ESCMID study group for infections in travelers and migrants, Basel, Switzerland
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7
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Stienstra Y, Beeres DT, Phillips R, Vonk M, Ravensbergen SJ. The public health control of scabies: priorities for research and action. Lancet 2019; 394:2068. [PMID: 31818403 DOI: 10.1016/s0140-6736(19)32479-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/31/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Ymkje Stienstra
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen 9713, Netherlands.
| | - Dorien T Beeres
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Machiel Vonk
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sofanne J Ravensbergen
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen 9713, Netherlands
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Ravensbergen SJ, Louka C, Ott A, Rossen JW, Cornish D, Pournaras S, Bathoorn E, Stienstra Y. Proportion of asylum seekers carrying multi-drug resistant microorganisms is persistently increased after arrival in the Netherlands. Antimicrob Resist Infect Control 2019; 8:6. [PMID: 30637100 PMCID: PMC6323800 DOI: 10.1186/s13756-018-0455-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 10/15/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022] Open
Abstract
Background Several studies have shown a high prevalence of multi-drug resistant organisms (MDRO) amongst asylum seekers when compared to the general population. The aim of this study is to assess the duration of MDRO carriage in this population. Methods Data were retrospectively collected between January 1st 2014 through December 31st 2016. Study material included screening samples for MDRO carriage and clinical samples from asylum seekers in need of medical care. The study focused on methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug resistant Enterobacteriaceae (MDRE). The rates of MRSA and MDRE detected were calculated every four weeks after arrival in the Netherlands. Results Samples from 2091 asylum seekers were included. 1270 (60.7%) were female, median age was 26 years (IQR 20–34) and median number of days in the Netherlands until first sample was 67 (IQR 4–235). In the patients’ first obtained samples, the rate of MRSA varied between 4.5 and 13.0% per time interval after arrival. The rate of MDRE fluctuated between 7.4% and 25.0%. No particular decline in positivity rates in first obtained samples was observed after arrival in the Netherlands. In the group of asylum seekers who arrived more than one year ago, MRSA was isolated in a percentage of 5.1% (n = 273, median months after arrival 34.1 (IQR 16.5–63.1)) and MDRE in 9.4% (n = 276, median months after arrival 35.4 (IQR 17–65)). Conclusion To our knowledge, this is the first study demonstrating that carriage rate of MDRO in asylum seekers remains high even after prolonged stay in the Netherlands. Longitudinal data on MDRO carriage after arrival in countries with a low MDRO prevalence are needed to determine optimal screening strategies, infection control measures and empirical antibiotic therapy.
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Affiliation(s)
- Sofanne J Ravensbergen
- 1University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.,2ESCMID study group for infections in travelers and migrants, Basel, Switzerland
| | - Christina Louka
- 1University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.,2ESCMID study group for infections in travelers and migrants, Basel, Switzerland
| | - Alewijn Ott
- 3Department of Medical Microbiology, Certe, Groningen, The Netherlands
| | - John W Rossen
- 2ESCMID study group for infections in travelers and migrants, Basel, Switzerland.,4University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, University of Groningen, Groningen, The Netherlands.,5ESCMID study group for genomic and molecular diagnostics, Basel, Switzerland
| | - Darren Cornish
- Babylon Primary Health Care Services, Elst, The Netherlands
| | - Spyros Pournaras
- 7'ATTIKON' University Hospital, Kapodistrian University of Athens, Athens, Greece
| | - Erik Bathoorn
- 4University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, University of Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- 1University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands.,2ESCMID study group for infections in travelers and migrants, Basel, Switzerland
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9
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Ravensbergen SJ, Nellums LB, Hargreaves S, Stienstra Y, Friedland JS. National approaches to the vaccination of recently arrived migrants in Europe: A comparative policy analysis across 32 European countries. Travel Med Infect Dis 2019; 27:33-38. [PMID: 30336255 PMCID: PMC6370981 DOI: 10.1016/j.tmaid.2018.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 06/14/2018] [Revised: 10/11/2018] [Accepted: 10/14/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Migrants may be underimmunised and at higher risk of vaccine-preventable diseases, yet there has been no comprehensive examination of what policies are currently implemented across Europe targeting child and adult migrants. We analysed vaccination policies for migrants in 32 EU/EEA countries and Switzerland. METHODS Using framework analysis, we did a comparative analysis of national policies and guidelines pertaining to vaccination in recently arrived migrants through a systematic guideline and literature review and by approaching national experts. RESULTS Six (18.8%) of 32 countries had comprehensive policies specific to the vaccination of migrants (two focused only on child migrants, four on both adults and children). Nineteen (59.4%) countries applied their national vaccination schedule for migrant vaccinations, predominantly focusing on children; and five (15.6%) countries had circulated additional migrant-specific resources to relevant health-care providers. In six (18.8%) countries, policies on migrant vaccination focused on outbreak-specific vaccines only. In ten (31.3%) countries, policies focused on priority vaccinations, with polio being the vaccine most commonly administered and heterogeneity noted in vaccines recommended to adults, adolescents, and children. Eighteen (56.3%) countries recommended that an individual should be considered as unvaccinated where vaccination records were missing, and vaccines re-administered. Nine (28.1%) countries reported that specific vaccinations were mandatory. CONCLUSION There is considerable variation in policies across Europe regarding approaches to vaccination in adult and child migrants, and a lack of clarity on optimum ways forward, what vaccines to offer, with a need for robust research in this area. More emphasis must be placed on ensuring migrant-specific guidance is disseminated to front-line healthcare professionals to improve vaccine delivery and uptake in diverse migration populations across the region.
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Affiliation(s)
- Sofanne J Ravensbergen
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Laura B Nellums
- Institute for Infection and Immunity, St George's, University of London, London, WC1E 7HU, UK; Section of Infectious Diseases & Immunity, Imperial College London, London, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, WC1E 7HU, UK; Section of Infectious Diseases & Immunity, Imperial College London, London, UK.
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jon S Friedland
- Institute for Infection and Immunity, St George's, University of London, London, WC1E 7HU, UK; Section of Infectious Diseases & Immunity, Imperial College London, London, UK
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10
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Hargreaves S, Nellums LB, Ravensbergen SJ, Friedland JS, Stienstra Y. Divergent approaches in the vaccination of recently arrived migrants to Europe: a survey of national experts from 32 countries, 2017. Euro Surveill 2018; 23:1700772. [PMID: 30326996 PMCID: PMC6194906 DOI: 10.2807/1560-7917.es.2018.23.41.1700772] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 11/17/2017] [Accepted: 06/14/2018] [Indexed: 12/13/2022] Open
Abstract
BackgroundMigrants within the European Union and European Economic Area (EU/EEA) may be underimmunised and lack documentation on previous vaccinations. We investigated approaches to vaccination in recently arrived adult and child migrants, and guideline availability and implementation. Methods: Between March and May 2017, a national vaccination expert from every EU/EEA country and Switzerland completed an electronic questionnaire. We used descriptive analyses to calculate percentages, and framework analysis to synthesise free-text responses. Results: We approached 32 countries (response rate 100%). Although 28 experts reported vaccination guidance at national level, specific guidelines for recently arrived migrants were only available in six countries and not consistently implemented. Twenty-three countries administered vaccinations during on-arrival health checks. Most experts recommended multiple vaccination opportunities be made available: at point of entry (n = 13) or at holding level (reception centres, migrant camps, detention centres) (n = 21). In 30 countries, child migrants without evidence of previous vaccination were re-vaccinated according to the national schedule. Diphtheria-pertussis-tetanus and polio vaccinations were given to migrant children in all countries, measles-mumps-rubella (MMR) in 31 countries, hepatitis B vaccination in 25. Low levels of catch-up vaccination were reported in adult migrants, with only 13 countries offering MMR and 10 countries charging fees. Conclusion: Existing guidance is often not migrant-specific and may not be applied in practice; clarification is needed on which vaccines should be given. Strategies are needed specifically for catch-up vaccination in adult migrants. Vaccinations should be offered in multiple settings, free of charge, with sufficient guidance and training provided to front-line healthcare professionals.
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Affiliation(s)
- Sally Hargreaves
- These authors are joint first authors
- The Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
- The International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom
| | - Laura B Nellums
- These authors are joint first authors
- The Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
- The International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom
| | - Sofanne J Ravensbergen
- These authors are joint first authors
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jon S Friedland
- The Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
- The International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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11
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Beeres DT, Ravensbergen SJ, Heidema A, Cornish D, Vonk M, Wijnholds LD, Hendriks JJH, Kleinnijenhuis J, Omansen TF, Stienstra Y. Efficacy of ivermectin mass-drug administration to control scabies in asylum seekers in the Netherlands: A retrospective cohort study between January 2014 - March 2016. PLoS Negl Trop Dis 2018; 12:e0006401. [PMID: 29771941 PMCID: PMC5957329 DOI: 10.1371/journal.pntd.0006401] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 11/21/2017] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
Scabies is a skin infestation with the mite Sarcoptes scabiei causing itch and rash and is a major risk factor for bacterial skin infections and severe complications. Here, we evaluated the treatment outcome of 2866 asylum seekers who received (preventive) scabies treatment before and during a scabies intervention programme (SIP) in the main reception centre in the Netherlands between January 2014 and March 2016. A SIP was introduced in the main national reception centre based on frequent observations of scabies and its complications amongst Eritrean and Ethiopian asylum seekers in the Netherlands. On arrival, all asylum seekers from Eritrea or Ethiopia were checked for clinical scabies signs and received ivermectin/permethrin either as prevention or treatment. A retrospective cohort study was conducted to compare the reinfestations and complications of scabies in asylum seekers who entered the Netherlands before and during the intervention and who received ivermectin/permethrin. In total, 2866 asylum seekers received treatment during the study period (January 2014 –March 2016) of which 1359 (47.4%) had clinical signs of scabies. During the programme, most of the asylum seekers with scabies were already diagnosed on arrival as part of the SIP screening (580 (64.7%) of the 897). Asylum seekers with more than one scabies episode reduced from 42.0% (194/462) before the programme to 27.2% (243/897) during the programme (RR = 0.64, 95% CI = 0.55–0.75). Development of scabies complications later in the asylum procedure reduced from 12.3% (57/462) to 4.6% (41/897). A scabies prevention and treatment programme at start of the asylum procedure was feasible and effective in the Netherlands; patients were diagnosed early and risk of reinfestations and complications reduced. To achieve a further decrease of scabies, implementation of the programme in multiple asylum centres may be needed. The high number of asylum seekers arriving in Europe between 2014 and 2016 emphasized the importance to expand knowledge on best practice regarding health care provision and control of infectious diseases that may come with migration. Adequate control of scabies is important to prevent severe forms of scabies and prevent spread of the disease. Studies on interventions preventing or treating scabies in asylum seekers are very limited. To the best of our knowledge, this is the first study that provides data on an intervention targeting scabies in asylum seekers. This study shows that a scabies prevention and treatment programme at start of the asylum procedure is feasible and effective in the Netherlands. Patients were diagnosed early and risk of reinfestations and complications reduced. The programme may be used both to improve clinical practice and could serve as model for future policies on similar programmes.
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Affiliation(s)
- Dorien T. Beeres
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sofanne J. Ravensbergen
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
- * E-mail:
| | - Annelies Heidema
- Primary Health Care Centre for Asylum Seekers (GCA), Ter Apel, The Netherlands
| | - Darren Cornish
- Babylon Primary Health Care Services, Elst, The Netherlands
| | - Machiel Vonk
- Municipal health Care Centre Groningen, Groningen, The Netherlands
| | | | - Jessica J. H. Hendriks
- Health Care Service for Asylum seekers (Gezondheidscentrum Asielzoekers), Wageningen, The Netherlands
| | - Johanneke Kleinnijenhuis
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
| | - Till F. Omansen
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
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12
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Beeres DT, Cornish D, Vonk M, Ravensbergen SJ, Maeckelberghe ELM, Boele Van Hensbroek P, Stienstra Y. Screening for infectious diseases of asylum seekers upon arrival: the necessity of the moral principle of reciprocity. BMC Med Ethics 2018; 19:16. [PMID: 29499693 PMCID: PMC5834863 DOI: 10.1186/s12910-018-0256-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
Background With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition ‘to return good in proportion to the good we receive, and to make reparations for the harm we have done’, as a mid-level principle in infectious disease screening policies. Main text More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers’ participation and the benefits for the control of public health. Conclusion The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases.
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Affiliation(s)
- Dorien T Beeres
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Darren Cornish
- Babylon Primary Health Care Services, Elst, Groningen, The Netherlands
| | - Machiel Vonk
- Department of Infectious Diseases, Regional Public Health Service Groningen, Groningen, The Netherlands
| | - Sofanne J Ravensbergen
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Els L M Maeckelberghe
- Institute for Medical Education, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter Boele Van Hensbroek
- Faculty of Philosophy, Department of Ethics, Social and Political Philosophy, University of Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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13
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Ravensbergen SJ, Louka C, Lokate M, Bathoorn E, Pournaras S, van der Werf TS, de Lange WCM, Stienstra Y, Akkerman OW. Case Report: Carbapenemase-Producing Enterobacteriaceae in an Asylum Seeker with Multidrug-Resistant Tuberculosis. Am J Trop Med Hyg 2018; 98:376-378. [PMID: 29280429 PMCID: PMC5929199 DOI: 10.4269/ajtmh.17-0544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/10/2017] [Indexed: 03/27/2024] Open
Abstract
A Syrian asylum seeker with multidrug-resistant tuberculosis (TB) developed a bronchopleural fistula after pneumonectomy. Although screening tests were negative on admission, carbapenemase-producing Enterobacteriaceae were cultured after a few months of TB treatment. Prevalence of multidrug-resistant organisms is reported to be increased in asylum seekers compared with the general Dutch population. Arduous conditions during transit and interrupted health care delivery in our patient led to multiple-resistant microorganisms that complicated treatment.
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Affiliation(s)
- Sofanne J. Ravensbergen
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Christina Louka
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
- Department of Medical Microbiology, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Mariëtte Lokate
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Erik Bathoorn
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Spyros Pournaras
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Tjip S. van der Werf
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wiel C. M. de Lange
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, The Netherlands
| | - Ymkje Stienstra
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Onno W. Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, The Netherlands
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14
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Ravensbergen SJ, Berends M, Stienstra Y, Ott A. High prevalence of MRSA and ESBL among asylum seekers in the Netherlands. PLoS One 2017; 12:e0176481. [PMID: 28441421 PMCID: PMC5404783 DOI: 10.1371/journal.pone.0176481] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 11/10/2016] [Accepted: 04/11/2017] [Indexed: 11/19/2022] Open
Abstract
Migration is one of the risk factors for the spread of multidrug-resistant organisms (MDRO). The increasing influx of migrants challenges local health care systems. To provide evidence for both hospital hygiene measure and empirical antibiotic therapy, we analysed all cultures performed in asylum seekers between January 1st 2014 and December 31st 2015 for methicillin resistant Staphylococcus aureus (MRSA) and for multidrug-resistant Enterobacteriaceae (MDRE). We compared these with cultures from the Dutch patient population with risk factors for carriage of MDRO. A total of 7181 patients were screened for MRSA. 7357 S. aureus were isolated in clinical cultures. Of 898 screened asylum seekers, almost 10% were MRSA positive. Of 118 asylum seekers with S. aureus in clinical cultures almost 19% were MRSA positive. The general patient population had a 1.3% rate of MRSA in S. aureus isolates. A higher rate of Panton-Valentine leukocidin (PVL) positive strains (RR: 2.4; 95% CI: 1.6-3.4) was found in asylum seekers compared to the general patient population. In 33475 patients one or more Enterobacteriaceae were obtained. More than 21% of the asylum seekers were carrier of MDRE, most of them producing extended spectrum beta-lactamases (20.3%). 5.1% of the general patient population was MDRE carrier. It can be concluded that asylum seekers present with higher rate of MDRO compared to the general patient population. These results justify continued screening of asylum seekers to anticipate multidrug-resistant organisms during hospital care of patients.
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Affiliation(s)
- Sofanne J. Ravensbergen
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- * E-mail:
| | - Matthijs Berends
- Department of Medical Microbiology, Certe, Groningen, the Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Alewijn Ott
- Department of Medical Microbiology, Certe, Groningen, the Netherlands
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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15
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Ravensbergen SJ, Lokate M, Cornish D, Kloeze E, Ott A, Friedrich AW, van Hest R, Akkerman OW, de Lange WC, van der Werf TS, Bathoorn E, Stienstra Y. High Prevalence of Infectious Diseases and Drug-Resistant Microorganisms in Asylum Seekers Admitted to Hospital; No Carbapenemase Producing Enterobacteriaceae until September 2015. PLoS One 2016; 11:e0154791. [PMID: 27144599 PMCID: PMC4856320 DOI: 10.1371/journal.pone.0154791] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 12/29/2015] [Accepted: 04/19/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction The current refugee crisis emphasizes the need for information on infectious diseases and resistant microorganisms in asylum seekers with possible consequences for public health and infection control. Methods We collected data from asylum seekers admitted to our university hospital or who presented at the Emergency Department (n = 273). We collected general and demographic characteristics including country of origin, the reason of presentation, and the screening results of multi-drug resistant organisms. Results 67% of the patients were male with a median age of the study group of 24 years (IQR 15–33); 48% of the patients had an infectious disease—predominantly malaria with P. vivax or tuberculosis. Patients also reported with diseases which are less common—e.g. leishmaniasis, or even conditions rarely diagnosed in Europe—e.g. louse borne relapsing fever. A carriage rate of 31% for multi-drug resistant microorganisms (MDRO) was observed, with ESBL-expressing E.coli (n = 20) being the most common MDRO. No carriage of Carbapenemase Producing Enterobacteriaceae was found. Conclusion The current refugee crisis in Europe challenges hospitals to quickly identify and respond to communicable diseases and the carriage of MDRO. A rapid response is necessary to optimize the treatment of infectious diseases amongst asylum seekers to maximize infection control.
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Affiliation(s)
- Sofanne J. Ravensbergen
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Mariëtte Lokate
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Darren Cornish
- Primary Health Care Centre for Asylum Seekers (Gezondheidscentrum Asielzoekers), Ter Apel, The Netherlands
| | - Eveline Kloeze
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Alewijn Ott
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Medical Microbiology, Certe, Groningen, The Netherlands
| | - Alex W. Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rob van Hest
- Department of Tuberculosis Control, Regional Public Health Service Groningen, Groningen, The Netherlands
| | - Onno W. Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Wiel C. de Lange
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Tjip S. van der Werf
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Erik Bathoorn
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- * E-mail:
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