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van Bilsen CJA, Brinkhues S, Hoebe CJPA, Stabourlos C, Moonen CPB, Demarest S, Hanssen DAT, van Loo IHM, Savelkoul PHM, Philippsen D, van der Zanden BAM, Dukers-Muijrers NHTM. Cross-border mobility in the Meuse-Rhine Euroregion: impact of COVID-19 border restrictions on everyday activities and visiting social network members. Front Public Health 2024; 12:1281072. [PMID: 38726234 PMCID: PMC11079879 DOI: 10.3389/fpubh.2024.1281072] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Cross-border mobility (CBM) to visit social network members or for everyday activities is an important part of daily life for citizens in border regions, including the Meuse-Rhine Euroregion (EMR: neighboring regions from the Netherlands, Belgium, and Germany). We assessed changes in CBM during the COVID-19 pandemic and how participants experienced border restrictions. Methods Impact of COVID-19 on the EMR' is a longitudinal study using comparative cross-border data collection. In 2021, a random sample of the EMR-population was invited for participation in online surveys to assess current and pre-pandemic CBM. Changes in CBM, experience of border restrictions, and associated factors were analyzed using multinomial and multivariable logistic regression analysis. Results Pre-pandemic, 82% of all 3,543 participants reported any CBM: 31% for social contacts and 79% for everyday activities. Among these, 26% decreased social CBM and 35% decreased CBM for everyday activities by autumn 2021. Negative experience of border restrictions was reported by 45% of participants with pre-pandemic CBM, and was higher (p < 0.05) in Dutch participants (compared to Belgian; aOR= 1.4), cross-border [work] commuters (aOR= 2.2), participants with cross-border social networks of friends, family or acquaintances (aOR= 1.3), and those finding the measures 'limit group size' (aOR= 1.5) and 'minimalize travel' (aOR= 2.0) difficult to adhere to and finding 'minimalize travel' (aOR= 1.6) useless. Discussion CBM for social contacts and everyday activities was substantial in EMR-citizens, but decreased during the pandemic. Border restrictions were valued as negative by a considerable portion of EMR-citizens, especially when having family or friends across the border. When designing future pandemic control strategies, policy makers should account for the negative impact of CBM restrictions on their citizens.
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Affiliation(s)
- Céline J. A. van Bilsen
- Department of Social Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, Netherlands
| | - Stephanie Brinkhues
- Department of Knowledge & Innovation, Public Health Service South Limburg, Heerlen, Netherlands
| | - Christian J. P. A. Hoebe
- Department of Social Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, Netherlands
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | | | - Chrissy P. B. Moonen
- Department of Social Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, Netherlands
| | - Stefaan Demarest
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Daniëlle A. T. Hanssen
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Care and Primary Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Inge H. M. van Loo
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Care and Primary Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Paul H. M. Savelkoul
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Care and Primary Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Dirk Philippsen
- Gesundheitsberichterstattung, Gesundheitsamt Düren, Düren, Germany
| | | | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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van Bilsen CJA, Stabourlos C, Moonen CPB, Brinkhues S, Demarest S, Hanssen DAT, van Loo IHM, Savelkoul PHM, Philippsen D, van der Zanden BAM, Dukers-Muijrers NHTM, Hoebe CJPA. Differences in non-positive intention to accept the COVID-19 booster vaccine between three countries in the cross-border region Meuse-Rhine Euroregion: The Netherlands, Belgium, and Germany. Vaccine X 2023; 14:100306. [PMID: 37113740 PMCID: PMC10116119 DOI: 10.1016/j.jvacx.2023.100306] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
COVID-19 booster vaccination has shown to add to the protection against infection with SARS-CoV2 and subsequent severe disease. This longitudinal cross-border study aimed to identify factors associated with COVID-19 booster vaccine intentions in an initially vaccinated adult population living in the Meuse-Rhine Euroregion (EMR; including the Netherlands, Belgium, and Germany) and differences between countries. Data collection took place in autumn of 2021 and consisted of online questionnaires sent to a random sample of the population based on governmental registries. Data from 3,319 fully and partially vaccinated adults were used to examine determinants of non-positive intention for a booster vaccination (i.e., uncertain or do not want), using multivariable logistic regression analyses weighted by age group, sex, and country. Compared to German residents, Dutch residents (OR = 2.4) and Belgian residents (OR = 1.4) were more likely to be uncertain or not want to receive a booster vaccine in September-October 2021. Factors independently associated with non-positive intention were female sex (OR = 1.6), absence of comorbidities (OR = 1.3), time since last vaccination less than 3 months ago for those fully vaccinated (OR = 1.6), being partially vaccinated (OR = 3.6), a negative experience with communication of COVID-19 measures (OR = 2.2), and regarding measures as ineffective (OR = 1.1). Results indicate that booster vaccine intentions differ between countries in the cross border Meuse-Rhine Euroregion. Non-positive intention for the booster vaccine is prevalent in all three countries of the EMR, but to a different extent, as shown in this study. Cross-border collaboration and sharing information and knowledge about vaccination strategies could play a role in limiting the impact of COVID-19.
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Affiliation(s)
- Céline J A van Bilsen
- Department of Social Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Public Health Service South Limburg, Heerlen, the Netherlands
| | | | - Chrissy P B Moonen
- Department of Social Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Public Health Service South Limburg, Heerlen, the Netherlands
| | - Stephanie Brinkhues
- Department of Knowledge & Innovation, Public Health Service South Limburg, Heerlen, the Netherlands
| | - Stefaan Demarest
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Daniëlle A T Hanssen
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- Care and Primary Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Inge H M van Loo
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- Care and Primary Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Paul H M Savelkoul
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
- Care and Primary Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Dirk Philippsen
- Gesundheitsberichterstattung, Gesundheitsamt Düren, Düren, Germany
| | | | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Public Health Service South Limburg, Heerlen, the Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Christian J P A Hoebe
- Department of Social Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Public Health Service South Limburg, Heerlen, the Netherlands
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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Stabourlos C, van Bilsen CJA, Brinkhues S, Moonen CPB, Demarest S, Hanssen DAT, van Loo IHM, Savelkoul PHM, Philippsen D, van der Zanden BAM, Dukers-Muijrers NHTM, Hoebe CJPA. COVID-19 pandemic response in the Meuse-Rhine Euroregion: methods, participation and recommendations of a longitudinal cross-border study. Arch Public Health 2023; 81:91. [PMID: 37179369 PMCID: PMC10182536 DOI: 10.1186/s13690-023-01102-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Comparative data collection in transborder areas can contribute to informed decision making processes when dealing with borderless health threats such as pandemics, and thus help minimize the negative health effects for its citizens. To examine the pandemic response over time and the impact of infectious disease control in a cross-border setting, a prospective longitudinal study was conducted in the border area between Germany, Belgium and the Netherlands. In the spring of 2021, a random sample of 26,925 adult citizens selected from governmental registries was invited to collect a blood sample at home for SARS-CoV-2 antibody testing and to fill in an online questionnaire on attitudes and behaviour towards infection prevention measures, cross-border mobility, social network and support, COVID-19 self-reported infection(s) and symptoms, vaccination, general self-reported health and socio-demographics. In autumn 2021, participants were invited for a follow-up round. An online tool was developed to coordinate fieldwork procedures, real-time monitoring of participation and consultation of antibody test results. Furthermore, a helpdesk in all three languages for participants' support was set up. RESULTS In the first round, 6,006 citizens in the Meuse-Rhine Euroregion participated. 15.3% of the invited citizens on the Belgian side of the border participated. In the Netherlands and Germany this was respectively 27% and 23.7%. In the follow-up round 4,286 (71.4%) citizens participated for the second time. The participation rate was highest in the age group 50-69 years and lowest in > 80 in all sub regions of the Meuse-Rhine Euroregion. More women participated than men. Overall, more blood samples were returned than completed questionnaires. In total, 3,344 citizens in the Meuse-Rhine Euroregion completed all components of participation in both rounds. CONCLUSIONS The collection of comparative data can help better assess the pandemic response and the impact of infectious disease control in a cross-border area. Recommendations for a longitudinal cross-border study include a centralized online environment, mapping out potential challenges related to national regulations in the preparation phase and organizing regional coordination centres to create more familiarity and trust towards the involved organisations.
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Affiliation(s)
- C Stabourlos
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium.
| | - C J A van Bilsen
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, the Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - S Brinkhues
- Public Health Service South Limburg, Department of Knowledge and Innovation, Public Health Service (GGD) South Limburg, Heerlen, the Netherlands
| | - C P B Moonen
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, the Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - S Demarest
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - D A T Hanssen
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - I H M van Loo
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P H M Savelkoul
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D Philippsen
- GesundheitsberichterstattungGesundheitsamt Düren, Düren, Germany
| | | | - N H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, the Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - C J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, the Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
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Moonen CPB, den Heijer CDJ, Dukers-Muijrers NHTM, van Dreumel R, Steins SCJ, Hoebe CJPA. A systematic review of barriers and facilitators for hepatitis B and C screening among migrants in the EU/EEA region. Front Public Health 2023; 11:1118227. [PMID: 36875381 PMCID: PMC9975596 DOI: 10.3389/fpubh.2023.1118227] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Hepatitis B and C are a threat to public health. Screening of high-risk groups, such as migrants from high-endemic areas, enables early identification and treatment initiation. This systematic review identified barriers and facilitators for hepatitis B and C screening among migrants in the European Union/European Economic Area (EU/EEA). Methods Following PRISMA guidelines, databases PubMed, Embase via Ovid, and Cochrane were searched for English articles published between 1 July 2015 and 24 February 2022. Articles were included, not restricted to a specific study design, if they elaborated on HBV or HCV screening in migrant populations from countries outside Western Europe, North America, and Oceania, and residing in EU/EEA countries. Excluded were studies with solely an epidemiological or microbiological focus, including only general populations or non-migrant subgroups, or conducted outside the EU/EEA, without qualitative, quantitative, or mixed methods. Data appraisal, extraction, and quality assessment were conducted and assessed by two reviewers. Barriers and facilitators were categorized into seven levels based on multiple theoretical frameworks and included factors related to guidelines, the individual health professional, the migrant and community, interaction, the organization and economics, the political and legal level, and innovations. Results The search strategy yielded 2,115 unique articles of which 68 were included. Major identified barriers and facilitators to the success of screening related to the migrant (knowledge and awareness) and community level (culture, religion, support) and the organizational and economic level (capacity, resources, coordinated structures). Given possible language barriers, language support and migrant sensitivity are indispensable for facilitating interaction. Rapid point-of-care-testing is a promising strategy to lower screening barriers. Discussion The inclusion of multiple study designs provided extensive insight into barriers, strategies to lower these barriers, and facilitators to maximize the success of screening. A great variety of factors were revealed on multiple levels, therefore there is no one-size-fits-all approach for screening, and initiatives should be adopted for the targeted group(s), including tailoring to cultural and religious beliefs. We provide a checklist of facilitators and barriers to inform adapted interventions to allow for optimal screening impact.
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Affiliation(s)
- Chrissy P B Moonen
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Casper D J den Heijer
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Nicole H T M Dukers-Muijrers
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Ragni van Dreumel
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | - Sabine C J Steins
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | - Christian J P A Hoebe
- Living Lab Public Health, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
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Pagen DME, van Bilsen CJA, Brinkhues S, Moonen CPB, Van Herck M, Konings K, den Heijer CDJ, Mujakovic S, ter Waarbeek HLG, Bouwmeester-Vincken N, Vaes AW, Spruit MA, Hoebe CJPA, Dukers-Muijrers NHTM. Design and recruitment of a large-scale cohort study on prevalence, risk factors and impact evaluation of post-COVID-19 condition and its wider long-term social, mental, and physical health impact: The PRIME post-COVID study. Front Public Health 2022; 10:1032955. [PMID: 36589958 PMCID: PMC9799054 DOI: 10.3389/fpubh.2022.1032955] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background Persistent symptoms, described as long COVID or post-COVID-19 condition, pose a potential public health problem. Here, the design and recruitment of the PRIME post-COVID study is described. PRIME post-COVID is a large-scale population-based observational study that aims to improve understanding of the occurrence, risk factors, social, physical, mental, emotional, and socioeconomic impact of post-COVID-19 condition. Methods An observational open cohort study was set up, with retrospective and prospective assessments on various health-conditions and health-factors (medical, demographic, social, and behavioral) based on a public health COVID-19 test and by self-report (using online questionnaires in Dutch language). Invited for participation were, as recorded in a public health registry, adults (18 years and older) who were tested for COVID-19 and had a valid Polymerase Chain Reaction (PCR) positive or negative test result, and email address. In November 2021, 61,655 individuals were invited by email to participate, these included all eligible adults who tested PCR positive between 1 June 2020 and 1 November 2021, and a sample of adults who tested negative (2:1), comparable in distribution of age, sex, municipality of residence and year-quarter of testing. New recruitment periods are planned as well. Participants are followed over time by regular follow-up measurements. Data are analyzed using the appropriate data-analyses methods. Discussion The PRIME post-COVID study will provide insights into various health-related aspects of post-COVID-19 condition in the context of various stages of the COVID-19 pandemic. Results will inform practical guidance for society, clinical and public health practice for the prevention and care for long-term impact of COVID-19. Trial registration ClinicalTrialsgov identifier NCT05128695.
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Affiliation(s)
- Demi M. E. Pagen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands,Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Maastricht University, Maastricht, Netherlands,*Correspondence: Demi M. E. Pagen
| | - Céline J. A. van Bilsen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands,Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Maastricht University, Maastricht, Netherlands
| | - Stephanie Brinkhues
- Department of Knowledge and Innovation, South Limburg Public Health Service, Heerlen, Netherlands
| | - Chrissy P. B. Moonen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands,Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Maastricht University, Maastricht, Netherlands
| | - Maarten Van Herck
- Department of Research and Education, Ciro, Horn, Netherlands,School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands,The Rehabilitation Research Center (REVAL), BIOMED–Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kevin Konings
- Department of Process and Information Management, Communication and Automation, South Limburg Public Health Service, Heerlen, Netherlands
| | - Casper D. J. den Heijer
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands,Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Maastricht University, Maastricht, Netherlands
| | - Suhreta Mujakovic
- Department of Process and Information Management, Communication and Automation, South Limburg Public Health Service, Heerlen, Netherlands
| | - Henriëtte L. G. ter Waarbeek
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands
| | | | - Anouk W. Vaes
- Department of Research and Education, Ciro, Horn, Netherlands
| | - Martijn A. Spruit
- Department of Research and Education, Ciro, Horn, Netherlands,School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands,Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Maastricht University, Maastricht, Netherlands,Care and Public Health Research Institute (CAPHRI), Department of Medical Microbiology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands,Care and Public Health Research Institute (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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