Two cases of mild IgM-negative measles in previously vaccinated adults, the Netherlands, April and July 2011

We describe two cases of mild, modified measles in fully vaccinated adults in the Netherlands. The mildness of disease, the lack of an IgM antibody response, the relatively low amounts of virus detected and the fact that no additional cases were reported, suggests that these vaccinated patients were less contagious than unvaccinated patients.

Two cases of mild IgM-negative measles in previously vaccinated adults, the Netherlands, April and July 2011

We describe two cases of mild, modified measles in fully vaccinated adults in the Netherlands. The mildness of disease, the lack of an IgM antibody response, the relatively low amounts of virus detected and the fact that no additional cases were reported, suggests that these vaccinated patients were less contagious than unvaccinated patients.

A persistent problem with scabies in and outside a nursing home in Amsterdam: indications for resistance to lindane and ivermectin

An ongoing outbreak of scabies in and outside a nursing home in Amsterdam is described. Despite standard treatment with lindane and ivermectin, many recurrences were observed which suggested resistance to these drugs. After treatment with 5% permethrine, the patients were finally cured.

A persistent problem with scabies in and outside a nursing home in Amsterdam: indications for resistance to lindane and ivermectin

An ongoing outbreak of scabies in and outside a nursing home in Amsterdam is described. Despite standard treatment with lindane and ivermectin, many recurrences were observed which suggested resistance to these drugs. After treatment with 5% permethrine, the patients were finally cured.

Changes in prevention and outbreak management of Legionnaires’ disease in the Netherlands between two large outbreaks in 1999 and 2006

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Changes in prevention and outbreak management of Legionnaires disease in the Netherlands between two large outbreaks in 1999 and 2006

We describe an outbreak of Legionnaires' disease in 2006 in Amsterdam, the Netherlands. Comparisons with the outbreak that took place in 1999 are made to evaluate changes in legionella prevention and outbreak management. The 2006 outbreak was caused by a wet cooling tower. Thirty-one patients were reported. The outbreak was detected two days after the first patient was admitted to hospital, and the source was eliminated five days later. The 1999 outbreak was caused by a whirlpool at a flower show, and 188 patients were reported. This outbreak was detected 14 days after the first patient was admitted to hospital, and two days later the source was traced. Since 1999, the awareness of legionellosis among physicians, the availability of a urinary antigen tests and more efficient early warning and communication systems improved the efficiency of legionellosis outbreak management. For prevention, extensive legislation with clear responsibilities has been put in place. For wet cooling towers, however, legislation regarding responsibility and supervision of maintenance needs to be improved.

The effects of maternal exercise on fetal heart rate and movement patterns

The aim of this study was to investigate the effects of maternal exercise on fetal movement and heart rate patterns. Twelve healthy women at 29-32 weeks of pregnancy performed a (sub)maximal bicycle exercise test, reaching 53-99% (median 82%) of their maximal increase in heart rate (MIHR). Fetal heart rate (FHR) and its variation and fetal body and breathing movements were recorded for 1 h before and after the exercise and also on a control day. After exercise, FHR was higher for 30 min and FHR variation reduced for 20 min as compared with pre-exercise levels (P < 0.01). Fetal body movements were reduced for the first 5 min following exercise (P < 0.05). In two cases, fetal bradycardia was observed (at 89 and 99% MIHR) followed by a considerable reduction in FHR variation and absence of body and breathing movements for 20 min. In the other 10 fetuses fetal breathing activity was increased for the first 5 min after exercise (P < 0.05). FHR (and to a lesser extent breathing movements) increased with increasing level of maternal exercise, but decreased when the % MIHR exceeded approximately 90%. Body movements were negatively correlated with the % MIHR (P < 0.05). In conclusion, moderate to heavy maternal exercise clearly affects the human fetus with signs of transient fetal impairment after heavy exercise.