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Lekkerkerk WSN, Haenen A, van der Sande MAB, Leenstra T, de Greeff S, Timen A, Tjon-a-Tsien A, Richardus JH, van de Sande-Bruinsma N, Vos MC. Newly identified risk factors for MRSA carriage in The Netherlands. PLoS One 2017; 12:e0188502. [PMID: 29190731 PMCID: PMC5708665 DOI: 10.1371/journal.pone.0188502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/07/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To elucidate new risk factors for MRSA carriers without known risk factors (MRSA of unknown origin; MUO). These MUO carriers are neither pre-emptively screened nor isolated as normally dictated by the Dutch Search & Destroy policy, thus resulting in policy failure. METHODS We performed a prospective case control study to determine risk factors for MUO acquisition/carriage (Dutch Trial Register: NTR2041). Cases were MUO carriers reported by participating medical microbiological laboratories to the RIVM from September 1st 2011 until September 1st 2013. Controls were randomly selected from the community during this period. RESULTS Significant risk factors for MUO in logistic multivariate analysis were antibiotic use in the last twelve months, aOR 8.1 (5.6-11.7), screened as contact in a contact tracing but not detected as a MRSA carrier at that time, aOR 4.3 (2.1-8.8), having at least one foreign parent, aOR 2.4 (1.4-3.9) and receiving ambulatory care, aOR 2.3 (1.4-3.7). Our found risk factors explained 83% of the MUO carriage. CONCLUSIONS Identifying new risk factors for MRSA carriers remains crucial for countries that apply a targeted screening approach as a Search and Destroy policy or as vertical infection prevention measure.
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Affiliation(s)
- W. S. N. Lekkerkerk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - A. Haenen
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - M. A. B. van der Sande
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
- UMCU, Julius Centre, Utrecht, The Netherlands
- The Institute of Tropical Medicine, Antwerp, Belgium
| | - T. Leenstra
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - S. de Greeff
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - A. Timen
- RIVM, National Centre for Health and Environment, Bilthoven, The Netherlands
| | - A. Tjon-a-Tsien
- Municipal Public Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
| | - J. H. Richardus
- Municipal Public Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - M. C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hoenderboom BM, van Oeffelen AAM, van Benthem BHB, van Bergen JEAM, Dukers-Muijrers NHTM, Götz HM, Hoebe CJPA, Hogewoning AA, van der Klis FRM, van Baarle D, Land JA, van der Sande MAB, van Veen MG, de Vries F, Morré SA, van den Broek IVF. The Netherlands Chlamydia cohort study (NECCST) protocol to assess the risk of late complications following Chlamydia trachomatis infection in women. BMC Infect Dis 2017; 17:264. [PMID: 28399813 PMCID: PMC5387293 DOI: 10.1186/s12879-017-2376-y] [Citation(s) in RCA: 15] [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: 03/02/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022] Open
Abstract
Background Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection (STI) among young women, can result in serious sequelae. Although the course of infection is often asymptomatic, CT may cause pelvic inflammatory disease (PID), leading to severe complications, such as prolonged time to pregnancy, ectopic pregnancy, and tubal factor subfertility. The risk of and risk factors for complications following CT-infection have not been assessed in a long-term prospective cohort study, the preferred design to define infections and complications adequately. Methods In the Netherlands Chlamydia Cohort Study (NECCST), a cohort of women of reproductive age with and without a history of CT-infection is followed over a minimum of ten years to investigate (CT-related) reproductive tract complications. This study is a follow-up of the Chlamydia Screening Implementation (CSI) study, executed between 2008 and 2011 in the Netherlands. For NECCST, female CSI participants who consented to be approached for follow-up studies (n = 14,685) are invited, and prospectively followed until 2022. Four data collection moments are foreseen every two consecutive years. Questionnaire data and blood samples for CT-Immunoglobulin G (IgG) measurement are obtained as well as host DNA to determine specific genetic biomarkers related to susceptibility and severity of infection. CT-history will be based on CSI test outcomes, self-reported infections and CT-IgG presence. Information on (time to) pregnancies and the potential long-term complications (i.e. PID, ectopic pregnancy and (tubal factor) subfertility), will be acquired by questionnaires. Reported subfertility will be verified in medical registers. Occurrence of these late complications and prolonged time to pregnancy, as a proxy for reduced fertility due to a previous CT-infection, or other risk factors, will be investigated using longitudinal statistical procedures. Discussion In the proposed study, the occurrence of late complications following CT-infection and its risk factors will be assessed. Ultimately, provided reliable risk factors and/or markers can be identified for such late complications. This will contribute to the development of a prognostic tool to estimate the risk of CT-related complications at an early time point, enabling targeted prevention and care towards women at risk for late complications. Trial registration Dutch Trial Register NTR-5597. Retrospectively registered 14 February 2016.
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Affiliation(s)
- B M Hoenderboom
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. .,Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
| | - A A M van Oeffelen
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - B H B van Benthem
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J E A M van Bergen
- Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Amsterdam, the Netherlands.,STI AIDS Netherlands (SOA AIDS Nederland), Amsterdam, The Netherlands
| | - N H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - H M Götz
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond (GGD Rotterdam), Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - A A Hogewoning
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - F R M van der Klis
- Laboratory for Infectious Diseases and Perinatal Screening, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - D van Baarle
- Department Immune Mechanisms, Center for Infectious Disease control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J A Land
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - M A B van der Sande
- Epidemiology and Surveillance Unit, 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
| | - M G van Veen
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - F de Vries
- Department of Clinical Pharmacology and Toxicology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - S A Morré
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.,Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - I V F van den Broek
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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van Aar F, den Daas C, van der Sande MAB, Soetens LC, de Vries HJC, van Benthem BHB. Outbreaks of syphilis among men who have sex with men attending STI clinics between 2007 and 2015 in the Netherlands: a space-time clustering study. Sex Transm Infect 2016; 93:390-395. [PMID: 27986969 DOI: 10.1136/sextrans-2016-052754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/14/2016] [Accepted: 11/28/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Infectious syphilis (syphilis) is diagnosed predominantly among men who have sex with men (MSM) in the Netherlands and is a strong indicator for sexual risk behaviour. Therefore, an increase in syphilis can be an early indicator of resurgence of other STIs, including HIV. National and worldwide outbreaks of syphilis, as well as potential changes in sexual networks were reason to explore syphilis trends and clusters in more depth. METHODS National STI/HIV surveillance data were used, containing epidemiological, behavioural and clinical data from STI clinics. We examined syphilis positivity rates stratified by HIV status and year. Additionally, we performed space-time cluster analysis on municipality level between 2007 and 2015, using SaTScan to evaluate whether or not there was a higher than expected syphilis incidence in a certain area and time period, using the maximum likelihood ratio test statistic. RESULTS Among HIV-positive MSM, the syphilis positivity rate decreased between 2007 (12.3%) and 2011 (4.5%), followed by an increasing trend (2015: 8.0%). Among HIV-negative MSM, the positivity rate decreased between 2007 (2.8%) and 2011 also (1.4%) and started to increase from 2013 onwards (2015: 1.8%). In addition, we identified three geospatial clusters. The first cluster consisted of MSM sex workers in the South of the Netherlands (July 2009-September 2010, n=10, p<0.001). The second cluster were mostly HIV-positive MSM (58.5%) (Amsterdam; July 2011-December 2015; n=1123, p<0.001), although the proportion of HIV-negative MSM increased over time. The third cluster was large in space (predominantly the city of Rotterdam; April-September 2015, n=72, p=0.014) and were mostly HIV-negative MSM (62.5%). CONCLUSIONS Using SaTScan analysis, we observed several not yet recognised outbreaks and a rapid resurgence of syphilis among known HIV-positive MSM first, but more recently, also among HIV-negative MSM. The three identified clusters revealed locations, periods and specific characteristics of the involved MSM that could be used when developing targeted interventions.
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Affiliation(s)
- F van Aar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - C den Daas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M A B van der Sande
- 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, The Netherlands
| | - L C Soetens
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - H J C de Vries
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - B H B van Benthem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Fournet N, Koedijk FDH, van Leeuwen AP, van Rooijen MS, van der Sande MAB, van Veen MG. Young male sex workers are at high risk for sexually transmitted infections, a cross-sectional study from Dutch STI clinics, the Netherlands, 2006-2012. BMC Infect Dis 2016; 16:63. [PMID: 26847196 PMCID: PMC4743128 DOI: 10.1186/s12879-016-1388-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 06/09/2015] [Accepted: 01/27/2016] [Indexed: 11/18/2022] Open
Abstract
Background Male sex workers (MSW) are particularly exposed to sexually transmitted infections (STI) including HIV. In the Netherlands, data about STI among MSW are scarce. We estimated chlamydia, gonorrhoea, syphilis and HIV diagnoses among MSW attending STI clinics and determined associated factors to guide prevention policies. Methods Using 2006–2012 cross-sectional national surveillance data from Dutch STI clinics, we calculated the proportion of consultations with a positive test for any of three bacterial STI or HIV among MSW. Associated factors were determined by using Poisson logistic regression with robust variance. Results We identified 3,053 consultations involving MSW, of which 18.1 % included at least one positive bacterial STI test and 2.5 % a positive HIV test. Factors associated with bacterial STI and/or HIV diagnoses were respectively age groups < 35 y.o. and self-reporting homo- or bisexual preferences (aRR = 1.6; 95 % CI: 1.3–2.1), and age group 25–34 y.o. (aRR = 2.7; 95 % CI: 1.2–6.5) and self-reporting homo- or bisexual preferences (aRR = 24.4; 95 % CI: 3.4–176.9). Newly diagnosed and pre-existing HIV infection were associated with an increased risk for bacterial STI (aRR = 2.7, 95 % CI: 1.7–2.6 and aRR = 2.1, 95 % CI: 2.2–3.4 respectively). MSW with no history of HIV screening were more likely to be tested positive for HIV compared to those with a previous HIV-negative test (aRR = 2.6, 95 % CI: 1.6–4.3). Conclusion Health promotion activities should target MSW who are young, homo- or bisexual, those who are HIV-infected or who have never been tested for HIV, to increase early diagnosis, prevention and treatment.
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Affiliation(s)
- N Fournet
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. .,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - F D H Koedijk
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. .,Public Health Service Twente, Enschede, The Netherlands.
| | - A P van Leeuwen
- Public Health Service Amsterdam, Amsterdam, The Netherlands.
| | - M S van Rooijen
- Public Health Service Amsterdam, Amsterdam, The Netherlands.
| | - M A B van der Sande
- Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. .,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - M G van Veen
- Public Health Service Amsterdam, Amsterdam, The Netherlands.
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Bijkerk P, Fanoy EB, van der Sande MAB. [When should notification of an infectious disease be mandatory? A decision aid to determine whether mandatory notification is justified]. Ned Tijdschr Geneeskd 2016; 160:A9768. [PMID: 27050495] [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: 06/05/2023]
Abstract
In the Netherlands, all physicians are required to report cases of certain infectious diseases to the public health services, to allow appropriate control measures. In recent years, various requests have been submitted to add certain infectious diseases to the list of notifiable diseases. In order to decide whether such a request should be granted, we developed a structured decision aid based on a range of existing criteria for mandatory notification, applied in the Netherlands and other countries. In this article, we describe the development of this decision aid and illustrate its use in the mandatory notification application reviews for Vibrio vulnificus infection and tularaemia respectively. Based on the decision aid outcomes, mandatory notification for V. vulnificus infection was advised as not necessary whereas notification is considered mandatory for tularaemia.
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Affiliation(s)
- P Bijkerk
- Rijksinstituut voor Volksgezondheid en Milieu, Centrum Infectieziektebestrijding, Bilthoven
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van Veen MG, Trienekens SCM, Heijman T, Gotz HM, Zaheri S, Ladbury G, de Wit J, Fennema JSA, de Wolf F, van der Sande MAB. Delayed linkage to care in one-third of HIV-positive individuals in the Netherlands. Sex Transm Infect 2015; 91:603-9. [PMID: 25964506 DOI: 10.1136/sextrans-2014-051980] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 12/10/2014] [Accepted: 04/21/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To determine time to linkage to HIV care following diagnosis and to identify risk factors for delayed linkage. METHODS Patients newly diagnosed with HIV at sexually transmitted infections (STI) clinics in the Netherlands were followed until linkage to care. Data were collected at the time of diagnosis and at first consultation in care, including demographics, behavioural information, CD4+ counts and HIV viral load (VL) measurements. Delayed linkage to care was defined as >4 weeks between HIV diagnosis and first consultation. RESULTS 310 participants were included; the majority (90%) being men who have sex with men (MSM). For 259 participants (84%), a date of first consultation in care was known; median time to linkage was 9 days (range 0-435). Overall, 95 (31%) of the participants were not linked within 4 weeks of diagnosis; among them, 44 were linked late, and 51 were not linked at all by the end of study follow-up. Being young (<25 years), having non-Western ethnicity or lacking health insurance were independently associated with delayed linkage to care as well as being referred to care indirectly. Baseline CD4+ count, VL, perceived social support and stigma at diagnosis were not associated with delayed linkage. Risk behaviour and CD4+ counts declined between diagnosis and linkage to care. CONCLUSIONS Although most newly diagnosed patients with HIV were linked to care within 4 weeks, delay was observed for one-third, with over half of them not yet linked at the end of follow-up. Vulnerable subpopulations (young, uninsured, ethnic minority) were at risk for delayed linkage. Testing those at risk is not sufficient, timely linkage to care needs to be better assured as well.
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Affiliation(s)
- M G van Veen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Public Health Service, Amsterdam, The Netherlands
| | - S C M Trienekens
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - T Heijman
- Public Health Service, Amsterdam, The Netherlands
| | - H M Gotz
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - S Zaheri
- HIV Monitoring Foundation (SHM), Amsterdam, The Netherlands
| | - G Ladbury
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands EPIET, ECDC, Stockholm, Sweden
| | - J de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - F de Wolf
- HIV Monitoring Foundation (SHM), Amsterdam, The Netherlands
| | - M A B van der Sande
- 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 of Utrecht, Utrecht, The Netherlands
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van Aar F, de Moraes M, Morré SA, van Bergen JEAM, van der Klis FRM, Land JA, van der Sande MAB, van den Broek IVF. Chlamydia trachomatisIgG seroprevalence in the general population of the Netherlands in 1996 and in 2007: differential changes by gender and age. Sex Transm Infect 2014; 90:434-40. [DOI: 10.1136/sextrans-2013-051074] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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van der Sande MAB, Jacobi A, Meijer A, Wallinga J, van der Hoek W, van der Lubben M. The 2009 influenza A (H1N1) pandemic. Management and vaccination strategies in The Netherlands. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:67-75. [PMID: 23275958 PMCID: PMC7079869 DOI: 10.1007/s00103-012-1582-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 12/02/2022]
Abstract
Prior to 2009, The Netherlands had prepared itself extensively for a potential pandemic. Multidisciplinary guidelines had been drafted to control transmission and limit adverse outcomes for both a phase of early incidental introduction and for a phase with widespread transmission. The Ministry of Health had ensured a supply and distribution schedule for antivirals and negotiated a contract for vaccine purchases. During the pandemic, existing surveillance was expanded, the established infectious disease response structure was activated, and the previously prepared protocols for communication, diagnostics, use of antivirals, and vaccination implementation were operationalized and implemented. When the pandemic turned out to be less severe than many had anticipated, risk communication and rapid modification of guidelines and communication became a major challenge. Antivirals and pandemic vaccines were reserved for those at high risk for severe outcomes only. Overall, the impact of the pandemic was comparable to the impact of an average seasonal influenza epidemic, but with a shift in (severe) outcomes from the very young and elderly toward young adults. Established prepared protocols enabled timely coordinated responses. In preparing for the worst, sufficient attention must be given to preparing for a mild scenario as well.
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Affiliation(s)
- M A B van der Sande
- RIVM - Centre Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, 3720 BA, Bilthoven, The Netherlands.
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van Gageldonk-Lafeber AB, Wever PC, van der Lubben IM, de Jager CPC, Meijer A, de Vries MC, Elberse K, van der Sande MAB, van der Hoek W. The aetiology of community-acquired pneumonia and implications for patient management. Neth J Med 2013; 71:418-425. [PMID: 24127502] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Understanding which pathogens are associated with clinical manifestation of community-acquired pneumonia (CAP) is important to optimise treatment. We performed a study on the aetiology of CAP and assessed possible implications for patient management in the Netherlands. METHODS Patients with CAP attending the emergency department of a general hospital were invited to participate in the study. We used an extensive combination of microbiological techniques to determine recent infection with respiratory pathogens. Furthermore, we collected data on clinical parameters and potential risk factors. RESULTS From November 2007 through January 2010, 339 patients were included. Single bacterial infection was found in 39% of these patients, single viral infection in 12%, and mixed bacterial-viral infection in 11%. Streptococcus pneumoniae was the most frequently identified pathogen (22%; n=74). Infection with atypical bacteria was detected in 69 (20%) of the patients. CONCLUSION Initial empirical antibiotics should be effective against S. pneumoniae, the most common pathogen identified in CAP patients. The large proportion of patients with infection with atypical bacteria points to the need for improved diagnostic algorithms including atypical bacteria, especially since these atypical bacteria are not covered by the first-choice antibiotic treatment according to the recently revised Dutch guidelines on the management of CAP.
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Affiliation(s)
- A B van Gageldonk-Lafeber
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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van der Sande MAB, Luong TN, Schim van der Loeff MF, Sabally S, Aveika AA, Corrah T, Sarge-Njie R, Kaye S, Whittle HC. Dual HIV-1 and HIV-2 infection in a West African infant. ACTA ACUST UNITED AC 2013; 24:277-8. [PMID: 15479581 DOI: 10.1179/027249304225019073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Broek IVFVD, Land JA, Bergen JEAMV, Morré SA, Sande MABVD. P3.024 Comparison of Chlamydia TrachomatisAntibodies in Vaginal Mucosa and Serum in Women a Fertility Clinic and an STI-Clinic. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Koper NE, Sande MABVD, Götz HM, Koedijk FDH. P3.140 Lymphogranuloma Venereum Among Men Who Have Sex with Men in the Netherlands: An Update on the Current Situation. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Broek IVFVD, Trienekens SM, Donker GA, Bergen JEAMV, Sande MABVD. P3.034 General Practitioners in the Netherlands Miss Opportunities to Test For STI/HIV During STI-Related Consultations. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fournet N, Koedijk FDH, Leeuwen APV, Rooijen MSV, Hahné SJ, Sande MABVD, Veen MGV. P3.167 Young Commercial Sex Workers Are at Higher Risk of Sexually Transmitted Infections, the Netherlands, 2006–2011. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Koedijk FDH, Benthem BHV, Vrolings EMDC, Sande MABVD. P3.157 Increasing STI Rates in Young MSM in the Netherlands, 2006–2011. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Aar FV, Moraes MD, Morré SA, Bergen JEAMV, Klis FRMVD, Land JA, Sande MABVD, Broek IVFVD. P3.333 Chlamydia TrachomatisIgG Seroprevalence in the General Population of the Netherlands in 1996 and 2007. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Rijn VMV, Mollers M, Mooij SH, Speksnijder ACGL, King AJ, Vries HJCD, Klis FRMVD, Melker HED, Sande MABVD, Loeff MFSVD. O16.5 Concordance of Anal, Penile, and Oral Human Papillomavirus Hr-HPV Infections and HPV Seropositivity in HIV-Infected and HIV-Negative Men Who Have Sex with Men: The HIV & HPV in MSM (H 2M) Study. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Koedijk FDH, van Bergen JEAM, Dukers-Muijrers NHTM, van Leeuwen AP, Hoebe CJPA, van der Sande MAB. The value of testing multiple anatomic sites for gonorrhoea and chlamydia in sexually transmitted infection centres in the Netherlands, 2006–2010. Int J STD AIDS 2012; 23:626-31. [DOI: 10.1258/ijsa.2012.011378] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
National surveillance data from 2006 to 2010 of the Dutch sexually transmitted infection (STI) centres were used to analyse current practices on testing extragenital sites for chlamydia and gonorrhoea in men who have sex with men (MSM) and women. In MSM, 76.0% and 88.9% were tested at least at one extragenital site (pharyngeal and/or anorectal) for chlamydia and gonorrhoea, respectively; for women this was 20.5% and 30.2%. Testing more than one anatomic site differed by STI centre, ranging from 2% to 100%. In MSM tested at multiple sites, 63.0% and 66.5% of chlamydia and gonorrhoea diagnoses, respectively, would have been missed if screened at the urogenital site only, mainly anorectal infections. For women tested at multiple sites, the proportions of missed chlamydia and gonorrhoea diagnoses would have been 12.9% and 30.0%, respectively. Testing extragenital sites appears warranted, due to the numerous infections that would have been missed. Adding anorectal screening to urogenital screening for all MSM visiting an STI centre should be recommended. Since actual testing practices differ by centre, there is a need for clearer guidelines. Routine gonorrhoea and chlamydia screening at multiple sites in STI centres should be investigated further as this might be a more effective approach to reduce transmission than current practice.
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Affiliation(s)
- F D H Koedijk
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven
| | - J E A M van Bergen
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven
- STI AIDS Netherlands, Amsterdam, Keizersgracht 392, 1016 GB Amsterdam
| | - N H T M Dukers-Muijrers
- Department of Infectious Diseases, Public Health Service South Limburg, PO Box 2022, 6160 HA Geleen
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), PO Box 5800, 6202 AZ Maastricht
| | - A P van Leeuwen
- Department of Infectious Diseases, Municipal Health Service Amsterdam, PO Box 2200, 1000 CE Amsterdam
| | - C J P A Hoebe
- Department of Infectious Diseases, Public Health Service South Limburg, PO Box 2022, 6160 HA Geleen
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), PO Box 5800, 6202 AZ Maastricht
| | - M A B van der Sande
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven
- Academic Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
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Lekkerkerk WSN, van de Sande-Bruinsma N, van der Sande MAB, Tjon-A-Tsien A, Groenheide A, Haenen A, Timen A, van den Broek PJ, van Wamel WJB, de Neeling AJ, Richardus JH, Verbrugh HA, Vos MC. Emergence of MRSA of unknown origin in the Netherlands. Clin Microbiol Infect 2011; 18:656-61. [PMID: 21967090 DOI: 10.1111/j.1469-0691.2011.03662.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Netherlands is known for its low methicillin-resistant Staphylococcus aureus (MRSA) prevalence. Yet MRSA with no link to established Dutch risk factors for acquisition, MRSA of unknown origin (MUO), has now emerged and hampers early detection and control by active screening upon hospital admittance. We assessed the magnitude of the problem and determined the differences between MUO and MRSA of known origin (MKO) for CC398 and non-CC398. National MRSA Surveillance data (2008-2009) were analysed for epidemiological determinants and genotypic characteristics (Panton-Valentine leukocidin, spa). A quarter (24%) of the 5545 MRSA isolates registered were MUO, i.e. not from defined risk groups. There are two genotypic MUO groups: CC398 MUO (352; 26%) and non-CC398 MUO (998; 74%). CC398 MUO needs further investigation because it could suggest spread, not by direct contact with livestock (pigs, veal calves), but through the community. Non-CC398 MUO is less likely to be from a nursing home than non-CC398 MKO (relative risk 0.55; 95% CI 0.42-0.72) and Panton-Valentine leukocidin positivity was more frequent in non-CC398 MUO than MKO (relative risk 1.19; 95% CI 1.11-1.29). Exact transmission routes and risk factors for non-CC398 as CC398 MUO remain undefined.
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Affiliation(s)
- W S N Lekkerkerk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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20
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Koedijk F, van Beek P, Koops K, van der Sande MAB. P1-S2.44 Trends in STI in MSM visiting Dutch STI centres; does age matter? Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Haasnoot A, Koedijk FDH, Op de Coul ELM, van der Sande MAB, Gotz HM, Fennema JFA, van den Broek IVF. P1-S4.02 Ethnicity based on the country of birth is better to identify the young population at high risk for Chlamydia infection than self-defined ethnicity. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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van den Broek IVF, van Bergen JANEAM, Fennema HSA, Gotz HM, Hoebe CJPA, Over E, van der Sande MAB, Schmid BV, Op de Coul ELM. O1-S09.03 Main results and impact analysis of annual Chlamydia screening in a large register-based programme in the Netherlands. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Wielders CCH, van Lier EA, van 't Klooster TM, van Gageldonk-Lafeber AB, van den Wijngaard CC, Haagsma JA, Donker GA, Meijer A, van der Hoek W, Lugner AK, Kretzschmar MEE, van der Sande MAB. The burden of 2009 pandemic influenza A(H1N1) in the Netherlands. Eur J Public Health 2010; 22:150-7. [DOI: 10.1093/eurpub/ckq187] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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24
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Looijmans-van den Akker I, van Delden JJM, Verheij TJM, van der Sande MAB, van Essen GA, Riphagen-Dalhuisen J, Hulscher ME, Hak E. Effects of a multi-faceted program to increase influenza vaccine uptake among health care workers in nursing homes: A cluster randomised controlled trial. Vaccine 2010; 28:5086-92. [PMID: 20580740 DOI: 10.1016/j.vaccine.2010.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 04/29/2010] [Accepted: 05/03/2010] [Indexed: 11/16/2022]
Abstract
Despite the recommendation of the Dutch association of nursing home physicians (NVVA) to be immunized against influenza, vaccine uptake among HCWs in nursing homes remains unacceptably low. Therefore we conducted a cluster randomised controlled trial among 33 Dutch nursing homes to assess the effects of a systematically developed multi-faceted intervention program on influenza vaccine uptake among HCWs. The intervention program resulted in a significantly higher, though moderate, influenza vaccine uptake among HCWs in nursing homes. To take full advantage of this measure, either the program should be adjusted and implemented over a longer time period or mandatory influenza vaccination should be considered.
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Affiliation(s)
- I Looijmans-van den Akker
- Julius Center for Health Sciences and Primary Health Care, University Medical Center Utrecht, HP 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
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25
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Friesema IHM, Koppeschaar CE, Donker GA, Dijkstra F, van Noort SP, Smallenburg R, van der Hoek W, van der Sande MAB. Internet-based monitoring of influenza-like illness in the general population: experience of five influenza seasons in The Netherlands. Vaccine 2009; 27:6353-7. [PMID: 19840672 DOI: 10.1016/j.vaccine.2009.05.042] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 05/07/2009] [Accepted: 05/11/2009] [Indexed: 11/29/2022]
Abstract
Like in most other countries, influenza surveillance in The Netherlands is based upon influenza-like illness (ILI) consultations reported by sentinel general practitioners (GP). In addition, an internet-based monitoring of ILI in the general population started in 2003/2004 (Great Influenza Survey (GIS)). We compared GIS results over 5 influenza seasons with results from the GP system. Weekly ILI incidence from GIS correlated well with ILI incidence from the GP system the same week and even better 1 week later. This suggests that GIS is useful for early detection of trends in influenza activity. However, two important vulnerable groups, children and the elderly, are clearly underrepresented in the GIS. Furthermore, virological confirmation is lacking in the GIS. So, GIS can be a useful addition to the GP system, especially when representativeness can be improved and when participation remains at the current high level.
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Affiliation(s)
- I H M Friesema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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26
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Buijtels PCAM, van der Sande MAB, Parkinson S, Verbrugh HA, Petit PLC, van Soolingen D. Isolation of non-tuberculous mycobacteria at three rural settings in Zambia; a pilot study. Clin Microbiol Infect 2009; 16:1142-8. [PMID: 19832715 DOI: 10.1111/j.1469-0691.2009.03072.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [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
To assess the role of non-tuberculous mycobacteria (NTM) as a cause of tuberculosis-like diseases in Zambia, 167 chronically ill patients, hospitalized in three rural hospitals in Katete, Sesheke and Chilonga, were examined by microscopy and liquid culture for the presence of NTM. The percentages of patients with a positive culture for Mycobacterium tuberculosis complex were similar in the three geographical locations (19-25%). In contrast, the percentage of NTM ranged from 78% in Katete and 65% in Sesheke to 21% in Chilonga. Furthermore, the distribution of NTM species was different at the three geographical sites. In seven patients, true NTM-associated disease was suspected: five with Mycobacterium lentiflavum and two with Mycobacterium intracellulare. Analysis of possible risk factors indicated that the OR for NTM culture-positive sputum was significantly higher for patients living in Katete and Sesheke. Female gender and chest X-ray appearances of tuberculosis were independently associated with NTM culture-positive sputum. NTM colonization and disease in hospitalized, chronically ill patients in rural Zambia appear to be common.
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Affiliation(s)
- P C A M Buijtels
- Department of Medical Microbiology, Medical Centre Rijnmond-Zuid, The Netherlands.
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27
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Koedijk FDH, van Veen MG, de Neeling AJ, Linde GB, van der Sande MAB. Increasing trend in gonococcal resistance to ciprofloxacin in The Netherlands, 2006-8. Sex Transm Infect 2009; 86:41-5. [DOI: 10.1136/sti.2009.037135] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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28
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Buijtels PCAM, van de Sande WWJ, Parkinson S, Petit PLC, van der Sande MAB, van Soolingen D, Verbrugh HA, van Belkum A. Polymorphism in CC-chemokine ligand 2 associated with tuberculosis in Zambia. Int J Tuberc Lung Dis 2008; 12:1485-1488. [PMID: 19017462] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Polymorphism in various genes that may influence susceptibility to tuberculosis (TB) was examined in 46 TB patients and 119 healthy tuberculin-positive controls in Zambia. The odds of having TB was 2.8-fold higher in carriers of the -2518 AG single-nucleotide polymorphism in the promoter region of the CC-chemokine ligand 2 than in those carrying the homozygous genotype AA (95%CI 1.3-5.5).
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Affiliation(s)
- P C A M Buijtels
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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29
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Den Boer JW, Coutinho RA, Yzerman EPF, van der Sande MAB. Use of surface water in drinking water production associated with municipal Legionnaires' disease incidence. J Epidemiol Community Health 2008; 62:e1. [DOI: 10.1136/jech.2007.061598] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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30
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Swaan CM, van der Sande MAB, Speelman P, Conyn-van Spaendonck MAE, Straus SMJM, Coutinho RA. [Adverse events following influenza vaccination: reaction to specific reports and the necessity of a central registration system]. Ned Tijdschr Geneeskd 2007; 151:2166-2169. [PMID: 17957995] [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: 05/25/2023]
Abstract
The influenza vaccine is considered safe, but information on vaccine-related adverse events is limited and a nationwide overview of adverse events is lacking. In 2006, after deaths occurred in Israel and the Netherlands following influenza vaccination, the Dutch Ministry of Health, Welfare and Sport (VWS) asked the National Institute for Public Health and the Environment (RIVM) twice for a recommendation regarding the continuation of the national vaccination campaign. After 4 deaths were reported in Israel in October 2006 following administration of Vaxigrip, the Dutch vaccination campaign was suspended for one week. One month later, 4 additional deaths were reported after influenza vaccination in the Netherlands. The newly appointed outbreak management team concluded that a causal relationship between vaccination and the deaths was highly unlikely, based on data regarding the individual cases, background mortality rates and prior reports of adverse events. Further suspension of the vaccination campaign was deemed unnecessary this time. A centralised nationwide registry of adverse events has since been established to provide further insight into the incidence of adverse events following influenza vaccination. Physicians are advised to report potential adverse events following influenza vaccination to the Netherlands Pharmacovigilance Centre Lareb (www.lareb.nl).
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Affiliation(s)
- C M Swaan
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Interne Geneeskunde, Amsterdam.
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31
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Koedijk FDH, de Boer IM, de Vries HJC, Thiesbrummel HFJ, van der Sande MAB. An ongoing outbreak of lymphogranuloma venereum in the Netherlands, 2006-2007. ACTA ACUST UNITED AC 2007; 12:E070419.2. [PMID: 17868613 DOI: 10.2807/esw.12.16.03177-en] [Citation(s) in RCA: 4] [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] [Indexed: 11/20/2022]
Abstract
As reported previously, lymphogranuloma venereum (LGV) has emerged as a significant public health problem in the Netherlands since an outbreak among mainly HIV-positive men having sex with men (MSM) in Rotterdam in 2004 [1,2]. As of March 2007, 232 confirmed cases of LGV had been reported in the Netherlands.
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Affiliation(s)
- F D H Koedijk
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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32
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van der Sande MAB, Mendy M, Waight P, Doherty C, McConkey SJ, Hall AJ, Whittle HC. Similar long-term vaccine efficacy of two versus three doses of HBV vaccine in early life. Vaccine 2006; 25:1509-12. [PMID: 17095130 DOI: 10.1016/j.vaccine.2006.10.023] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Revised: 09/24/2006] [Accepted: 10/12/2006] [Indexed: 11/21/2022]
Abstract
WHO currently recommends three vaccinations against hepatitis B to provide optimal protection against infection and carriage. However, immunological theory and mathematical modelling suggest that similar protection could be induced with two doses, and trials among adolescents and adults have shown comparable rates for both primary seroprotection and geometric mean titres following vaccination. We determined vaccine efficacy among 60 children who only received two doses of hepatitis B vaccine as infants and among 463 children who had received three doses after 4-7 years of follow-up. Vaccine efficacy among the two-dose group was 86.3% against anti-HBc positivity (infection) and 92.3% against HBsAg positivity (carriage), which was similar to the vaccine efficacy found among the participants who had received three doses. To confirm this comparable vaccine efficacy a randomised controlled non-inferiority trial with long-term follow-up is needed.
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van der Sande MAB, Waight P, Mendy M, Rayco-Solon P, Hutt P, Fulford T, Doherty C, McConkey SJ, Jeffries D, Hall AJ, Whittle HC. Long‐Term Protection against Carriage of Hepatitis B Virus after Infant Vaccination. J Infect Dis 2006; 193:1528-35. [PMID: 16652281 DOI: 10.1086/503433] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [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: 02/01/2005] [Accepted: 12/19/2005] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Carriage of hepatitis B virus (HBV) is a major risk factor for liver cirrhosis and hepatocellular carcinoma. Infant vaccination has been effective in preventing horizontal transmission during early childhood. It is unknown whether protection is maintained into early adulthood. METHODS In 1984, early childhood vaccination was introduced in 2 rural Gambian villages. In 2003, serological assessment of 81.5% of 1,350 eligible participants 1-24 years old was done, to determine vaccine efficacy against infection and carriage. RESULTS Overall vaccine efficacy against infection and carriage was 83.4% (95% confidence interval [CI], 79.8%-86.6%) and 96.5% (85% CI, 93.9%-98.9%), respectively. Vaccine efficacy against infection was similar when restricted to primary responders (85.3%), but a significant effect of peak antibody concentration was found. Both vaccine efficacy and levels of hepatitis B surface antibody (anti-HBs) decreased with age, resulting in a vaccine efficacy against infection and carriage among 20-24-year-old participants of 70.9% (95% CI, 60.4%-80.5%) and 91.1% (95% CI, 75.8%-100%), respectively. Fifteen years after vaccination, fewer than half of the vaccinees had detectable anti-HBs. The prevalence of carriage in the unvaccinated population was similar to the prevalence 20 years earlier. CONCLUSIONS HBV vaccination early during life can provide long-lasting protection against carriage, despite decreasing antibody levels. The role played by subclinical boosting and the necessity of a booster need to be evaluated.
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Ota MOC, van der Sande MAB, Walraven GEL, Jeffries D, Nyan OA, Marchant A, McAdam KPWJ. Absence of association between delayed type hypersensitivity to tuberculin and atopy in children in The Gambia. Clin Exp Allergy 2003; 33:731-6. [PMID: 12801305 DOI: 10.1046/j.1365-2222.2003.01599.x] [Citation(s) in RCA: 37] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND An inverse association between delayed type hypersensitivity to tuberculin and atopy has been observed in children, suggesting that exposure to mycobacteria may influence the immune response to allergens. OBJECTIVE To investigate the relationship between tuberculin responses and atopy in children living in three different environments in The Gambia. METHODS In this cross-sectional study a total of 507 school-aged children were recruited from rural, urban poor or urban affluent communities. They were assessed for skin responses to five common allergens and tuberculin, presence of bacille Calmette-Guérin (BCG) scar, presence of intestinal parasites, and total serum IgE. Atopy was defined as the presence of a skin prick test response > or = 3 x 3 mm to at least one allergen. RESULTS The overall prevalence of atopy was 33% but there was a significant variation among the three study groups. The prevalence of atopy was 22% in urban poor, 36% in urban affluent, and 43% in rural children. Controlling for potential confounding factors, children in the rural community had a significantly higher odds ratio, 3.3 (95% confidence interval 1.8-6.0) of being atopic than children from the urban poor community. No association between atopy and tuberculin response or BCG scar was observed in any of the three groups. Serum IgE levels were higher among children of the urban poor group but were not associated with tuberculin response or BCG scar in any of the groups. CONCLUSION Environmental factors have an important influence on the development of atopy in children in The Gambia but delayed type hypersensitivity to tuberculin is not a protective factor.
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Affiliation(s)
- M O C Ota
- Medical Research Council Laboratories, The Gambia.
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35
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van der Sande MAB. Cardiovascular disease in sub-Saharan Africa: a disaster waiting to happen. Neth J Med 2003; 61:32-6. [PMID: 12735418] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The looming threat posed by the emergence of cardiovascular disease (CVD) in sub-Saharan Africa (sSA) is underestimated and often denied. The health services and societies struggle to cope with the direct effects of poverty, war, fragile social and economic structures and AIDS. The threat of CVD seems less direct and few reliable data are available. This has resulted in neglecting serious warning signs on the emergence of CVD in sSA. This short review deals with the strong increase in a number of risk factors for CVD in certain areas, necessitating preventive measures to lighten the 'double burden of disease' in this part of the world.
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van der Sande MAB, Kidd IM, Goetghebuer T, Martynoga RA, Magnusen A, Allen S, Weber MW, Fielding KL, Marchant A, Whittle HC. Severe respiratory syncytial virus infection in early life is associated with increased type 2 cytokine production in Gambian children. Clin Exp Allergy 2002; 32:1430-5. [PMID: 12372121 DOI: 10.1046/j.1365-2745.2002.01521.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [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: 11/20/2022]
Abstract
BACKGROUND Severe respiratory syncytial virus (RSV) infection in early childhood has been associated with subsequent wheezing and atopy. The aim of this study was to test if severe RSV infection in early life was associated with an increase in type 2 cytokine production and atopy in Gambian children 5 years later. METHODS A cohort of children with severe RSV infection during the first year of life ('cases', n = 66) and without ('controls', n = 122) was followed-up at 5 years of age. Immediate hypersensitivity to common allergens, airway reactivity, serum IgE concentration and the production of IFN-gamma, IL-5 and IL-13 by lymphocytes activated in vitro with RSV F-G or control antigens was determined. RESULTS After adjustment for confounders, cases produced significantly higher concentrations of IL-13 in response to RSV F-G and of IL-5 and IL-13 in response to tuberculin. Cases were more likely to have presented with a wheezy lower respiratory tract infection in the first 3 years of life (adjusted odds ratio = 9.9; 95% CI 1.6-61.0), but not thereafter. Cases and controls had similar skin response to allergens, airway reactivity and serum IgE concentrations. CONCLUSION Severe RSV infection in early life is associated with a higher production of type 2 cytokines in Gambian children at 5 years of age. However this does not appear to result in increased risk of atopy or clinical allergy at that age.
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