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Dequeker S, van Hensbergen M, den Heijer CDJ, Dhaeze W, Raven SFH, Ewalts-Hakkoer H, Tolsma P, Willemsen I, van Drunen-Kamp KJ, van der Slikke-Verstraten K, Goossens H, Kluytmans-van den Bergh MFQ, Hoebe CJPA. Cross-border differences in the prevalence and risk factors for carriage of antimicrobial resistance in children attending daycare centers: a point prevalence study in the Netherlands and Belgium. BMC Infect Dis 2024; 24:131. [PMID: 38267878 PMCID: PMC10809597 DOI: 10.1186/s12879-024-08996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Day care centres (DCCs) are ideal settings for drug-resistant bacteria to emerge. Prevalence numbers of faecal carriage of antimicrobial resistant bacteria in these settings are rare. We aimed to determine the prevalence of faecal antimicrobial resistant bacteria carriage in children attending DCCs and to assess and identify infection risk factors within DCCs in The Netherlands and Belgium. METHODS A point-prevalence study was conducted in 28 Dutch (499 children) and 18 Belgian (448 children) DCCs. Stool samples were taken from the children's diapers and a questionnaire was filled in by their parents. Hygiene related to stool and toilet use, hygiene related to food, environmental contamination, hand hygiene and hygiene guidelines were assessed conform a standardized questionnaire by the infection prevention and control expert visiting the DCC. Multilevel logistical regression analyses were used to define which characteristics predicted the presence of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), carbapenemase-producing Enterobacterales (CPE), vancomycin-resistant enterococci (VRE), and ciprofloxacin-resistant Enterobacterales (CipR-E). RESULTS The ESBL-E prevalence was 16% (n = 71) in Belgium and 6% (n = 30) in the Netherlands. The CipR-E prevalence was 17% (n = 78) in Belgium and 8% (n = 38) in the Netherlands. Antimicrobial use (RR: 0.30; 95% CI: 0.33-0.48) and hospital admissions (RR: 0.37; 95% CI: 0.25-0.54) were lower in the Netherlands. Children travelling to Asia were at higher risk of being an ESBL-E carrier. Children using antimicrobials were at higher risk of being a CipR-E carrier. Cleaning the changing mat after each use was found as a protective factor for CipR-E carriage. CONCLUSIONS We established a significant difference in ESBL-E and CipR-E carriage and antimicrobial use and hospital admissions between the Netherlands and Belgium among children attending DCCs. The differences between both countries should be further studied to improve the policy on anti-microbial use and hospital admissions in children.
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Affiliation(s)
- Sara Dequeker
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium.
- Agency for Care and Health, Infection Prevention and Control, Government of Flanders, Brussels, Belgium.
| | - Mitch van Hensbergen
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Casper D J den Heijer
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Wouter Dhaeze
- Agency for Care and Health, Infection Prevention and Control, Government of Flanders, Brussels, Belgium
| | - Stijn F H Raven
- Department of Infectious Diseases, Public Health Service region Utrecht, Zeist, The Netherlands
| | | | - Paulien Tolsma
- Public Health Service Brabant-Zuidoost, Eindhoven, The Netherlands
| | - Ina Willemsen
- Contrain Infectiepreventiecoach, Breda, The Netherlands
- Amphia Hospital, Breda, The Netherlands
| | | | | | | | | | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
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2
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Oude Munnink BB, Sikkema RS, Nieuwenhuijse DF, Molenaar RJ, Munger E, Molenkamp R, van der Spek A, Tolsma P, Rietveld A, Brouwer M, Bouwmeester-Vincken N, Harders F, Hakze-van der Honing R, Wegdam-Blans MCA, Bouwstra RJ, GeurtsvanKessel C, van der Eijk AA, Velkers FC, Smit LAM, Stegeman A, van der Poel WHM, Koopmans MPG. Transmission of SARS-CoV-2 on mink farms between humans and mink and back to humans. Science 2020; 371:172-177. [PMID: 33172935 PMCID: PMC7857398 DOI: 10.1126/science.abe5901] [Citation(s) in RCA: 690] [Impact Index Per Article: 172.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a zoonotic virus—one that spilled over from another species to infect and transmit among humans. We know that humans can infect other animals with SARS-CoV-2, such as domestic cats and even tigers in zoos. Oude Munnink et al. used whole-genome sequencing to show that SARS-CoV-2 infections were rife among mink farms in the southeastern Netherlands, all of which are destined to be closed by March 2021 (see the Perspective by Zhou and Shi). Toward the end of June 2020, 68% of mink farm workers tested positive for the virus or had antibodies to SARS-CoV-2. These large clusters of infection were initiated by human COVID-19 cases with viruses that bear the D614G mutation. Sequencing has subsequently shown that mink-to-human transmission also occurred. More work must be done to understand whether there is a risk that mustelids may become a reservoir for SARS-CoV-2. Science, this issue p. 172; see also p. 120 Animal experiments have shown that nonhuman primates, cats, ferrets, hamsters, rabbits, and bats can be infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition, SARS-CoV-2 RNA has been detected in felids, mink, and dogs in the field. Here, we describe an in-depth investigation using whole-genome sequencing of outbreaks on 16 mink farms and the humans living or working on these farms. We conclude that the virus was initially introduced by humans and has since evolved, most likely reflecting widespread circulation among mink in the beginning of the infection period, several weeks before detection. Despite enhanced biosecurity, early warning surveillance, and immediate culling of animals in affected farms, transmission occurred between mink farms in three large transmission clusters with unknown modes of transmission. Of the tested mink farm residents, employees, and/or individuals with whom they had been in contact, 68% had evidence of SARS-CoV-2 infection. Individuals for which whole genomes were available were shown to have been infected with strains with an animal sequence signature, providing evidence of animal-to-human transmission of SARS-CoV-2 within mink farms.
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Affiliation(s)
- Bas B Oude Munnink
- Department of Viroscience, Erasmus MC, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, Netherlands.
| | - Reina S Sikkema
- Department of Viroscience, Erasmus MC, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, Netherlands
| | - David F Nieuwenhuijse
- Department of Viroscience, Erasmus MC, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, Netherlands
| | | | - Emmanuelle Munger
- Department of Viroscience, Erasmus MC, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, Netherlands
| | - Richard Molenkamp
- Department of Viroscience, Erasmus MC, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, Netherlands
| | - Arco van der Spek
- Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht, Netherlands
| | - Paulien Tolsma
- Municipal Health Services GGD Brabant-Zuidoost, Eindhoven, Netherlands
| | - Ariene Rietveld
- Municipal Health Services GGD Hart voor Brabant, 's-Hertogenbosch, Netherlands
| | - Miranda Brouwer
- Municipal Health Services GGD Hart voor Brabant, 's-Hertogenbosch, Netherlands
| | | | - Frank Harders
- Wageningen Bioveterinary Research, Lelystad, Netherlands
| | | | | | | | - Corine GeurtsvanKessel
- Department of Viroscience, Erasmus MC, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, Netherlands
| | - Annemiek A van der Eijk
- Department of Viroscience, Erasmus MC, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, Netherlands
| | - Francisca C Velkers
- Division of Farm Animal Health, Department of Population Health Sciences, Utrecht University, Utrecht, Netherlands
| | - Lidwien A M Smit
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Arjan Stegeman
- Division of Farm Animal Health, Department of Population Health Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Marion P G Koopmans
- Department of Viroscience, Erasmus MC, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Rotterdam, Netherlands
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3
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Oreshkova N, Molenaar RJ, Vreman S, Harders F, Oude Munnink BB, Hakze-van der Honing RW, Gerhards N, Tolsma P, Bouwstra R, Sikkema RS, Tacken MGJ, de Rooij MMT, Weesendorp E, Engelsma MY, Bruschke CJM, Smit LAM, Koopmans M, van der Poel WHM, Stegeman A. SARS-CoV-2 infection in farmed minks, the Netherlands, April and May 2020. Euro Surveill 2020; 25:2001005. [PMID: 32553059 PMCID: PMC7403642 DOI: 10.2807/1560-7917.es.2020.25.23.2001005] [Citation(s) in RCA: 453] [Impact Index Per Article: 113.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Respiratory disease and increased mortality occurred in minks on two farms in the Netherlands, with interstitial pneumonia and SARS-CoV-2 RNA in organ and swab samples. On both farms, at least one worker had coronavirus disease-associated symptoms before the outbreak. Variations in mink-derived viral genomes showed between-mink transmission and no infection link between the farms. Inhalable dust contained viral RNA, indicating possible exposure of workers. One worker is assumed to have attracted the virus from mink.
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Affiliation(s)
- Nadia Oreshkova
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | | | - Sandra Vreman
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Frank Harders
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Bas B Oude Munnink
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Nora Gerhards
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Paulien Tolsma
- Regional Public Health Service Brabant-Zuid-Oost, Eindhoven, the Netherlands
| | | | - Reina S Sikkema
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mirriam GJ Tacken
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Myrna MT de Rooij
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Eefke Weesendorp
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Marc Y Engelsma
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | | | - Lidwien AM Smit
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Marion Koopmans
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wim HM van der Poel
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Arjan Stegeman
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
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4
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Oreshkova N, Molenaar RJ, Vreman S, Harders F, Oude Munnink BB, Hakze-van der Honing RW, Gerhards N, Tolsma P, Bouwstra R, Sikkema RS, Tacken MG, de Rooij MM, Weesendorp E, Engelsma MY, Bruschke CJ, Smit LA, Koopmans M, van der Poel WH, Stegeman A. SARS-CoV-2 infection in farmed minks, the Netherlands, April and May 2020. Euro Surveill 2020. [PMID: 32553059 DOI: 10.1101/2020.05.18.101493] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Respiratory disease and increased mortality occurred in minks on two farms in the Netherlands, with interstitial pneumonia and SARS-CoV-2 RNA in organ and swab samples. On both farms, at least one worker had coronavirus disease-associated symptoms before the outbreak. Variations in mink-derived viral genomes showed between-mink transmission and no infection link between the farms. Inhalable dust contained viral RNA, indicating possible exposure of workers. One worker is assumed to have attracted the virus from mink.
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Affiliation(s)
- Nadia Oreshkova
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | | | - Sandra Vreman
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Frank Harders
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Bas B Oude Munnink
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Nora Gerhards
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Paulien Tolsma
- Regional Public Health Service Brabant-Zuid-Oost, Eindhoven, the Netherlands
| | | | - Reina S Sikkema
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mirriam Gj Tacken
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Myrna Mt de Rooij
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Eefke Weesendorp
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Marc Y Engelsma
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | | | - Lidwien Am Smit
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Marion Koopmans
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wim Hm van der Poel
- Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, the Netherlands
| | - Arjan Stegeman
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
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5
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Freidl G, Schoss S, Te Wierik M, Heck M, Tolsma P, Urbanus A, Slegers-Fitz-James I, Friesema I. Tracing Back the Source of an Outbreak of Salmonella Typhimurium; National Outbreak Linked to the Consumption of Raw and Undercooked Beef Products, the Netherlands, October to December 2015. PLoS Curr 2018; 10:ecurrents.outbreaks.1c667d62b51eb9840f5f7eb617e56bc1. [PMID: 30214830 PMCID: PMC6117123 DOI: 10.1371/currents.outbreaks.1c667d62b51eb9840f5f7eb617e56bc1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION On 23 October 2015, six related cases with gastroenteritis called the Netherlands Food and Consumer Product Safety Authority. They suspected filet américain, a raw beef spread, to be the source of infection. Leftovers and stool samples tested positive for Salmonella Typhimurium. Multiple locus variable-number of tandem repeat analysis (MLVA) revealed a MLVA pattern (02-23-08-08-212), which had not been detected in the Netherlands before. Concomitantly, an increase of this MLVA type was observed in the national Salmonella surveillance, amounting to 46 cases between 26 October and 9 December. METHODS To investigate whether filet américain or an alternative (related) source could be linked to surveillance-reported cases, cases (n=38) were invited to complete a questionnaire and upstream source tracing to map the food supply chain was initiated. RESULTS Rapid interdisciplinary action resulted in identification of a contaminated 46-ton batch of beef distributed via a Dutch deboning plant as the likely source of infection. In total, 24/29 respondents (83%) could be linked to the incriminated batch of beef products (predominantly filet américain and minced beef). DISCUSSION Repeated identification of raw meat products as a source of infection emphasizes the importance of awareness of the risk of infection when handling or consuming these products. Improved measures and procedures on product labelling, pre-treatment or product testing should be considered.
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Affiliation(s)
- Gudrun Freidl
- EPIET fellowNational Institution for Public Health and the Environment
| | - Stefanie Schoss
- Netherlands Food and Consumer Product Safety Authority (NVWA)
| | - Margreet Te Wierik
- Consultant Communicable Disease ControlNational Institute of Public Health and the Environment
| | - Max Heck
- RIVMNational Institute for Public Helath and the Evironment
| | | | - Anouk Urbanus
- National Institution for Public Health and the Environment
| | | | - Ingrid Friesema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Fraaij PLA, Wildschut ED, Houmes RJ, Swaan CM, Hoebe CJ, de Jonge HCC, Tolsma P, de Kleer I, Pas SD, Oude Munnink BB, Phan MVT, Bestebroer TM, Roosenhoff RS, van Kampen JJA, Cotten M, Beerens N, Fouchier RAM, van den Kerkhof JH, Timen A, Koopmans MP. Severe acute respiratory infection caused by swine influenza virus in a child necessitating extracorporeal membrane oxygenation (ECMO), the Netherlands, October 2016. Euro Surveill 2016; 21:30416. [PMID: 27934581 PMCID: PMC5388114 DOI: 10.2807/1560-7917.es.2016.21.48.30416] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/30/2016] [Indexed: 11/20/2022] Open
Abstract
In October 2016, a severe infection with swine influenza A(H1N1) virus of the Eurasian avian lineage occurred in a child with a previous history of eczema in the Netherlands, following contact to pigs. The patient's condition deteriorated rapidly and required life support through extracorporeal membrane oxygenation. After start of oseltamivir treatment and removal of mucus plugs, the patient fully recovered. Monitoring of more than 80 close unprotected contacts revealed no secondary cases.
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Affiliation(s)
- Pieter L A Fraaij
- Department of Viroscience Erasmus MC, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision Infectious diseases and Immunology, Erasmus MC - Sophia, Rotterdam, The Netherlands
| | - Enno D Wildschut
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Robert J Houmes
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Corien M Swaan
- Centre for Infectious Disease Control-National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Christian J Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
- Faculty of Health, Medicine and Life Sciences Department of Medical Microbiology, Maastricht Infection Center (MINC),School of Public Health and Primary Care (CAPHRI),Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - H C C de Jonge
- Gemeentelijke Gezondheidsdienst Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Paulien Tolsma
- Gemeentelijke Gezondheidsdienst Brabant zuidoost, Eindhoven, The Netherlands
| | - Isme de Kleer
- Department of Paediatrics, Subdivision of pulmonary medicine, Erasmus MC - Sophia, Rotterdam, The Netherlands
| | - Suzan D Pas
- Department of Viroscience Erasmus MC, Rotterdam, The Netherlands
| | | | - My V T Phan
- Department of Viroscience Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | - Matthew Cotten
- Department of Viroscience Erasmus MC, Rotterdam, The Netherlands
| | - Nancy Beerens
- Wageningen Bioveterinary reseach- Wageningen University and Research, Lelystad, the Netherlands
| | - Ron A M Fouchier
- Department of Viroscience Erasmus MC, Rotterdam, The Netherlands
| | - Johannes H van den Kerkhof
- Centre for Infectious Disease Control-National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aura Timen
- Centre for Infectious Disease Control-National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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7
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van der Giessen J, Franssen F, Fonville M, Kortbeek T, Beckers P, Tolsma P, Stenvers O, Teunis P, Takumi K. How safe is the meat inspection based on artificial digestion of pooled samples for Trichinella in pork? A scenario from wildlife to a human patient in a non-endemic region of Europe. Vet Parasitol 2013; 194:110-2. [PMID: 23433990 DOI: 10.1016/j.vetpar.2013.01.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The occurrence of trichinellosis in a resident of the Netherlands prompted us to examine the likelihood of this originating from infected rats in spite of prevailing biosecurity and testing procedures. In so doing, we sought to calculate the possible risks for trichinellosis in countries deemed non-endemic. The infection risk was determined by simulating a scenario from a reservoir of minimally contaminated wildlife to pigs to humans. Results indicate that humans might become infected even in the event that artificial digestion had been performed on individually tested pig carcasses. Our conclusions justify reconsidering Trichinella control strategies based on the current testing protocol, and emphasize the importance of proper cooking as further insurance against human infection.
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Affiliation(s)
- Joke van der Giessen
- National Institute for Public Health and The Environment (RIVM), Bilthoven, The Netherlands.
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