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    Virologische NIVEL/RIVM-surveillance van respiratoire virusinfecties in het seizoen 1994/95

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    Authors
    Bestebroer TM
    Bartelds AIM
    Loon AM van
    Boswijk H
    Bijlsma K
    Claas ECJ
    Kleijne JAFW
    Verweij C
    Verweij-Uijterwaal MW
    Wermenbol AG
    Jong J de
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    Type
    Onderzoeksrapport
    Language
    nl
    
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    Title
    Virologische NIVEL/RIVM-surveillance van respiratoire virusinfecties in het seizoen 1994/95
    Translated Title
    Virological NIVEL/RIVM-surveillance of respiratory virus infection in the season 1994/95
    Publiekssamenvatting
    Sinds het seizoen 1992/93 sturen de NIVEL (Nederlands Instituut voor Onderzoek van de Gezondheidszorg) peilstationartsen neus-/keelwatten op van door hen behandelde patienten met acute luchtwegklachten naar het RIVM. Aldaar worden deze monsters m.b.v. de kweek in celcultuur op virussen onderzocht. In het seizoen 1994/95 werden de monsters tevens m.b.v. de polymerase chain reactie (PCR) onderzocht op Mycoplasma pneumoniae, Chlamydia pneumoniae, rhinovirus, enterovirus, RS-virus, coronavirus OC43 en coronavirus 229E. Deze surveillance verschaft een beter inzicht in de etiologie en de incidenties van minder ernstig verlopende luchtweginfecties dan de virusisoleringen voor diagnostische doeleinden. In het seizoen 1994/95 stuurden de peilstationartsen 557 monsters van patienten met respiratoire aandoeningen naar het RIVM. In 189 (34%) werd een respiratoir virus en/of bacterie aangetoond. Influenza B-virus (9%) en rhinovirus (9%) waren de meest voorkomende verwekkers gevolgd door coronavirus OC43 (4%), influenza A-virus (3%), RS-virus (3%) en adenovirus (2%). In 8 (4%) van de positieve monsters werden twee verwekkers aangetoond. In 70 (37%) van de positieve monsters werd alleen m.b.v. de PCR een micro-organisme aangetoond. Worden deze resultaten vergeleken met die uit de diagnostische laboratoria, dan zijn de belangrijkste verschillen het relatief hogere aantal influenzavirus-isolaten en het relatief lagere aantal RS-virus-isolaten in het NIVEL/RIVM-surveillance netwerk. Tevens is influenza B-virus de meest voorkomende verwekker in het NIVEL/RIVM-surveillance netwerk in tegenstelling tot de diagnostische laboratoria, waar het type A(H3N2) domineerde. Van 68 PCR-positieve patienten werden 72 vervolgmonsters afgenomen na gemiddeld 24 dagen. Drie patienten bleken PCR-positief te blijven voor hetzelfde agens ; in twee gevallen betrof het Chlamydia pneumoniae. De klinische relevantie van de PCR lijkt daarom goed te zijn voor de onderzochte respiratoire virussen en voor Mycoplasma pneumoniae.
    The Netherlands institute of primary health care (NIVEL) is running a surveillance network of 46 sentinel general practices (GP) stations, spread over the country in proportion to the population density. The GP of this network sent nose/throat swabs from the part of their patients with respiratory illnesses to the RIVM. In the season 1994/95 557 respiratory specimens were examined by virus isolation and PCR. In 189 (34%) of the samples a respiratory virus or bacterium was detected by either technique. Influenza B (9%) and rhinovirus (9%) were the predominant viruses followed by coronavirus OC43 (4%), influenza A virus (3%), RS virus (3%), and adenovirus (2%). In 8 (4%) of the positive samples two etiologic agents were detected. In 70 (37%) of the causative agents were only recognized by PCR. When comparing the results of the surveillance among patients in the GP network with those of the examinations of virus diagnostic laboratories, the main differences were the higher proportion of influenza virus isolations and the lower proportion of RS virus isolations in the GP system. Among the isolated influenza viruses, type B prevailed in the GP system and type A(H3N2) in the virus diagnostic laboratories. From 68 PCR-positive patients 72 follow-up samples could be obtained, taken on an average 24 days after the first specimen. In only three patients the agent could still be demonstrated in the follow-up sample ; in two of these the agent was Chlamydia pneumoniae. Conclusions: The proportions of at least part of the viruses isolated from patients with respiratory complaints in a GP network differ considerably from those isolated in virus diagnostic laboratories, the samples of which are mainly derived from hospitalised patients. Surveillance of respiratory infections among patients of GP is therefore essential for the insight in the epidemiology of respiratory diseases. On the average, illness from infection with influenza B-virus appears to be less severe compared to influenza A(H3N2) virus. Application of the PCR-technique enhances considerably the rate of positive results of the examination of respiratory specimens. Important respiratory pathogens as coronavirus, Mycoplasma pneumoniae, and Chlamydia pneumoniae even can only be detected by PCR. The clinical relevance of the PCR-technique appears to be high for the tested respiratory viruses and for Mycoplasma pneumoniae. The rhinovirus PCR and the virus culture technique should be improved, whereas the bacterial surveillance should be extended to important cultivable respiratory bacteria.
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    http://hdl.handle.net/10029/256584
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