The Annual Plan 2009 includes the main areas of research of the Center for Infectious Disease Control (CIb) in the year 2009. The plan contains the control of infectious diseases in all its facets. The mission of the CIb of the RIVM is infectious decease identification and prevention to sustain public health in the Netherlands. The Annual Plan 2009 describes the work that the CIb does to implement its core tasks. To create insight in the infectious disease control, the CIb identifies relevant developments and promotes interventions. This process is illustrated in the annual plan with an explanation on the following topics: the National Vaccination Program, emerging infectious disease problems, tuberculosis, antibiotic resistance, sexually transmitted diseases and mathematical modeling. Within the themes several areas of research will be highlighted. The core tasks of the CIb are: - understanding infectious diseases through diagnosis, surveillance and research; - informing the national government on prevention and strengthening of vigilance. Rapid response during outbreaks is possible through a solid coordination of the infectious disease control, international cooperation and an overview on the implementation of the National Vaccination Program; - create effective infectious disease control and prevention by advising professionals and ministries, by means of granting research funds and by providing the public with information.

In view of the parliamentary elections in May 1994, the National Institute of Public Health and Environmental Protection has evaluated the environmental effects of the election programmes of two political parties: D66 and GroenLinks. This report presents the findings of this evaluation. Four chapters deal with the environmental policy proposals of both parties, their results for social developments (primarly traffic, energy and agriculture) and areas of environmental concern and its environmental costs. The outcomes are presented in respect to the first and second National Environmental Policy Plans (NEPP-1 and NEPP-2). The main conclusion of this first electoral environmental outlook is that when the proposed environmental measures are fully implemented and enforced, environmental pressures will be further reduced. However, the intended measures of GroenLinks and D66 are insufficient to achieve the targets for all areas of environmental concern within the fixed time. However, the environmental policy proposals of GroenLinks have more impact than those mentioned in NEPP-1 and NEPP-2, both in 2000 and 2010. The environmental policy proposals of GroenLinks will lead to a substantial reduction of the emissions of CO2 to probably below the 2000 target level. In addition, the emissions of acidifying substances (particularly NOx and SO2) will be strongly reduced even in comparison to NEPP-2 proposals. The most important impact of the environmental policy proposals of D66 is also an additional reduction of the CO2 emissions, but not as large as the reduction, resulting from the GroenLinks election programme.

This 1993 annual report presents the results of biosphere sample measurements by the Laboratory of Radiation Research (LSO) of the National Institute of Public Health and Environmental Protection (RIVM). The measurements are part of the National Measurement Programme (NMP) of the Coordinating Committee for the Monitoring of Radioactive and Xenobiotic Substances (CCRX) in the Netherlands. The NMP is considered essential for an adequate assessment of radioactivity in the biosphere. The programme of the RIVM/LSO includes samples of airdust and deposition taken at the RIVM premises in Bilthoven. Samples of grass and milk were taken from the surroundings of nuclear installations in the Netherlands and on Dutch territory in the vicinity of such installations situated abroad. An overall country milk sample from four milk factories in the Netherlands was also analyzed. This report also presents the data of the National Radioactivity Monitoring Network (LMR) in 1993. These data are not included in the NMP. In 1993, the yearly average gross alpha- and gross beta-activity concentration of airdust was 0.09 +- 0.01 (SD 0.04) and 0.55 +- 0.04 (SD 0.37) mBq.m-3, respectively. These values were significantly higher than those of previous years. This effect is explained by a change in the procedures for sample taking and sample treatment. The gamma-spectrometric analysis was performed on airdust sampled with a high volume sampler. For Be-7, Cs-137 and Pb-210 the yearly average of the activity concentrations were 3600 +- 50 (SD 1300), 1.7 +- 0.1 (SD 1.3) and 530 +- 10 (SD 500) muBq.m-3, respectively (well detector results). The yearly total gross alpha- and gross beta-activity of the deposition in Bilthoven was 54.3 +- 0.7 and 87.9 +- 0.8 Bq.m-2, respectively, and the deposition of H-3 was 1310 +- 30 Bqm-2. The total activity of Cs-137 in deposition was 0.80 +- 0.03 Bq.m-2, of Pb-210 105 +- 2 Bq.m-2 and Po-210 6.0 +- 0.6 Bq.m-2 (alpha-spectroscopy). These activities are comparable to those of previous years. The yearly average concentrations of Cs-137 and Sr-90 in consumer milk from a nationwide sample mix was 0.09 +- 0.02 and 0.04 +- 0.01 Bq.L-1, respectively, which are about equal to that of the previous year. For the gross alpha-activity concentration, as measured by the aerosol monitors of the LMR, values in the range of 0.3 - 12.1 Bq.m-3 were found (5-percentile - 95-percentile values), with an average value across the country of 2.6 Bq.m-3. This value corresponds to the value of 2.4 Bq.m-3 in 1992. No 'man-made' beta-activity was measured with the LMR monitors. The dose-equivalent rate measured with the LMR monitors was in the range of 54.5 - 95.3 nSv.h-1 (5 percentile - 95 percentile values). The average value of 77.3 nSv.h-1 was in good agreement with the 1992 and 1991 averages (79.3 and 78.9 nSv.h-1, respectively).<br>

This report describes the research methodology of the RIVM as a response to recent criticism that too little measuring is done, that there is too much reliance on models and that RIVM does not communicate the uncertainties of data and model results sufficiently to politicians. The methodolgy described demonstrates that recommendations from the RIVM are based on a well-balanced combination of scientific knowledge, mathematical models and monitoring data. Theoretical concepts are validated by measurements or experiments. Validated models are used to optimize the measurement efforts and to interpolate monitoring data. Furthermore, the models give the measurements an extra dimension, describing the processes and causal relationships behind the monitoring results as they do. Uncertainties are part and parcel of any scientific research and this is well communicated to the scientific community. In policy-oriented reports uncertainties are normally described qualitatively rather than quantitatively, except where uncertainties can affect the policy conclusions. In these cases quantitative uncertainty margins are reported and (the need for) additional research is mentioned.The report describes the uncertainties in measurements and model results for the main environmental problems: climate change, ozone layer, acidification, tropospheric ozone, particulate matter, eutrophication, noise pollution and external risks related to airport developments. Further to this is an outline on how environmental data are gathered and what models are used.

The report "Environmental return of the NEPP-2, supplement to the National Environmental Outlook 3" presents in outline the environmental costs and effects of additional policy measures which are proposed in the second National Environmental Policy Plan (NEPP-2) released in December 1993. The report "Environmental return of the NEPP-2, Appendices E to H' underpins its main results in four enclosures. The first enclosure gives for different areas of environmental concern an extensive description of costs and environmental effects of separate proposed measures whose effectiveness is projected for the years 2000 and 2010. Enclosure F describes new national manure policy measures which are focused on the concerns with manure and ammonia. The next enclosure highlights the environmental effectiveness of NEPP-2 measures on the deposition of acidifying substances. The last enclosure deals with the environmental costs of the NEPP-2 measures in proportion to the environmental costs amounted in the last National Environmental Outlook.

An Environmental Balance for the Netherlands is drawn up yearly in accordance with the Environmental Management Act to describe the quality of the environment related to the environmental policy realised. Developments related to target sectors like agriculture, industry, energy and transport sectors, and consumers are assessed with respect to the change in emission levels of various substances. The state of environment for themes like climate change, acidification, air, water, soil, and groundwater quality is assessed, and the effects of environmental pressures on humans and the environment are presented.

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Met ingang van 2005 is het nationale meetprogramma "Radioactiviteit en straling in het milieu" uitgebreid met radioactiviteitsbepalingen in een standaard voedselpakket en controlemetingen in melk. Het meetprogramma voldeed daarmee voor het eerst aan de Europese aanbevelingen uit 2000, die een nieuwe uitleg geven aan de meetverplichting voor lidstaten van de EU zoals vastgelegd in het EURATOM-verdrag uit 1957. Metingen in lucht en omgeving lieten voor 2005 een spreiding zien die geheel verklaard kan worden door de normale variaties in de natuurlijke achtergrond. In voedsel en melk zijn geen radioactiviteitniveaus aangetroffen boven de in Europees verband vastgestelde limieten voor export en consumptie. In oppervlaktewater is op een aantal locaties voor een aantal radionucliden de streefwaarde overschreden zoals vastgelegd in de Vierde Nota Waterhuishouding. De streefwaarden zijn mede gebaseerd op achtergrondwaarden voor oppervlaktewater in Nederland. Streefwaarden zijn waarden die bij voorkeur niet overschreden worden, maar het zijn geen limieten.

This report is about a study of the health risks resulting from the exposure of Ministry of Defence personnel to chromium-6 carried out at the request of the Minister of Defence between 2014 and 2018. Exposure to this hazardous substance took place at five NATO equipment storage sites that were operational in the Netherlands in the period 1984-2006. At these Prepositioned Organizational Materiel Storage (POMS) sites, employees of the Ministry of Defence carried out maintenance activities on NATO equipment. The chief source of chromium-6 was the primer coating used to protect the equipment, and maintenance activities could cause the release of this substance. Exposure to chromium-6 at the POMS sites and health effects The extent to which Ministry of Defence personnel at the five POMS sites came into contact with chromium-6 differed according to their positions. Employees in technical maintenance positions were the most exposed to chromium-6. This mainly took place during activities, such as sanding, carried out on equipment that had been treated with paint containing chromium-6 but also when coating equipment with paint containing chromium-6. Diverse health effects can arise as a result of exposure to chromium-6. Ministry of Defence personnel working in technical maintenance positions were exposed to chromium-6 that could have caused the following diseases: lung cancer, nasal and paranasal sinus cancer, gastric cancer, chromium-6-related allergic contact eczema, allergic asthma and allergic rhinitis, chronic lung diseases and perforation of the nasal septum due to chromium ulcers. Because most of these diseases can also arise due to other causes, in many cases it cannot be determined with certainty that these diseases in former employees are the result of exposure to chromium-6 at the POMS sites. Insufficient or no scientific evidence has been found to support a possible connection between exposure to chromium-6 and other health problems reported by former employees, such as problems with their teeth. The chromium-6 to which Ministry of Defence personnel were exposed in the period 1984-2006 can no longer be detected in their bodies. The fact is that chromium-6 is converted to chromium-3 in the body and subsequently excreted. Responsibilities, working conditions and duty of care In its capacity as an employer, the Ministry of Defence had the responsibility of notifying both employees and occupational physicians of the risks of exposure to paint containing chromium-6. Most POMS employees have indicated that they were not aware of the health risks relating to chromium-6. Furthermore, hardly any of the occupational physicians at the Ministry of Defence spoken to in the context of this study knew that there was a possibility that employees were being exposed to chromium-6 in the period that the POMS sites were operational. The Ministry of Defence's prevention and care policy did not meet the applicable rules, particularly in the early years. There was a lack of: (1) prompt attention for collective control measures, such as adequate ventilation and the screening off of work rooms; (2) adequate availability and quality of personal protective equipment; (3) effective supervision of compliance with the instructions for use; (4) registration of the use of hazardous substances, including chromium-6; (5) a periodic occupational health medical examination for employees who were exposed to health risks in the course of their work. Is the Ministry of Defence liable for damage to the health of former employees? If a former employee has health problems that have been diagnosed by a doctor and that can, with a certain degree of probability, be attributed to chromium-6, the employer is liable for them if (a) it can be demonstrated that the employee was exposed to chromium-6 during his or her work, and (b) the protective measures in the workplace did not comply with the regulations or what could otherwise be required. In these cases, the individual suffering the damage will, from the point of view of evidence, be aided by the rule of reversal, which means that most of the evidence will have to be furnished by the person or authority who allowed him or her to work with chromium-6. For damage to health caused by working with chromium-6 after 1 February 1995, it is irrelevant whether adequate measures were taken or not. In these cases, the authority that allowed employees to work with chromium-6 is always liable for the resulting harmful consequences. The courts will deliver the ultimate judgement. Conclusion At the end of this report, a number of recommendations arising from the study have been made to the Ministry of Defence. Some of these recommendations concern the internal communications and the health and safety policy of the Ministry of Defence. Others focus on improving the registration and monitoring of Ministry of Defence personnel. This report outlines the findings from the study on chromium-6. The ten comprehensive partial reports provide more detailed information on the study.