de Haas R; Mintjes-de Groot AJ; Geubbels ELPE; van den Berg JMJ; de Boer AS(Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1998-04-30)
The objectives were to make recommendations for a standard method of Post-Discharge Surveillance (PDS) based on an inventory of PDS methods in hospitals participating in the PREZIES project and in foreign countries. Methods were telephone interviews on the PDS methods in the participating hospitals and a literature search on PDS methods in foreign countries. Twenty hospitals participated in the inventory, representing a response of 95%, in which the validity, efficiency and feasibility of the method were assessed. The preferred PDS method would seem to be an active system of surveillance in the outpatient clinic in which the examining specialist states in writing whether a patient has a post-operative infection or not. A good alternative is the outpatient medical record review. Checkups in the outpatient clinic about 30 days after the operation is thought preferable. SSIs occurring within 30 days of the operation are concluded to be related to the operation, except infections occurring after implantations, for which the interval is one year.<br>
Haas R de; Mintjes AJ; Geubbels ELPE; Berg JMJ van den; Boer AS de(CBO, 1998-04-30)
The objectives were to evaluate the use of surveillance results in hospitals participating in the PREZIES project. Methods: a questionnaire to determine distribution and use of surveillance results, influence on policy and/or decisions on infection prevention. From the 48 contacts asked to complete the questionnaire, 79% responded. The results of the surveillance carried out in one's own hosptital were (partly) distributed in practically all cases to infection committee and to surgeons, as well as, in most cases, to nursing units and management. In comparison with the other PREZIES hospitals, the questionnaire was distributed in almost every case to the infection committee and surgeons, and less often to nursing units and management. The report on results was used in half the hospitals to provide information and, according to the contacts in all the hospitals, contributed to more awareness on infection prevention. In almost half the hospitals the results led to an intervention measure. A number of contacts in these hospitals stated that the measure led to decreased surgical site infections. In many hospitals, the time following the introduction of the intervention measure was too short to be able to assess the effect. In more than half the hospitals the surveillance supported the policy and/or decisions on infection prevention. Eighty-four per cent of the hospitals were pleased with the PREZIES project in its current form, and 89% wish to continue their participation in the national surveillance.
de Melker HE; Conyn-van Spaendonck MAE; Schellekens JFP(Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1995-11-01)
The objective was to obtain insight into the current incidence of pertussis. Design: Comparison study from different surveillance sources. Method: For the years 1989-1994 the incidence of pertussis was estimated from the number of pertussis notifications, from laboratory data from serodiagnosis, isolations of Bordetella and from the national registration of clinical diagnosis of hospital admissions. Results: The number of notifications and positive serological results yielded similar average annual incidence for the period 1989-1994 (2.3 and 2.2/100,000, respectively). According to notifications peak incidences occurred in 1989 (3.5/100,000) and 1994 (3.4/100,000). For positive serodiagnosis the incidences in 1989 and 1994 were 2.4/100,000 and 3.2/100,0000, respectively. In 1993 the incidence of notifications and positive serodiagnosis (2.4 and 3.2 per 100,000) was also higher than in the other years. The incidence based on hospitalizations, notifications and positive serology was highest among children younger than one year. In 1994 and 1993 the estimations for the vaccine efficacy were 84% (95%-confidence interval 80-87%) and 92% (95%-confidence interval 90-94%), respectively. Conclusion: For 1989-1994, the pattern indicated that pertussis is endemic with four-yearly peaks. The incidence of hospitalizations emphasizes the seriousness of the illness in infants. Due to the vaccine coverage in the Netherlands, the incidence among unvaccinated children is much lower then among unvaccinated children in neighbouring areas with lower vaccine coverage. It is important that general practitioners are aware of the occurrence of pertussis in vaccinated and unvaccinated children and adults. The probable decrease in vaccine efficacy (92% in 1993; 84% in 1994) needs special attention and must be monitored. This stresses the importance of continued surveillance.<br>
Heuvelink AE; Tilburg JJHC; Voogt N; Pelt W van; Leeuwen WJ van; Sturm JMJ; Giessen AW van de(1998-11-30)
In order to obtain reliable data on the prevalences and trends of zoonotic agents in farm animals in the Netherlands, a monitoring system based on statistical principles was implemented in April 1997. This report presents the results of the first year of monitoring. The monitoring was focused on the occurrence of Salmonella spp. and E. coli O157 in broilers, laying hens (layers), veal calves and dairy cattle. In addition, broiler braces were examined for the presence of (thermophilic) Campylobacter spp. and a selection of braces from all farm animal categories were examined for the presence of verocytotoxin (VT)-producing E. coli (VTEC) of all serotypes. The prevalences of the zoonotic agents were estimated at brace level. Braces were sampled by randomly collecting fresh faecal droppings on the farms. Salmonella spp. were isolated from 22.0% of the broiler braces (n=100), 15.3% of the layer braces (n=163) and 1.6% of the veal calf herds (n=192). S. Enteritidis was isolated from 5.5% of the layer braces. Salmonella spp. were not isolated from any of the dairy cattle herds (n=136). The prevalence of Campylobacter in broiler braces (n=84) was 29.8%. E. coli O157 was isolated from 4.4% of the dairy cattle herds, from 1.6% of the veal calf herds (n=191) and from one of the layer braces. E. coli O157 was not isolated from any of the broiler braces. Found positive for VTEC were 40.5% and 17.2% for the veal calf and dairy cattle herds, and 4.4% and 3.2% for the layer and broiler braces, respectively. Poultry can therefore be concluded to still be an important reservoir of Salmonella spp. and Campylobacter spp. Cattle should be considered as an important reservoir of E. coli O157 and other VTEC serotypes.
During the surveillance conducted in 1995, focussing on special slaughter places, 199 samples of urine were analysed for the presence of residues of anabolic steroids and beta-agonists, 93 samples of bovine retina were analysed for the presence of residues of beta-agonists, 50 samples of kidney fat were analysed for the presence of gestagens and 63 samples of kidney were analysed for the presence of tranquillizers. In one sample of urine residues of clenbuterol were detected and in one sample of kidney residues of xylazine were detected. In none of the other samples any residues of the compounds mentioned were detected. We found out that 2 of the 604 samples (originating from 405 animals) were found positive for beta-agonists or tranquillizers.
van Duynhoven YTHP; de Wit MAS(Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2000-08-23)
Data are presented here on foodborne infections and intoxication in the Netherlands in 1999. This information was based on consumer notifications received at the Food Inspection Services on standard reports of outbreaks investigated by Municipal Health Services and on statutory notifications made by physicians to the Inspectorate for Health Care. All five regional Food Inspection Services submitted data for 1999; in one of the Food Inspection Services data were reported to be incomplete. The 320 outbreaks and 140 endemic cases of foodborne infections and intoxication reported formed a relatively low number compared with previous years. The Municipal Health Services reported 22 outbreak investigations of foodborne infections and intoxication cases in 1999; this was comparable to 1998, although the number of cases of infections and intoxication was higher compared to 1998. At the Inspectorate for Health Care, 265 patients were reported individually and another 159 as being linked to several outbreaks. This total of 424 patients represented a decrease in comparison with 1998. A probable cause for the foodborne infections and intoxication was found in 10% of the notifications received at the Food Inspection Services and in 55% of investigated outbreaks reported by the Municipal Health Services.<br>
Rumke HC; Conyn-van Spaendonck MAE; Plantinga AD(Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1994-03-31)
The Netherlands Immunization Programme has greatly reduced the incidence of target childhood diseases and their complications. However, continuous vigilance is required. In this report we propose an integrated approach for surveillance of the Netherlands Immunization Programme. Data collection for all target diseases should be combined as much as possible. Such surveillance system has four key elements: . epidemiological surveillance . immunosurveillance studies . microbiological surveillance . surveillance of adverse events following vaccinations. The proposed primary surveillance system is considered suitable to collect the relevant data at the level of the general population. Specific studies in subpopulations can be further initiated on signals from the primary system.<br>
de Melker HE; Conyn-van Spaendonck MAE; Schellekens JFP(Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1997-09-30)
A sudden and high increase in registrations, positive serodiagnostics, Bordetella isolations and hospital admissions were observed in the Netherlands in 1996. This seems to reflect a true increase in the incidence of pertussis. Most cases occurred among 1-9-year-old vaccinated children. In 1994-1995, and especially 1996 a higher proportion of vaccinated cases was seen among the cases registered. Despite the methodological constraints of vaccine-efficacy estimations using the screening method, a lower vaccine-efficacy for 1996 is probable. The proportion of registrations confirmed with one-point serology in the 1993-96 period which does not meet the formal criteria for registration increased from 25% to 48%. In addition to this 'overreporting', the underreporting of patients with positive two-point serology decreased from 74% in 1993 to 51% in 1996. The number of pertussis patients in 1996 was higher than in 1987. Increased awareness, changes in diagnostics and a lower vaccine coverage could not explain the epidemic. There are indications that changes occurred in the bacterium. This could have resulted in a mismatch between the vaccine-induced immunity and the circulating Bordetella strains. The constant ratio of hospital admissions and notifications and hospital admissions and positive two-point serology among infants less than one year old, indicate no change in the virulence of the circulating strains. In January 1997, active (monthly) surveillance by pediatricians of cases among hospitalized children was started to obtain insight into the severity of pertussis among infants. Protection of these infants is the main reason for pertussis vaccination. The methodological limitations of the current estimations based on the screening method and retrospective data, calls for optimisation of vaccine-efficacy estimations. Therefore a prospective study is considered to assess efficacy of the whole cell vaccine, differentiated by severity of disease, is under consideration.<br>
Reintjes R; Termorshuizen F; Laar MJW van de(1997-08-31)
In this study the STD registration at Municipal Health Services in the Netherlands is evaluated by the use of qualitative and quantitative methods. In the Netherlands a number of surveillance systems for STD with different focuses exists. The STD registration is the only surveillance system at a national level that provides information on STD and background information on patients. Nevertheless the validity of this system was questioned. The STD registration is an established surveillance system for STD. The willingness among health services to participate in this surveillance system has increased continuously over the last years. Although it is unknown what proportion of STD patients visit these health services, we believe that the data can be used to monitor trends in STD and their determinants. Despite its restrictions which are described in this report, the registration system is the only one at a national level with additional epidemiological information on patients and it is not restricted to a few selected STD. In the coming years the validity of the STD registration system will benefit greatly from improving the uniformity of protocols and process of automated data collection.
Mannien J; Beaumont MTA; Geubbels ELPE; Wille JC; de Boer AS(Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2002-02-25)
In the period from July 1997 to December 2000, 19 hospitals collected data on 3,921 patients in the Intensive Care Unit (ICU) for 41,744 ICU patient-days. Of these patients 1,065 had developed 1,673 infections, including 684 with pneumonia, 354 with sepsis, 353 with urinary tract infections and 282 with other infections. Of the total number of patients, 63% were mechanically ventilated, 88% had a urinary bladder catheter and 66% had at least one central vascular catheter. The number of ventilation-related pneumonias was 24 per 1000 ventilation-days, the number of catheter-related urinary tract infections was 10 per 1000 catheter-days, and the number of central catheter-related sepsis was 4 per 1000 central-venous catheter-days. The surveillance results led to interventions in only 2 hospitals, and 7 hosptials supported the policy and/or the decision-making process on infection prevention in the ICUs.<br>
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