• Een uitbraak met Campylobacter fetus na het eten van rauwmelkse schapenkaas : Hoe traceer je de bron van een uitbraak

      Koppenaal, H; Groenendijk, F; van den Berge, M; Verkade, E; Verduin, K; Zomer, A L; Duim, B; Wagenaar, J A; Tijsma, A S L; Spierenburg, M A H; et al. (2017-10-17)
      Campylobacter fetus is a species of gram-negative bacteria whose primary reservoir is the gastrointestinal tracts of cattle and sheep. Human infections are rare, though often invasive and sometimes fatal. In this paper, we studied an outbreak of six patients with a C. fetus infection and outlined their disease histories. In each case we were able to identify factors that led to a reduced resistance, including pre-existing illnesses and old age. Because of the unusually high number of patients that presented in a time period of only five months, the Community Health Services were commissioned to identify the source of infection. Using whole genome sequencing, we showed that 5 out of 6 patients belonged to the same cluster. This One Health approach resulted in the conclusion that the infection originated from unpasteurized sheep's milk processed into unripened cheese. Finally, various measures were put into place to prevent any further outbreaks.
    • Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews.

      Fournet, N; Mollema, L; Ruijs, W L; Harmsen, I A; Keck, F; Durand, J Y; Cunha, M P; Wamsiedel, M; Reis, R; French, J; et al. (2018-01-30)
      Despite effective national immunisation programmes in Europe, some groups remain incompletely or un-vaccinated ('under-vaccinated'), with underserved minorities and certain religious/ideological groups repeatedly being involved in outbreaks of vaccine preventable diseases (VPD). Gaining insight into factors regarding acceptance of vaccination of 'under-vaccinated groups' (UVGs) might give opportunities to communicate with them in a trusty and reliable manner that respects their belief system and that, maybe, increase vaccination uptake. We aimed to identify and describe UVGs in Europe and to describe beliefs, attitudes and reasons for non-vaccination in the identified UVGs.
    • Underreporting of meningococcal disease incidence in the Netherlands: results from a capture-recapture analysis based on three registration sources with correction for false positive diagnoses.

      Greeff, Sabine C de; Spanjaard, Lodewijk; Dankert, Jacob; Hoebe, Christian J P A; Nagelkerke, Nico J D; Melker, Hester E de (2006-05-10)
      In order to come to a reliable evaluation of the effectiveness of the chosen vaccination policy regarding meningococcal disease, the completeness of registrations on meningococcal disease in the Netherlands was estimated with the capture-recapture method. Data over 1993-1998 were collected from (A) mandatory notifications (n = 2926); (B) hospital registration (n = 3968); (C) laboratory surveillance (n = 3484). As the standard capture-recapture method does not take into account false positive diagnoses, we developed a model to adjust for the lack of specificity of our sources. We estimated that 1363 cases were not registered in any of the three sources in the period of study. The completeness of the three sources was therefore estimated at 49% for source A, 67% for source B and 58% for source C. After adjustment for false positive diagnoses, the completeness of source A, B, and C was estimated as 52%, 70% and 62%, respectively. The capture-recapture methods offer an attractive approach to estimate the completeness of surveillance sources and hence contribute to a more accurate estimate of the disease burden under study. However, the method does not account for higher-order interactions or presence of false positive diagnoses. Being aware of these limitations, the capture-recapture method still elucidates the (in)completeness of sources and gives a rough estimate of this (in)completeness. This makes a more accurate monitoring of disease incidence possible and hence attributes to a more reliable foundation for the design and evaluation of health interventions such as vaccination programs.
    • Understanding conflicting views of endocrine disruptor experts: a pilot study using argumentation analysis

      Clahsen, SCS; van Klaveren, HS; Vermeire, TG; van Kamp, I; Garssen, B; Piersma, AH; Lebret, E (2019-01-28)
    • Unifying the functional diversity in natural and cultivated soils using the overall body-mass distribution of nematodes.

      Mulder, Christian; Maas, Rob (2017-11-28)
      Sustainable use of our soils is a key goal for environmental protection. As many ecosystem services are supported belowground at different trophic levels by nematodes, soil nematodes are expected to provide objective metrics for biological quality to integrate physical and chemical soil variables. Trait measurements of body mass carried out at the individual level can in this way be correlated with environmental properties that influence the performance of soil biota.
    • Unraveling the drivers of regional variation in healthcare spending by analyzing prevalent chronic diseases.

      de Vries, Eline F; Heijink, Richard; Struijs, Jeroen N; Baan, Caroline A (2018-05-03)
      To indicate inefficiencies in health systems, previous studies examined regional variation in healthcare spending by analyzing the entire population. As a result, population heterogeneity is taken into account to a limited extent only. Furthermore, it clouds a detailed interpretation which could be used to inform regional budget allocation decisions to improve quality of care of one chronic disease over another. Therefore, we aimed to gain insight into the drivers of regional variation in healthcare spending by studying prevalent chronic diseases.
    • Unveiling the important roles of coexisting contaminants on photochemical transformations of pharmaceuticals: Fibrate drugs as a case study.

      Zhang, Ya-Nan; Zhou, Yangjian; Qu, Jiao; Chen, Jingwen; Zhao, Jianchen; Lu, Ying; Li, Chao; Xie, Qing; Peijnenburg, Willie J G M (2018-09-15)
      Pharmaceuticals are a group of ubiquitous emerging pollutants, many of which have been shown to undergo efficient photolysis in the environment. Photochemically produced reactive intermediates (PPRIs) sensitized by the pharmaceuticals in sunlit natural waters may induce photodegradation of coexisting compounds. In this study, the roles of coexisting contaminants on the phototransformation of pharmaceuticals were unveiled with the fibrate drugs gemfibrozil (GMF), fenofibrate (FNF), and fenofibric acid (FNFA) as model compounds. GMF undergoes initial concentration dependent photodegradation due to the involvement of singlet oxygen (1O2) initiated self-sensitized photolysis, and undergoes pH dependent photodegradation due to dissociation and hydroxyl radical (OH) generation. The decarboxylated intermediates of GMF and coexisting FNFA significantly accelerated the photodegradation of GMF. The promotional effects of the decarboxylated intermediates are attributed to generation of PPRIs, e.g. 1O2, superoxide (O2-), that subsequently react with GMF. Besides, FNFA can also promote the photodegradation of GMF through the electron transfer reaction from ground state GMF to excited state FNFA, leading to the formation of decarboxylated intermediates. The formed intermediates can subsequently also facilitate GMF photodegradation. The results presented here provided valuable novel insights into the effects of coexisting contaminants on the photodegradation of pharmaceuticals in polluted waters.
    • Update on Neonatal Herpes Simplex Epidemiology in the Netherlands: A Health Problem of Increasing Concern?

      van Oeffelen, Louise; Biekram, Manisha; Poeran, Jashvant; Hukkelhoven, Chantal; Galjaard, Sander; van der Meijden, Wim; Op de Coul, Eline (2018-01-18)
      This paper provides an update on the incidence of neonatal herpes, guideline adherence by health care professionals (HCP), and trends in genital herpes simplex virus (HSV) infection during pregnancy in the Netherlands.
    • Updated classification of norovirus genogroups and genotypes.

      Chhabra, Preeti; de Graaf, Miranda; Parra, Gabriel I; Chan, Martin Chi-Wai; Green, Kim; Martella, Vito; Wang, Qiuhong; White, Peter A; Katayama, Kazuhiko; Vennema, Harry; et al. (2019-09-04)
    • Updated cost-effectiveness and risk-benefit analysis of two infant rotavirus vaccination strategies in a high-income, low-endemic setting.

      Bruijning-Verhagen, P; van Dongen, J A P; Verberk, J D M; Pijnacker, R; van Gaalen, R D; Klinkenberg, D; de Melker, H E; Mangen, M-J J (2018)
      Since 2013, a biennial rotavirus pattern has emerged in the Netherlands with alternating high and low endemic years and a nearly 50% reduction in rotavirus hospitalization rates overall, while infant rotavirus vaccination has remained below 1% throughout. As the rotavirus vaccination cost-effectiveness and risk-benefit ratio in high-income settings is highly influenced by the total rotavirus disease burden, we re-evaluated two infant vaccination strategies, taking into account this recent change in rotavirus epidemiology.
    • Urban Chikungunya in the Middle East and North Africa: A systematic review.

      Humphrey, John M; Cleton, Natalie B; Reusken, Chantal B E M; Glesby, Marshall J; Koopmans, Marion P G; Abu-Raddad, Laith J (2017-06)
      The epidemiology of Chikungunya virus (CHIKV) in the Middle East and North Africa (MENA) is not well characterized despite increasing recognition of its expanding infection and disease burden in recent years.
    • Urban road traffic noise and noise annoyance-a study on perceived noise control and its value among the elderly.

      Riedel, Natalie; Köckler, Heike; Scheiner, Joachim; van Kamp, Irene; Erbel, Raimund; Loerbroks, Adrian; Claßen, Thomas; Bolte, Gabriele (2018-07-26)
      Noise annoyance may reflect a pro-participatory attitude towards public information and consultation according to the European Environmental Noise Directive. However, noise annoyance is also indicative of a stress response to perceived uncontrollable noise exposure. Using cross-sectional data on a sample of elderly citizens (n = 1772), we investigated whether the value residents ascribed to being able to control noise exposure at home moderated the potential indirect effect of road traffic noise on annoyance through perceived noise control. Our results confirmed the presence of such a moderated mediation, which may justify studying the impact of residents' valuing perceived noise control on participation readiness.
    • The urgency for optimization and harmonization of thyroid hormone analyses and their interpretation in developmental and reproductive toxicology studies.

      Beekhuijzen, Manon; Schneider, Steffen; Barraclough, Narinder; Hallmark, Nina; Hoberman, Alan; Lordi, Sheri; Moxon, Mary; Perks, Deborah; Piersma, Aldert H; Makris, Susan L (2018-05-02)
      In recent years several OECD test guidelines have been updated and some will be updated shortly with the requirement to measure thyroid hormone levels in the blood of mammalian laboratory species. There is, however, an imperative need for clarification and guidance regarding the collection, assessment, and interpretation of thyroid hormone data for regulatory toxicology and risk assessment. Clarification and guidance is needed for 1) timing and methods of blood collection, 2) standardization and validation of the analytical methods, 3) triggers for additional measurements, 4) the need for T4 measurements in postnatal day (PND) 4 pups, and 5) the interpretation of changes in thyroid hormone levels regarding adversity. Discussions on these topics have already been initiated, and involve expert scientists from a number of international multisector organizations. This paper provides an overview of existing issues, current activities and recommendations for moving forward.
    • Urine as Sample Type for Molecular Diagnosis of Natural Yellow Fever Virus Infections.

      Reusken, Chantal B E M; Knoester, Marjolein; GeurtsvanKessel, Corine; Koopmans, Marion; Knapen, Daan G; Bierman, Wouter F W; Pas, Suzan (2017-11)
    • Usability of the international HAVNet hepatitis A virus database for geographical annotation, backtracing and outbreak detection.

      Kroneman, Annelies; de Sousa, Rita; Verhoef, Linda; Koopmans, Marion P G; Vennema, Harry; On Behalf Of The HAVNet Network (2018-09)
      BackgroundHAVNet is an international laboratory network sharing sequences and corresponding metadata on hepatitis A virus in an online database. Aim: We give an overview of the epidemiological and genetic data and assess the usability of the present dataset for geographical annotation, backtracing and outbreak detection. Methods: A descriptive analysis was performed on the timeliness, completeness, epidemiological data and geographic coverage of the dataset. Length and genomic region of the sequences were reviewed as well as the numerical and geographical distribution of the genotypes. The geographical signal in the sequences was assessed based on a short common nt stretch using a 100% identity analysis. Results: The 9,211 reports were heterogeneous for completeness and timeliness, and for length and genomic region of the sequences. Some parts of the world were not represented by the sequences. Geographical differences in prevalence of HAV genotypes described previously could be confirmed with this dataset and for a third (1,075/3,124) of the included sequences, 100% identity of the short common sequence coincided with an identical country of origin. Conclusion: Analysis of a subset of short, shared sequences indicates that a geographical annotation on the level of individual countries is possible with the HAVNet data. If the current incompleteness and heterogeneity of the data can be improved on, HAVNet could become very useful as a worldwide reference set for geographical annotation and for backtracing and outbreak detection.
    • The use of aminoglycosides in animals within the EU: development of resistance in animals and possible impact on human and animal health: a review.

      van Duijkeren, Engeline; Schwarz, Christine; Bouchard, Damien; Catry, Boudewijn; Pomba, Constança; Baptiste, Keith Edward; Moreno, Miguel A; Rantala, Merja; Ružauskas, Modestas; Sanders, Pascal; et al. (2019-04-19)
      Aminoglycosides (AGs) are important antibacterial agents for the treatment of various infections in humans and animals. Following extensive use of AGs in humans, food-producing animals and companion animals, acquired resistance among human and animal pathogens and commensal bacteria has emerged. Acquired resistance occurs through several mechanisms, but enzymatic inactivation of AGs is the most common one. Resistance genes are often located on mobile genetic elements, facilitating their spread between different bacterial species and between animals and humans. AG resistance has been found in many different bacterial species, including those with zoonotic potential such as Salmonella spp., Campylobacter spp. and livestock-associated MRSA. The highest risk is anticipated from transfer of resistant enterococci or coliforms (Escherichia coli) since infections with these pathogens in humans would potentially be treated with AGs. There is evidence that the use of AGs in human and veterinary medicine is associated with the increased prevalence of resistance. The same resistance genes have been found in isolates from humans and animals. Evaluation of risk factors indicates that the probability of transmission of AG resistance from animals to humans through transfer of zoonotic or commensal foodborne bacteria and/or their mobile genetic elements can be regarded as high, although there are no quantitative data on the actual contribution of animals to AG resistance in human pathogens. Responsible use of AGs is of great importance in order to safeguard their clinical efficacy for human and veterinary medicine.
    • The use of generic failure frequencies in QRA: the quality and use of failure frequencies and how to bring them up-to-date.

      Beerens, H I; Post, J G; Uijt de Haag, P A M (2006-03-31)
      Quantitative Risk Assessment (QRA) is a method which is often used in the chemical industry and, in some countries, also in land-use planning. In QRA calculations the frequency of an accident scenario is most often assessed by a generic failure frequency approach. The credibility and validity of the failure frequencies used in the Netherlands for land-use planning is evaluated by means of an historical review. Furthermore, the possibility is presented how these generic data can be revised and updated.
    • The use of genomic DNA sequences as type material for valid publication of bacterial species names will have severe implications for clinical microbiology and related disciplines.

      Bisgaard, Magne; Christensen, Henrik; Clermont, Dominique; Dijkshoorn, Lenie; Janda, J Michael; Moore, Edward R B; Nemec, Alexandr; Nørskov-Lauritsen, Niels; Overmann, Jörg; Reubsaet, Frans A G (2019-03-22)
    • Use of medicine pricing and reimbursement policies for universal health coverage in Indonesia.

      Wasir, Riswandy; Irawati, Sylvi; Makady, Amr; Postma, Maarten; Goettsch, Wim; Buskens, Erik; Feenstra, Talitha (2019-01-01)
      This study aimed to define the problems of the current use of the e-Catalogue and the national formulary (NF)-two elements of medicine pricing and reimbursement policies in Indonesia for achieving universal health coverage (UHC)-by examining the knowledge and attitudes of stakeholders. Specifically, to investigate (1) the perceived challenges involved in the further implementation of the e-Catalogue and the NF, (2) reasons of prescribing medicines not listed in the NF, and (3) possible improvements in the acceptance and use of the e-Catalogue and the NF. Semi-structured interviews were conducted with stakeholders (policymakers, healthcare providers, a pharmaceutical industry representative, and experienced patients) to collect the qualitative data. The data was analysed using directed content analysis, following the guidelines of the COnsolidated criteria for REporting Qualitative studies (COREQ) in reporting the findings. Interestingly, 20 of 45 participants decided to withdraw from the interview due to their lack of knowledge of the e-Catalogue and the NF. All 25 stakeholders who fully participated in this research were in favor of the e-Catalogue and the NF. However, interviewees identified a range of challenges. A major challenge was the lack of harmonization between the lists of medicines in the e-Catalogue and the NF. Several system and personal reasons for prescribing medicines not listed in the NF were identified. Important reasons were a lack of incentives for physicians as well as a lack of transparent and evidence-based methods of selection for the medicines to be listed in the NF. The e-Catalogue and the NF have not been fully utilized for achieving UHC in Indonesia. Some possible improvements suggested were harmonization of medicines listed in the e-Catalogue and the NF, restructuring incentive programs for prescribing NF medicines, and increasing the transparency and evidence-based approach for selection of medicines listed in the e-Catalogue and the NF.