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Apeldoorn, Netherlands

Staudova B.,Masaryk University | Strouhal M.,Masaryk University | Strouhal M.,University of Washington | Zobanikova M.,Masaryk University | And 10 more authors.
PLoS Neglected Tropical Diseases | Year: 2014

T. pallidum subsp. endemicum (TEN) is the causative agent of bejel (also known as endemic syphilis). Clinical symptoms of syphilis and bejel are overlapping and the epidemiological context is important for correct diagnosis of both diseases. In contrast to syphilis, caused by T. pallidum subsp. pallidum (TPA), TEN infections are usually spread by direct contact or contaminated utensils rather than by sexual contact. Bejel is most often seen in western Africa and in the Middle East. The strain Bosnia A was isolated in 1950 in Bosnia, southern Europe.The complete genome of the Bosnia A strain was amplified and sequenced using the pooled segment genome sequencing (PSGS) method and a combination of three next-generation sequencing techniques (SOLiD, Roche 454, and Illumina). Using this approach, a total combined average genome coverage of 513× was achieved. The size of the Bosnia A genome was found to be 1,137,653 bp, i.e. 1.6–2.8 kbp shorter than any previously published genomes of uncultivable pathogenic treponemes. Conserved gene synteny was found in the Bosnia A genome compared to other sequenced syphilis and yaws treponemes. The TEN Bosnia A genome was distinct but very similar to the genome of yaws-causing T. pallidum subsp. pertenue (TPE) strains. Interestingly, the TEN Bosnia A genome was found to contain several sequences, which so far, have been uniquely identified only in syphilis treponemes.The genome of TEN Bosnia A contains several sequences thought to be unique to TPA strains; these sequences very likely represent remnants of recombination events during the evolution of TEN treponemes. This finding emphasizes a possible role of repeated horizontal gene transfer between treponemal subspecies in shaping the Bosnia A genome. © 2014 Štaudová et al.

Vinkeles Melchers N.V.S.,University of Amsterdam | van Elsland S.L.,VU University Amsterdam | Lange J.M.A.,University of Amsterdam | Borgdorff M.W.,Public Health Service GGD Amsterdam | van den Hombergh J.,PharmAccess International
PLoS ONE | Year: 2013

Background: Prisoners are at high risk of developing tuberculosis (TB), causing morbidity and mortality. Prison facilities encounter many challenges in TB screening procedures and TB control. This review explores screening practices for detection of TB and describes limitations of TB control in prison facilities worldwide. Methods: A systematic search of online databases (e.g., PubMed and Embase) and conference abstracts was carried out. Research papers describing screening and diagnostic practices among prisoners were included. A total of 52 articles met the inclusion criteria. A meta-analysis of TB prevalence in prison facilities by screening and diagnostic tools was performed. Results: The most common screening tool was symptom questionnaires (63·5%), mostly reporting presence of cough. Microscopy of sputum with Ziehl-Neelsen staining and solid culture were the most frequently combined diagnostic methods (21·2%). Chest X-ray and tuberculin skin tests were used by 73·1% and 50%, respectively, as either a screening and/or diagnostic tool. Median TB prevalence among prisoners of all included studies was 1,913 cases of TB per 100,000 prisoners (interquartile range [IQR]: 332-3,517). The overall annual median TB incidence was 7·0 cases per 1000 person-years (IQR: 2·7-30·0). Major limitations for successful TB control were inaccuracy of diagnostic algorithms and the lack of adequate laboratory facilities reported by 61·5% of studies. The most frequent recommendation for improving TB control and case detection was to increase screening frequency (73·1%). Discussion: TB screening algorithms differ by income area and should be adapted to local contexts. In order to control TB, prison facilities must improve laboratory capacity and frequent use of effective screening and diagnostic tools. Sustainable political will and funding are critical to achieve this. © 2013 Vinkeles Melchers et al.

Baaten G.G.,Public Health Service GGD Amsterdam | Baaten G.G.,National Coordination Center for Travelers Health Advice | Sonder G.J.B.,Public Health Service GGD Amsterdam | Sonder G.J.B.,National Coordination Center for Travelers Health Advice | And 4 more authors.
Journal of Travel Medicine | Year: 2010

Objective. To evaluate whether changes in attack rates of fecal-orally transmitted diseases among travelers are related to changes in pretravel vaccination practices or better hygienic standards at travel destination. Methods. National surveillance data on all laboratory-confirmed cases of travel-related hepatitis A, shigellosis, and typhoid fever diagnosed in the Netherlands from 1995 to 2006 were matched with the number of Dutch travelers to developing countries to calculate region-specific annual attack rates. Trends in attack rates of non-vaccine-preventable shigellosis were compared with those of vaccine-preventable hepatitis A and typhoid fever. Trends were also compared with three markers for hygienic standards of the local population at travel destinations, drawn from the United Nations Development Programme database: the human development index, the sanitation index, and the water source index. Results. Attack rates among Dutch travelers to developing regions declined for hepatitis A, shigellosis, and typhoid fever. Region-specific trends in attack rates of shigellosis resembled trends of hepatitis A and typhoid fever. Declining attack rates of the three fecal-orally transmitted diseases correlated with improvements in socioeconomic, sanitary, and water supply conditions of the local population at travel destination. Conclusions. These findings suggest that improved hygienic standards at travel destination strongly contributed to the overall decline in attack rates of fecal-orally transmitted diseases among visiting travelers. © 2010 International Society of Travel Medicine. © 2010 International Society of Travel Medicine.

Bovee L.,Public Health Service GGD Amsterdam | Whelan J.,Public Health Service GGD Amsterdam | Sonder G.J.B.,Public Health Service GGD Amsterdam | van Dam A.P.,Public Health Laboratory | van Den Hoek A.,Public Health Service GGD Amsterdam
BMC Infectious Diseases | Year: 2012

Background: Internationally, guidelines to prevent secondary transmission of Shigella infection vary widely. Cases, their contacts with diarrhoea, and those in certain occupational groups are frequently excluded from work, school, or daycare. In the Netherlands, all contacts attending pre-school (age 0-3) and junior classes in primary school (age 4-5), irrespective of symptoms, are also excluded pending microbiological clearance. We identified risk factors for secondary Shigella infection (SSI) within households and evaluated infection control policy in this regard.Methods: This retrospective cohort study of households where a laboratory confirmed Shigella case was reported in Amsterdam (2002-2009) included all households at high risk for SSI (i.e. any household member under 16 years). Cases were classified as primary, co-primary or SSIs. Using univariable and multivariable binomial regression with clustered robust standard errors to account for household clustering, we examined case and contact factors (Shigella serotype, ethnicity, age, sex, household size, symptoms) associated with SSI in contacts within households.Results: SSI occurred in 25/ 337 contacts (7.4%): 20% were asymptomatic, 68% were female, and median age was 14 years (IQR: 4-38). In a multivariable model adjusted for case and household factors, only diarrhoea in contacts was associated with SSI (IRR 8.0, 95% CI:2.7-23.8). In a second model, factors predictive of SSI in contacts were the age of case (0-3 years (IRRcase≥6 years:2.5, 95% CI:1.1-5.5) and 4-5 years (IRRcase≥6 years:2.2, 95% CI:1.1-4.3)) and household size (>6 persons (IRR2-4 persons 3.4, 95% CI:1.2-9.5)).Conclusions: To identify symptomatic and asymptomatic SSI, faecal screening should be targeted at all household contacts of preschool cases (0-3 years) and cases attending junior class in primary school (4-5 years) and any household contact with diarrhoea. If screening was limited to these groups, only one asymptomatic adult carrier would have been missed, and potential exclusion of 70 asymptomatic contacts <6 years old from school or daycare, who were contacts of cases of all ages, could have been avoided. © 2012 Boveé et al.; licensee BioMed Central Ltd.

Baaten G.G.,Public Health Service GGD Amsterdam | Baaten G.G.,National Coordination Center for Travelers Health Advice | Geskus R.B.,Public Health Service GGD Amsterdam | Geskus R.B.,University of Amsterdam | And 5 more authors.
Journal of Travel Medicine | Year: 2011

Background. Immunocompromised travelers to developing countries are thought to have symptomatic infectious diseases more often and longer than non-immunocompromised travelers. Evidence for this is lacking. This study evaluates whether immunocompromised short-term travelers are at increased risk of diseases. Methods. A prospective study was performed between October 2003 and May 2010 among adult travelers using immunosuppressive agents (ISA) and travelers with inflammatory bowel disease (IBD), with their non- immunocompromised travel companions serving as matched controls with comparable exposure to infection. Data on symptoms of infectious diseases were recorded by using a structured diary. Results. Among 75 ISA, the incidence of travel-related diarrhea was 0.76 per person-month, and the number of symptomatic days 1.32 per month. For their 75 controls, figures were 0.66 and 1.50, respectively (p > 0.05). Among 71 IBD, the incidence was 1.19, and the number of symptomatic days was 2.48. For their 71 controls, figures were 0.73 and 1.31, respectively (p > 0.05). These differences also existed before travel. ISA had significantly more and longer travel-related signs of skin infection and IBD suffered more and longer from vomiting. As for other symptoms, no significant travel-related differences were found. Only 21% of immunocompromised travelers suffering from diarrhea used their stand-by antibiotics. Conclusions. ISA and IBD did not have symptomatic infectious diseases more often or longer than non-immunocompromised travelers, except for signs of travel-related skin infection among ISA. Routine prescription of stand-by antibiotics for these immunocompromised travelers to areas with good health facilities is probably not more useful than for healthy travelers. © 2011 International Society of Travel Medicine.

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