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Erkens C.G.M.,KNCV Tuberculosis Foundation | Kamphorst M.,KNCV Tuberculosis Foundation | Kamphorst M.,Municipal Public Health Service Rotterdam Rijnmond | Abubakar I.,Public Health England | And 8 more authors.
European Respiratory Journal | Year: 2010

Contact investigation to identify individuals with tuberculosis and latent infection with Mycobacterium tuberculosis is an important component of tuberculosis control in low tuberculosis incidence countries. This document provides evidence-based and best-practice policy recommendations for contact tracing among high- and medium-priority contacts in a variety of settings. It provides a basis for national guidelines on contact investigation and tuberculosis outbreak management, and should support countries and tuberculosis control managers in evaluating and revising national policies. A review of existing guidelines, a literature search, several meetings and consultation with experts were used to formulate and grade recommendations for action during contact investigation. Available tests to identify individuals with latent infection with M. tuberculosis are designed to identify immune response against mycobacterial antigens and have variable predictive value for the likelihood to develop active tuberculosis in different populations. Contact investigation should therefore be limited to situations with a clear likelihood of transmission or to those with a higher probability of developing active tuberculosis, for instance, young children and immunocompromised persons. A risk assessment-based approach is recommended, where the need to screen contacts is prioritised on the basis of the infectiousness of the index case, intensity of exposure and susceptibility of contacts. Copyright©ERS 2010.


Hahne S.J.M.,National Institute for Public Health and the Environment RIVM | Veldhuijzen I.K.,Municipal Public Health Service Rotterdam Rijnmond | Wiessing L.,European Monitoring Center for Drugs and Drug Addiction | Lim T.-A.,U.S. Center for Disease Control and Prevention | And 2 more authors.
BMC Infectious Diseases | Year: 2013

Background: Treatment for chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is improving but not benefiting individuals unaware to be infected. To inform screening policies we assessed (1) the hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus antibody (anti-HCV-Ab) prevalence for 34 European countries; and (2) the cost-effectiveness of screening for chronic HBV and HCV infection.Methods: We searched peer-reviewed literature for data on HBsAg and anti-HCV-Ab prevalence and cost-effectiveness of screening of the general population and five subgroups, and used data for people who inject drugs (PWID) and blood donors from two European organizations. Of 1759 and 468 papers found in the prevalence and cost-effectiveness searches respectively, we included 124 and 29 papers after assessing their quality. We used decision rules to calculate weighted prevalence estimates by country.Results: The HBsAg and anti-HCV-Ab prevalence in the general population ranged from 0.1%-5.6% and 0.4%-5.2% respectively, by country. For PWID, men who have sex with men and migrants, the prevalence of HBsAg and anti-HCV-Ab was higher than the prevalence in the general population in all but 3 countries. There is evidence that HCV screening of PWID and HBsAg screening of pregnant women and migrants is cost-effective.Conclusion: The prevalence of chronic HBV and HCV infection varies widely between European countries. Anti-HCV-Ab screening of PWID and HBsAg screening of pregnant women and migrants have European public health priority. Cost-effectiveness analyses may need to take effect of antiviral treatment on preventing HBV and HCV transmission into account. © 2013 Hahné et al.; licensee BioMed Central Ltd.


Alberts C.J.,Rotterdam University | Smith W.C.S.,University of Aberdeen | Meima A.,Municipal Public Health Service Rotterdam Rijnmond | Wang L.,Jiangxi Provincial Institute of Parasitic Diseases | Richardus J.H.,Rotterdam University
Bulletin of the World Health Organization | Year: 2011

Objective To assess different countries' chances of attaining the 2011-2015 global leprosy target set by the World Health Organization (WHO) and to assess the strategy's effect on the prevalence of grade 2 disability (G2D). Methods Trends in G2D rate were analysed for Brazil, China, India and Thailand and figures were compared with the WHO target: a 35% decrease by 2015 relative to the 2010 baseline. To estimate the prevalence of G2D in 2015 and 2035 for each country three assumptions were made: (i) maintenance of the current trend; (ii) attainment of the WHO target, and (iii) reduction of G2D by 50% every 5 years relative to 2010. Findings Since 1995, the G2D rate has decreased every 5 years in Brazil, China, India and Thailand by 12.7% (95% confidence interval, CI: 6.6-18.3), 7.7% (95% CI: 1.1-12.8), 53.7% (95% CI: 38.1-65.4) and 35.9% (95% CI: 23.4-46.3), respectively. New cases with G2D detected after 2010 will contribute 15% (Brazil), 3% (China), 2.5% (India) and 4% (Thailand) to the total prevalence of G2D in 2015. If no policies are changed, between 2015 and 2035, the prevalence of G2D will decrease by more than half in China, India and Thailand, and by 16% in Brazil. Conclusion The implications of attaining the WHO target are different for each country and using indicators other than G2D prevalence will help monitor progress. The strategy will not immediately reduce the prevalence of G2D, but if it is applied consistently over the next 25 years, its long-term effect can be substantial.


Kok G.,Maastricht University | Jonkers R.,ResCon Research and Consultancy | Gelissen R.,ResCon Research and Consultancy | Meertens R.,Maastricht University | And 2 more authors.
BMC Public Health | Year: 2010

Background. Little is known regarding which behavioural responses can be expected if an influenza pandemic were to occur. Methods. A survey comprising questions based on risk perception theories, in particular PMT, was conducted with a Dutch sample. Results. Although fear that an influenza pandemic may occur was high, participants do not feel well informed. General practitioners and local health authorities were considered trustworthy sources of information and the information considered most urgent pertained to which protective measures should be taken. Participants reported an intention to comply with recommendations regarding protective measures. However, response and self efficacy were low. Maladaptive behaviours can be expected. Increasing numbers of ill individuals and school closures are also expected to lead to a decreased work force. Participants indicated wanting antiviral drugs even if the supply were to be insufficient. Conclusions. Messages regarding health protective behaviours from local health authorities should anticipate the balance between overreacting and underreacting. Also, when protective recommendations from health professionals conflict with company policies, it is unclear how employees will react. © 2010 Kok et al; licensee BioMed Central Ltd.


Veldhuijzen I.K.,Municipal Public Health Service Rotterdam Rijnmond | Veldhuijzen I.K.,Rotterdam University | Toy M.,Rotterdam University | Hahne S.J.M.,National Institute of Public Health and the Environment RIVM | And 6 more authors.
Gastroenterology | Year: 2010

Background & Aims: Persons with chronic hepatitis B virus (HBV) infection are at risk of developing cirrhosis and hepatocellular carcinoma. Early detection of chronic HBV infection through screening and treatment of eligible patients has the potential to prevent these sequelae. We assessed the cost-effectiveness in The Netherlands of systematically screening migrants from countries that have high and intermediate HBV infection levels. Methods: Epidemiologic data of the expected numbers of patients with active chronic HBV infection in the target population and information about the costs of a screening program were used in a Markov model and used to determine costs and quality-adjusted life years (QALY) for patients who were and were not treated. Results: Compared with the status quo, a 1-time screen for HBV infection can reduce mortality of liver-related diseases by 10%. Using base case estimates, the incremental cost-effectiveness ratio (ICER) of screening, compared with not screening, is euros (€) 8966 per QALY gained. The ICER ranged from €7936 to €11,705 based on univariate sensitivity analysis, varying parameter values of HBV prevalence, participation rate, success in referral, and treatment compliance. Using multivariate sensitivity analysis for treatment effectiveness, the ICER ranged from €7222 to €15,694; for disease progression, it ranged from €5568 to €60,418. Conclusions: Early detection and treatment of people with HBV infection can have a large impact on liver-related health outcomes. Systematic screening for chronic HBV infection among migrants is likely to be cost-effective, even using low estimates for HBV prevalence, participation, referral, and treatment compliance. © 2010 AGA Institute.


Bults M.,Municipal Public Health Service Rotterdam Rijnmond | Beaujean D.J.M.A.,National Institute of Public Health and the Environment | Richardus J.H.,Municipal Public Health Service Rotterdam Rijnmond | Richardus J.H.,Rotterdam University | And 3 more authors.
Vaccine | Year: 2011

Introduction: During the 2009 influenza A (H1N1) pandemic, parents in the Netherlands were recommended to vaccinate healthy children between six months and five years of age. The aim of this study was to examine reasons for (non-)acceptance, risk perception, feelings of doubt and regret, influence of the social network, and information-seeking behavior of parents who accepted or declined H1N1 vaccination. Methods: Data on accepters were collected via exit interviews following the second-dose vaccination round in December 2009 (n= 1227). Data on decliners were gathered in June and July 2010 with questionnaires (n= 1900); 25 parents participated in in-depth interviews. Results: The most reported reasons for parental acceptance of H1N1 vaccination were " I don't want my child to become sick" (43%), " Mexican flu can be severe" (10%), " the government advises it, so I do it" (6%), and " if I don't do it, I will regret it" (6%). The most reported reasons declining the vaccination were " fear of side effects/harmful consequences" (51%), " just having a bad feeling about it" (46%), and " the vaccine was not thoroughly tested" (39%). More decliners than accepters experienced feelings of doubt about the vaccination decision (decliners 63% versus accepters 51%, p< 0.001), and decliners reported more often information-seeking behavior (decliners 76% versus accepters 56%, p< 0.001). Decliners more frequently solicited advice from their social network than accepters (decliners 72% versus accepters 61%, p< 0.001). Furthermore, accepters more often reported social influence on their vaccination decision (accepters 58% versus decliners 38%, p< 0.001) and experienced more negative feelings after their vaccination decision (accepters 8% versus decliners 2%, p< 0.001). Immigrant accepters and decliners more often had feelings of doubt and regret about the vaccination decision, solicited advice more often from their social network, and were more often influenced by this advice compared to native Dutch parents. Conclusion: To optimize response rates in future vaccination campaigns, health authorities should provide more information on vaccine benefits and possible risks, tailoring this information to specific risk groups. Health authorities should also invest in the development and implementation of effective vaccine risk/benefit communication tools. © 2011 Elsevier Ltd.


Zenner D.,Public Health England | Zenner D.,University College London | Southern J.,Public Health England | Van Hest R.,Municipal Public Health Service Rotterdam Rijnmond | And 5 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2013

In low-incidence countries, tuberculosis (TB) is now largely concentrated in high-risk groups such as migrants, homeless people, illicit drug users, alcoholics and prisoners. This has led to increased efforts to implement targeted active case finding for TB among specific populations. This review examines the evidence supporting active case finding in migrants and social risk groups, as well as the cost-effectiveness of interventions. While data from observational studies support active case finding in defined high-risk groups, further research to determine the effectiveness of specific tools and the cost-effectiveness of screening strategies is needed to inform evidence-based control methods in low-incidence countries. Inevitably, addressing TB in low-incidence countries will depend on effective disease control in high-burden countries. © 2013 The Union.


Beaujean D.J.M.A.,National Institute of Public Health and the Environment | Bults M.,Municipal Public Health Service Rotterdam Rijnmond | Bults M.,Erasmus University Rotterdam | Van Steenbergen J.E.,National Institute of Public Health and the Environment | And 2 more authors.
BMC Public Health | Year: 2013

Background: Lyme disease (LD) is the most common tick-borne disease in the United States and in Europe. The aim of this study was to examine knowledge, perceived risk, feelings of anxiety, and behavioral responses of the general public in relation to tick bites and LD in the Netherlands. Methods. From a representative Internet panel a random sample was drawn of 550 panel members aged 18 years and older (8-15 November 2010) who were invited to complete an online questionnaire. Results: Response rate (362/550, 66%). This study demonstrates that knowledge, level of concern, and perceived efficacy are the main determinants of preventive behavior. 35% (n = 125/362) of the respondents reported a good general knowledge of LD. While 95% (n = 344/362) perceived LD as severe or very severe, the minority (n = 130/362, 36%) perceived their risk of LD to be low. Respondents were more likely to check their skin after being outdoors and remove ticks if necessary, than to wear protective clothing and/or use insect repellent skin products. The percentage of respondents taking preventive measures ranged from 6% for using insect repellent skin products, to 37% for wearing protective clothing. History of tick bites, higher levels of knowledge and moderate/high levels of worry were significant predictors of checking the skin. Significant predictors of wearing protective clothing were being unemployed/retired, higher knowledge levels, higher levels of worry about LD and higher levels of perceived efficacy of wearing protective clothing. Conclusions: Prevention programs targeting tick bites and LD should aim at influencing people's perceptions and increasing their knowledge and perceived efficacy of protective behavior. This can be done by strengthening motivators (e.g. knowledge, concern about LD, perceived efficacy of wearing protective clothing) and removing barriers (e.g. low perceived personal risk, not knowing how to recognize a tick). The challenge is to take our study findings and translate them into appropriate prevention strategies. © 2013 Beaujean et al.; licensee BioMed Central Ltd.


Braks M.,National Institute for Public Health and the Environment | van Ginkel R.,Municipal Public Health Service Rotterdam Rijnmond | Wint W.,University of Oxford | Sedda L.,University of Oxford | Sprong H.,National Institute for Public Health and the Environment
International Journal of Environmental Research and Public Health | Year: 2014

Public health authorities are required to prepare for future threats and need predictions of the likely impact of climate change on public health risks. They may get overwhelmed by the volume of heterogeneous information in scientific articles and risk relying purely on the public opinion articles which focus mainly on global warming trends, and leave out many other relevant factors. In the current paper, we discuss various scientific approaches investigating climate change and its possible impact on public health and discuss their different roles and functions in unraveling the complexity of the subject. It is not our objective to review the available literature or to make predictions for certain diseases or countries, but rather to evaluate the applicability of scientific research articles on climate change to evidence-based public health decisions. In the context of mosquito borne diseases, we identify common pitfalls to watch out for when assessing scientific research on the impact of climate change on human health. We aim to provide guidance through the plethora of scientific papers and views on the impact of climate change on human health to those new to the subject, as well as to remind public health experts of its multifactorial and multidisciplinary character. © 2013 by the authors; licensee MDPI, Basel, Switzerland.


Visser H.,Municipal Public Health Service Rotterdam Rijnmond
Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin | Year: 2010

In February 2009, an outbreak of 38 cases of gastroenteritis occurred among the participants of two Dutch coach trips (A and B) who visited the same hotel in Germany. We initiated an outbreak investigation to determine possible risk of food-borne infection. A retrospective cohort study was performed among 87 passengers using a self-administered questionnaire. The response rate was 75 of 87 (86%). Mean age was 65 years. Cases were defined as participants of the two coach trips who had diarrhoea and/or vomiting at least once within 24 hours in the period between 7 and 14 February 2009. We distinguished early and late cases, with symptoms starting within or after 72 hours of arrival in the hotel. Overall attack-rate was 38 of 75 (51%). Microbiological investigation was performed on stool samples of two passengers from Coach A and two passengers from Coach B. Identical norovirus genotype II.4 sequences were detected in all four samples. Univariate analysis revealed a potential risk for early cases from juice consumption , which was most clearly seen for Coach B on day of arrival (juice at lunch: relative risk (RR): 3.9, 95% confidence interval (CI): 1.3-11.7; juice at dinner: RR: 5.5, 95% CI: 1.6-18.1). A dose-response relationship was found. This outbreak was probably caused by using the taps of juice served in large containers with a tap for self-service, due to environmental contamination through person-to-person transmission. Still the role of either contaminated juice or contact with contaminated juice cannot be ruled out.

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