Laboratory methods for case finding in human psittacosis outbreaks: a systematic review.

Psittacosis outbreak investigations require rapid identification of cases in order to trace possible sources and perform public health risk assessments. In recent outbreaks in the Netherlands, such investigations were hampered by the non-specificity of laboratory testing methods to identify human Chlamydia psittaci infections

Estimation of acute and chronic Q fever incidence in children during a three-year outbreak in the Netherlands and a comparison with international literature

Background:  In the Dutch 2007-2009 Q fever outbreak Coxiella burnetii was transmitted aerogenically from dairy goat farms to those living in the surrounding areas. Relatively few children were reported. The true number of pediatric infections is unknown. In this study, we estimate the expected number of acute and chronic childhood infections. Methods:  As Coxiella was transmitted aerogenic to those living near infected dairy goat farms, we could use adult seroprevalence data to estimate infection risk for inhabitants, children and adults alike. Using Statistics Netherlands data we estimated the number of children at (high) risk for developing chronic Q fever. Literature was reviewed for childhood (0-15 years) Q fever reports and disease rates. We compared this with Dutch reported and our estimated data for 2007-2009. Results:  In The Netherlands epidemic, 44 children were reported (1.2 % of total notifications). The childhood incidence was 0.15 compared to 2.6 per 10,000 inhabitants for adults. No complications were reported. Based on the expected similarity in childhood and adult exposure we assume that 9.8 % of children in the high-risk area had Q fever infection, resulting in 1562 acute infections during the Q fever epidemic interval. Based on the prevalence of congenital heart disease, at least 13 children are at high risk for developing chronic Q fever. In medical literature, 42 case reports described 140 childhood Q fever cases with a serious outcome (four deaths). In chronic Q fever, cardiac infections were predominant. Four outbreaks were reported involving children, describing 11 childhood cases. 36 National and/or regional studies reported seroprevalences varying between 0 and 70 %. Conclusion:  In the 3-year Dutch epidemic, few childhood cases were reported, with pulmonary symptoms leading, and none with a serious presentation. With an estimated 13 high-risk children for chronic infection in the high exposure area, and probably forty in the whole country, we may expect several chronic Q fever complications in the coming years in paediatric practice

Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective

Abstract Background A screening programme for pregnant women has been in place since the 1950s in the Netherlands. In 2004 universal HIV screening according to opting out was implemented. Here, we describe the evaluation of the effectiveness of antenatal screening in the Netherlands for 2006-2008 for HIV, hepatitis B virus (HBV) and syphilis in preventing mother-to-child transmission, by using various data sources. Methods The results of antenatal screening (2006-2008) were compared with data from pregnant women and newborns from other data sources. Results Each year, around 185,000 pregnant women were screened for HIV, HBV and syphilis. Refusal rates for the screening tests were low, and were highest (0.2%) for HIV. The estimated annual prevalence of HIV among pregnant women was 0.05%. Prior to the introduction of screening, 5-10 children were born with HIV annually After the introduction of screening in 2004, only 4 children were born with HIV (an average of 1 per year). Two of these mothers had become pregnant prior to 2004; the third mother was HIV negative at screening and probably became infected after screening; the fourth mother's background was unknown. Congenital syphilis was diagnosed in fewer than 5 newborns annually and 5 children were infected with HBV. In 3 of these, the mothers were HBeAg positive (a marker for high infectivity). We estimated that 5-10 HIV, 50-75 HBV and 10 syphilis cases in newborns had been prevented annually as a result of screening. Conclusions The screening programme was effective in detecting HIV, HBV and syphilis in pregnant women and in preventing transmission to the child. Since the introduction of the HIV screening the number of children born with HIV has fallen dramatically. Previous publication [Translation from: 'Prenatale screening op hiv, hepatitis B en syphilis in Nederland effectief', published in 'The Dutch Journal of Medicine ' (NTVG, in Dutch)]</p

Molecular characterization of MRSA collected during national surveillance between 2008 and 2019 in the Netherlands

BACKGROUND: Although the Netherlands is a country with a low endemic level, methicillin-resistant Staphylococcus aureus (MRSA) poses a significant health care problem. Therefore, high coverage national MRSA surveillance has been in place since 1989. To monitor possible changes in the type-distribution and emergence of resistance and virulence, MRSA isolates are molecularly characterized.METHODS: All 43,321 isolates from 36,520 persons, collected 2008-2019, were typed by multiple-locus variable number tandem repeats analysis (MLVA) with simultaneous PCR detection of the mecA, mecC and lukF-PV genes, indicative for PVL. Next-generation sequencing data of 4991 isolates from 4798 persons were used for whole genome multi-locus sequence typing (wgMLST) and identification of resistance and virulence genes.RESULTS: We show temporal change in the molecular characteristics of the MRSA population with the proportion of PVL-positive isolates increasing from 15% in 2008-2010 to 25% in 2017-2019. In livestock-associated MRSA obtained from humans, PVL-positivity increases to 6% in 2017-2019 with isolates predominantly from regions with few pig farms. wgMLST reveals the presence of 35 genogroups with distinct resistance, virulence gene profiles and specimen origin. Typing shows prolonged persistent MRSA carriage with a mean carriage period of 407 days. There is a clear spatial and a weak temporal relationship between isolates that clustered in wgMLST, indicative for regional spread of MRSA strains.CONCLUSIONS: Using molecular characterization, this exceptionally large study shows genomic changes in the MRSA population at the national level. It reveals waxing and waning of types and genogroups and an increasing proportion of PVL-positive MRSA.</p

Clostridium difficile Ribotype 027, Toxinotype III, the Netherlands

Outbreaks due to Clostridium difficile polymerase chain reaction (PCR) ribotype 027, toxinotype III, were detected in 7 hospitals in the Netherlands from April 2005 to February 2006. One hospital experienced at the same time a second outbreak due to a toxin A–negative C. difficile PCR ribotype 017 toxinotype VIII strain. The outbreaks are difficult to control

Molecular characterization of MRSA collected during national surveillance between 2008 and 2019 in the Netherlands

Background.Although the Netherlands is a country with a low endemic level, methicillin-resistant Staphylococcus aureus (MRSA) poses a significant health care problem. Therefore, high coverage national MRSA surveillance has been in place since 1989. To monitor possible changes in the type-distribution and emergence of resistance and virulence, MRSA isolates are molecularly characterized.Methods.All 43,321 isolates from 36,520 persons, collected 2008–2019, were typed by multiple-locus variable number tandem repeats analysis (MLVA) with simultaneous PCR detection of the mecA, mecC and lukF-PV genes, indicative for PVL. Next-generation sequencing data of 4991 isolates from 4798 persons were used for whole genome multi-locus sequence typing (wgMLST) and identification of resistance and virulence genes.Results.We show temporal change in the molecular characteristics of the MRSA population with the proportion of PVL-positive isolates increasing from 15% in 2008–2010 to 25% in 2017–2019. In livestock-associated MRSA obtained from humans, PVL-positivity increases to 6% in 2017–2019 with isolates predominantly from regions with few pig farms. wgMLST reveals the presence of 35 genogroups with distinct resistance, virulence gene profiles and specimen origin. Typing shows prolonged persistent MRSA carriage with a mean carriage period of 407 days. There is a clear spatial and a weak temporal relationship between isolates that clustered in wgMLST, indicative for regional spread of MRSA strains.Conclusions.Using molecular characterization, this exceptionally large study shows genomic changes in the MRSA population at the national level. It reveals waxing and waning of types and genogroups and an increasing proportion of PVL-positive MRSA

Antibodies against Coxiella burnetii and pregnancy outcome during the 2007-2008 Q fever outbreaks in the Netherlands

<p>Abstract</p> <p>Background</p> <p>Q fever has become a major public health problem in the Netherlands. Infection with <it>Coxiella burnetii </it>(Q fever) during pregnancy has resulted in adverse pregnancy outcome in the majority of reported cases. Therefore, we aimed to quantify this risk by examining the earliest periods corresponding to the epidemic in the Netherlands.</p> <p>Methods</p> <p>Serum samples that had been collected from the area of highest incidence by an existing national prenatal screening programme and data from the Netherlands Perinatal Registry (PRN) on diagnosis and outcome were used. We performed indirect immunofluorescence assay to detect the presence of IgM and IgG antibodies against <it>C. burnetii </it>in the samples. The serological results were analyzed to determine statistical association with recorded pregnancy outcome.</p> <p>Results</p> <p>Evaluation of serological results for 1174 women in the PRN indicated that the presence of IgM and IgG antibodies against phase II of <it>C. burnetii </it>was not significantly associated with preterm delivery, low birth weight, or several other outcome measures.</p> <p>Conclusion</p> <p>The present population-based study showed no evidence of adverse pregnancy outcome among women who had antibodies to <it>C. burnetii </it>during early pregnancy.</p

Injury Surveillance in Elite New Zealand Track Cyclists

Introduction: Injury surveillance is an essential component of elite sport. Little data is available on injury rates in track cyclists, with the majority of cycling research focussed on road cycling, and suggesting cyclists are at highest risk of overuse knee, back and neck injuries, and acute injuries involving the shoulder/clavicle, lower back and knee. Purpose: This research aims to establish the baseline incidence and prevalence of injury, and its effect on training and competition for elite New Zealand track-cyclists. Methods: All members of Cycling New Zealand’s elite track squad were invited to take part in this prospective, longitudinal study. Participants completed two baseline questionnaires detailing current and past injury status, current training volume, and other baseline characteristics. They then completed an online self-reporting injury survey every week for 52 consecutive weeks in the form of the Programme for Injury and Illness Surveillance (PILLS) tool. Injuries were classified using the OSICS-10 classification system. Key outcome measures were injury incidence and prevalence. Also recorded were self-reported measures of training exposures and intensity, injury classification, treatment received, duration of injury and where (geographical location) the injury occurred. Comparison of participant and therapist injury classification were made, and all outcome measures were calculated for the squad as a whole, as well as with breakdown for gender and squad. Results: Data were collected from 33 members of the elite NZ track cycling squad, comprising 17 males (17-32 years - mean 22.71, SD: 4.45), and 16 females (17-31 years - mean 21.5 years, SD: 4.82). 21 of the 33 participants sustained an injury during the period of inclusion in the study. Four reported injuring multiple body sites at one time, with one participant reporting two multi-site incidents during the period of data collection. 13 participants sustained multiple injuries, and 12 reported no incidence of injury. 11 injuries occurred in sports specific training, 20 in the gym, six in competition and seven other (mean 11, SD 6.38). 82% of injuries were recorded as being acute, 18% recurrent, with no overuse injuries reported. 8962 training exposures were planned (mean 689 exposures per four-weeks, SD 142), with 60 sessions (0.67%) missed and 84 (0.94%) modified due to injury, totalling 144/8962 (1.6%) training exposures affected by injury (mean 11.1, SD 7) per four-week block of surveys. Injury Incidence was 4.9 injuries per 1000 training and competition exposures. For all injuries sustained (53 body parts injured from 44 events), the injury incidence was 5.9 per 1000 exposures. Point prevalence ranged from one injury per four-week block to seven (mean 3.38, SD 1.80). No significant relationships were found between squad, gender, previous injury, years in sport, new injuries or injury frequency, or number of treatments. Conclusion: This research provides the first descriptive injury profile for the elite New Zealand track cycling cohort. 64% of participants sustained an injury over the study period, however injury incidence and prevalence was low with rapid return to training and competition. Greatest number of injuries was seen in the lower back, hip/buttock/pelvis region, and the knee, possibly reflecting the biomechanical requirements of cycling and the nature of the training required for this cohort. Previous studies investigating road cycling describe similar body sites injured, but with a large proportion classified as overuse whereas no overuse injuries were self-reported in this study. Further research is required to determine any reason for this. Total training exposures were recorded however little detail was documented on the intensity, nature and load of each specific training session and warrants more detailed investigation through future research

Estimation of acute and chronic Q fever incidence in children during a three-year outbreak in the Netherlands and a comparison with international literature

Background:  In the Dutch 2007-2009 Q fever outbreak Coxiella burnetii was transmitted aerogenically from dairy goat farms to those living in the surrounding areas. Relatively few children were reported. The true number of pediatric infections is unknown. In this study, we estimate the expected number of acute and chronic childhood infections. Methods:  As Coxiella was transmitted aerogenic to those living near infected dairy goat farms, we could use adult seroprevalence data to estimate infection risk for inhabitants, children and adults alike. Using Statistics Netherlands data we estimated the number of children at (high) risk for developing chronic Q fever. Literature was reviewed for childhood (0-15 years) Q fever reports and disease rates. We compared this with Dutch reported and our estimated data for 2007-2009. Results:  In The Netherlands epidemic, 44 children were reported (1.2 % of total notifications). The childhood incidence was 0.15 compared to 2.6 per 10,000 inhabitants for adults. No complications were reported. Based on the expected similarity in childhood and adult exposure we assume that 9.8 % of children in the high-risk area had Q fever infection, resulting in 1562 acute infections during the Q fever epidemic interval. Based on the prevalence of congenital heart disease, at least 13 children are at high risk for developing chronic Q fever. In medical literature, 42 case reports described 140 childhood Q fever cases with a serious outcome (four deaths). In chronic Q fever, cardiac infections were predominant. Four outbreaks were reported involving children, describing 11 childhood cases. 36 National and/or regional studies reported seroprevalences varying between 0 and 70 %. Conclusion:  In the 3-year Dutch epidemic, few childhood cases were reported, with pulmonary symptoms leading, and none with a serious presentation. With an estimated 13 high-risk children for chronic infection in the high exposure area, and probably forty in the whole country, we may expect several chronic Q fever complications in the coming years in paediatric practice