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.

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

Space-Time Cluster Analysis of Invasive Meningococcal Disease

Field clusters are commonly misinterpreted as clusters and would require genotyping to rule out misclassification

Seduced by System: Edmund Burke's Aesthetic Embrace of Adam Smith's Philosophy

No abstract available

Role of platelets in early pathogenesis of viridans group streptococcal endocarditis: a study on thrombodefensins. A study in which penicillin tolerance is shown to be associated with increased virulence.

In the pathogenesis of infective endocarditis the adherence of circulating bacteria to a preexisting cardiac vegetation (VG) and the survival of bacteria adherent to VG's are major events. One objective of the study was to determine whether the capacity of various Streptococcus sanguis type II strains to adhere to VGs coincided with the ability of the strains to produce endocarditis in rabbits with left heart catheter-induced vegetations (Chapter II). A significant difference in the frequency of culture-positive VGs between two test strains was observed when low concentrations of the bacteria were injected. The incidence of endocarditis caused by one of the test strains (strain 1) was significantly lower than the incidence of culturepositive VGs at 5 min after challenge. It appeared that adherent bacteria of strain 1 to VGs disappeared quite rapidly with time. Disappearance was neither due to detachment of bacteria nor to the complement-dependent serum bactericidal system. Phagocytosis of attached bacteria, as demonstrated in in vitro studies did not occur. ... Zie: Summary.