Zoonotic Diseases Report 2013

De Staat van zoönosen 2013 geeft een overzicht van de mate waarin zoönosen in Nederland voorkomen en ontwikkelingen daarin op de lange termijn. Zoönosen zijn infectieziekten die van dier op mens overgaan. Net als in voorgaande jaren waren er in 2013 geen uitgesproken veranderingen te zien in de mate waarin zoönosen in Nederland voorkomen. Zoals ieder jaar deden zich ook in 2013 enkele opmerkelijke voorvallen voor, zoals een geval van hazenpest. In deze jaarlijkse uitgave van het RIVM en de NVWA is het thema 'huis-, tuin- en keukenzoönosen': zoönosen die mensen kunnen oplopen in en om het huis. Opmerkelijke voorvallen Bij een haas afkomstig uit Noord-Limburg werd in mei 2013 hazenpest (tularemie) vastgesteld. Vervolgens werd ook bij een jongeman tularemie vastgesteld, die de infectie waarschijnlijk via een dazenbeet in een natuurgebied in Limburg had opgelopen. In 2011 is er mogelijk ook een in Nederland opgelopen geval van tularemie geweest, terwijl in de jaren daarvoor alleen sporadisch gevallen gemeld werden die in het buitenland waren opgelopen. Een andere opmerkelijke gebeurtenis betrof een uitbraak van Campylobacter onder bezoekers van een pluimveeslachthuis die waarschijnlijk via de lucht aan de ziekteverwekker waren blootgesteld. Negen mensen werden ziek. Ook blijkt uit een onderzoek naar de vossenlintworm (Echinococcus multilocularis) onder vossen en honden, dat deze lintworm bij vossen in Zuid-Limburg veel vaker voorkomt dan in voorgaande jaren. Thema: huis-, tuin- en keukenzoönosen Juist in en om het huis kunnen mensen worden blootgesteld aan allerlei zoönoseverwekkers. Duizenden mensen krijgen jaarlijks via hun huisdieren ringworm, een schimmelinfectie. Ook kunnen zoönosen afkomstig zijn van huisdieren of dieren die hun behoefte doen in de tuin. Verder komen voedselgerelateerde zoönosen aan de orde, waarbij aandacht is voor het feit dat zoönosen ook via groenten kunnen worden opgelopen.The Zoonotic Diseases Report is an annual publication of the Dutch National Institute for Public Health and the Environment (RIVM) and the Netherlands Food and Consumer Product Safety Authority (NVWA). The report provides an overview of the incidence of zoonotic diseases in the Netherlands, as well as the associated long-term trends. Zoonotic diseases or zoonoses are infectious diseases that can be transmitted from animals to humans. As in previous years, no marked changes were observed in 2013 in the incidence of zoonotic diseases in the Netherlands. Every year a number of notable incidents occurres. In 2013 this included a case of rabbit fever (tularemia). This year's edition of the Zoonotic Diseases Report focuses in particular on 'zoonoses close to home', i.e. the risk of contracting a zoonotic disease in or around the house. Notable incidents In May 2013, rabbit fever (tularemia) was discovered in a hare originating from the north of the province of Limburg. Tularemia was later also diagnosed in a young man, who had probably contracted the infection after having been bitten by a horse fly in a nature reserve in Limburg. Another person possibly contracted tularemia in the Netherlands in 2011. In previous years only incidental cases were reported, with the disease being contracted abroad. Another notable incident concerned an outbreak of Campylobacter infection among visitors to a poultry slaughterhouse who had probably been exposed to airborne pathogens. Nine people fell ill as a result of this outbreak. An investigation into the incidence of Echinococcus multilocularis in foxes and dogs showed that this tapeworm was much more common in foxes in the south of Limburg province than in previous years. 'Zoonoses close to home' Humans can be exposed to various zoonotic disease pathogens in or around the house. Every year, thousands of people contract dermatophytosis (a fungal infection commonly known in the Netherlands as 'ringworm') from their pets. Zoonotic diseases can also be contracted from pets or from animals defecating in the garden. The report also devotes attention to food-related zoonotic diseases, with a particular focus on the risk of contracting zoonoses through the consumption or handling of vegetables.NVW

Zoonotic Diseases Report 2014

De Staat van zoönosen geeft jaarlijks een overzicht van infectieziekten die overgaan van dier op mens, de zogenoemde zoönosen. Het gaat om de mate waarin meldingsplichtige zoönosen voorkomen en de ontwikkelingen daarvan op de lange termijn. Hierbij betreft het zowel het aantal ziektegevallen bij mensen als het voorkomen van deze ziekteverwekkers bij dieren. Ook worden elk jaar opmerkelijke voorvallen uitgelicht en wordt een thema behandeld. Voor de meeste zoönosen zijn in 2014 geen uitgesproken veranderingen waargenomen. Wel is het aantal mensen met leptospirose (waarvan de bekendste vorm de ziekte van Weil is) aanmerkelijk hoger dan het vorige jaar, van gemiddeld 30 gevallen in de afgelopen jaren naar 97 in 2014. Ook steeg het aantal Hantavirusinfecties (van gemiddeld 13 in de voorgaande jaren naar 36 in 2014). UItgelicht Een opmerkelijke gebeurtenis in 2014 is dat twee patiënten in een ziekenhuis zijn opgenomen met een ernstige longontsteking na een infectie met Chlamydia caviae. Beide patiënten bleken thuis cavia's te houden die een luchtweginfectie hadden doorgemaakt. Verder was er sinds 2003 weer een uitbraak van vogelgriep bij pluimveebedrijven veroorzaakt door een hoogpathogeen virus. Hierbij zijn vier van de vijf besmette bedrijven onafhankelijk van elkaar besmet geraakt. Het virus was vermoedelijk afkomstig van trekkende watervogels. Het is onbekend of dit virustype overdraagbaar is op de mens; wereldwijd zijn daar geen gevallen van bekend. Vogels Het thema van dit jaar is 'Onze gevleugelde vrienden' en gaat over zoönosen die via vogels kunnen worden overgebracht, zoals de papegaaienziekte. Hierbij wordt onder andere beschreven op welke vliegroutes van trekvogels gezamenlijke broed- en voederplaatsen liggen waar ze elkaar kunnen treffen en zoönoseverwekkers aan elkaar zouden kunnen overdragen.The Zoonotic Diseases Report provides an annual overview of infectious diseases transmitted from animals to humans, so-called zoonotic diseases or zoonoses. It focuses on the degree to which notifiable zoonoses occur and how they develop over the long term. Specifically, this concerns both the number of human cases and the occurrence of these pathogens in animals. Noteworthy incidents of zoonoses are also highlighted each year and a particular theme is discussed. For most zoonoses, no pronounced changes were observed in 2014. Nonetheless, the number of people with leptospirosis (of which the most well-known form is Weil's disease) was considerably higher than in the previous year, rising from an average of 30 cases in recent years to 97 cases in 2014. The number of Hantavirus infections also rose (from an average of 13 cases in the previous years to 36 cases in 2014). A closer look A notable event in 2014 is the admission of two patients to hospital with serious lung infections after being infected with Chlamydia caviae. Both patients kept guinea pigs at home that suffered from respiratory infections. There was also the first outbreak of highly pathogenic avian influenza since 2003 affecting five poultry farms. Four of the five farms became contaminated independently of each other. It is thought that the virus was transmitted from waterfowls. It is not known whether the particular virus strain can be transmitted to humans; worldwide no cases of such transmission have been reported. Birds This year's theme is 'Our winged friends'. It focuses on zoonoses that can be transmitted by birds, such as psittacosis (parrot fever). The migratory routes that coincide with shared breeding and feeding locations where migratory birds can come into contact with one another and thereby possibly transmit zoonotic pathogens to each other are also described.NVW

The incidence of liver injury in Uyghur patients treated for TB in Xinjiang Uyghur autonomous region, China, and its association with hepatic enzyme polymorphisms nat2, cyp2e1, gstm1 and gstt1.

BACKGROUND AND OBJECTIVE: Of three first-line anti-tuberculosis (anti-TB) drugs, isoniazid is most commonly associated with hepatotoxicity. Differences in INH-induced toxicity have been attributed to genetic variability at several loci, NAT2, CYP2E1, GSTM1and GSTT1, that code for drug-metabolizing enzymes. This study evaluated whether the polymorphisms in these enzymes were associated with an increased risk of anti-TB drug-induced hepatitis in patients and could potentially be used to identify patients at risk of liver injury. METHODS AND DESIGN: In a cross-sectional study, 2244 tuberculosis patients were assessed two months after the start of treatment. Anti-TB drug-induced liver injury (ATLI) was defined as an ALT, AST or bilirubin value more than twice the upper limit of normal. NAT2, CYP2E1, GSTM1 and GSTT1 genotypes were determined using the PCR/ligase detection reaction assays. RESULTS: 2244 patients were evaluated, there were 89 cases of ATLI, a prevalence of 4% 9 patients (0.4%) had ALT levels more than 5 times the upper limit of normal. The prevalence of ATLI was greater among men than women, and there was a weak association with NAT2*5 genotypes, with ATLI more common among patients with the NAT2*5*CT genotype. The sensitivity of the CT genotype for identifying patients with ATLI was 42% and the positive predictive value 5.9%. CT ATLI was more common among slow acetylators (prevalence ratio 2.0 (95% CI 0.95,4.20) )compared to rapid acetylators. There was no evidence that ATLI was associated with CYP2E1 RsaIc1/c1genotype, CYP2E1 RsaIc1/c2 or c2/c2 genotypes, or GSTM1/GSTT1 null genotypes. CONCLUSIONS: In Xinjiang Uyghur TB patients, liver injury was associated with the genetic variant NAT2*5, however the genetic markers studied are unlikely to be useful for screening patients due to the low sensitivity and low positive predictive values for identifying persons at risk of liver injury

Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy:a population-based study in six European regions

Objective To explore the prescribing patterns of selective serotonin reuptake inhibitors (SSRIs) before, during and after pregnancy in six European population-based databases. Design Descriptive drug utilisation study. Setting Six electronic healthcare databases in Denmark, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Population All women with a pregnancy ending in a live or stillbirth starting and ending between 2004 and 2010. Methods A common protocol was implemented across databases to identify SSRI prescriptions issued (UK) or dispensed (non-UK) in the year before, during or in the year following pregnancy. Main outcome measures The percentage of deliveries in which the woman received an SSRI prescription in the year before, during or in the year following pregnancy. We also compared the choice of SSRIs and changes in prescribing over the study period. Results In total, 721 632 women and 862 943 deliveries were identified. In the year preceding pregnancy, the prevalence of SSRI prescribing was highest in Wales [9.6%; 95% confidence interval (CI95), 9.4-9.8%] and lowest in Emilia Romagna (3.3%; CI95, 3.2-3.4%). During pregnancy, SSRI prescribing had dropped to between 1.2% (CI95, 1.1-1.3%) in Emilia Romagna and 4.5% (CI95, 4.3-4.6%) in Wales. The higher UK pre-pregnancy prescribing rates resulted in higher first trimester exposures. After pregnancy, SSRI prescribing increased most rapidly in the UK. Paroxetine was more commonly prescribed in the Netherlands and Italian regions than in Denmark and the UK. Conclusions The higher SSRI prescribing rates in the UK, compared with other European regions, raise questions about differences in the prevalence and severity of depression and its management in pregnancy across Europe. Keywords Drug utilisation, electronic health records, pregnancy, serotonin uptake inhibitors

The economic impact of alcohol consumption: a systematic review

<p>Abstract</p> <p>Background</p> <p>Information on the economic impact of alcohol consumption can provide important evidence in supporting policies to reduce its associated harm. To date, several studies on the economic costs of alcohol consumption have been conducted worldwide. This study aims to review the economic impact of alcohol worldwide, summarizing the state of knowledge with regard to two elements: (1) cost components included in the estimation; (2) the methodologies employed in works conducted to date.</p> <p>Methods</p> <p>Relevant publications concerning the societal cost of alcohol consumption published during the years 1990-2007 were identified through MEDLINE. The World Health Organization's global status report on alcohol, bibliographies and expert communications were also used to identify additional relevant studies.</p> <p>Results</p> <p>Twenty studies met the inclusion criteria for full review while an additional two studies were considered for partial review. Most studies employed the human capital approach and estimated the gross cost of alcohol consumption. Both direct and indirect costs were taken into account in all studies while intangible costs were incorporated in only a few studies. The economic burden of alcohol in the 12 selected countries was estimated to equate to 0.45 - 5.44% of Gross Domestic Product (GDP).</p> <p>Conclusion</p> <p>Discrepancies in the estimation method and cost components included in the analyses limit a direct comparison across studies. The findings, however, consistently confirmed that the economic burden of alcohol on society is substantial. Given the importance of this issue and the limitation in generalizing the findings across different settings, further well-designed research studies are warranted in specific countries to support the formulation of alcohol-related policies.</p

Obesity Indexes and Total Mortality among Elderly Subjects at High Cardiovascular Risk: The PREDIMED Study

BackgroundDifferent indexes of regional adiposity have been proposed for identifying persons at higher risk of death. Studies specifically assessing these indexes in large cohorts are scarce. It would also be interesting to know whether a dietary intervention may counterbalance the adverse effects of adiposity on mortality.MethodsWe assessed the association of four different anthropometric indexes (waist-to-height ratio (WHtR), waist circumference (WC), body mass index (BMI) and height) with all-cause mortality in 7447 participants at high cardiovascular risk from the PREDIMED trial. Forty three percent of them were men (55 to 80 years) and 57% were women (60 to 80 years). All of them were initially free of cardiovascular disease. The recruitment took place in 11 recruiting centers between 2003 and 2009.ResultsAfter adjusting for age, sex, smoking, diabetes, hypertension, intervention group, family history of coronary heart disease, and leisure-time physical activity, WC and WHtR were found to be directly associated with a higher mortality after 4.8 years median follow-up. The multivariable-adjusted HRs for mortality of WHtR (cut-off points: 0.60, 0.65, 0.70) were 1.02 (0.78–1.34), 1.30 (0.97–1.75) and 1.55 (1.06–2.26). When we used WC (cut-off points: 100, 105 and 110 cm), the multivariable adjusted Hazard Ratios (HRs) for mortality were 1.18 (0.88–1.59), 1.02 (0.74–1.41) and 1.57 (1.19–2.08). In all analyses, BMI exhibited weaker associations with mortality than WC or WHtR. The direct association between WHtR and overall mortality was consistent within each of the three intervention arms of the trial.ConclusionsOur study adds further support to a stronger association of abdominal obesity than BMI with total mortality among elderly subjects at high risk of cardiovascular disease. We did not find evidence to support that the PREDIMED intervention was able to counterbalance the harmful effects of increased adiposity on total mortality.Trial RegistrationControlled-Trials.com ISRCTN3573963

Beta-alanine (Carnosyn™) supplementation in elderly subjects (60–80 years): effects on muscle carnosine content and physical capacity

The aim of this study was to investigate the effects of beta-alanine supplementation on exercise capacity and the muscle carnosine content in elderly subjects. Eighteen healthy elderly subjects (60–80 years, 10 female and 4 male) were randomly assigned to receive either beta-alanine (BA, n = 12) or placebo (PL, n = 6) for 12 weeks. The BA group received 3.2 g of beta-alanine per day (2 × 800 mg sustained-release Carnosyn™ tablets, given 2 times per day). The PL group received 2 × (2 × 800 mg) of a matched placebo. At baseline (PRE) and after 12 weeks (POST-12) of supplementation, assessments were made of the muscle carnosine content, anaerobic exercise capacity, muscle function, quality of life, physical activity and food intake. A significant increase in the muscle carnosine content of the gastrocnemius muscle was shown in the BA group (+85.4%) when compared with the PL group (+7.2%) (p = 0.004; ES: 1.21). The time-to-exhaustion in the constant-load submaximal test (i.e., TLIM) was significantly improved (p = 0.05; ES: 1.71) in the BA group (+36.5%) versus the PL group (+8.6%). Similarly, time-to-exhaustion in the incremental test was also significantly increased (p = 0.04; ES 1.03) following beta-alanine supplementation (+12.2%) when compared with placebo (+0.1%). Significant positive correlations were also shown between the relative change in the muscle carnosine content and the relative change in the time-to-exhaustion in the TLIM test (r = 0.62; p = 0.01) and in the incremental test (r = 0.48; p = 0.02). In summary, the current data indicate for the first time, that beta-alanine supplementation is effective in increasing the muscle carnosine content in healthy elderly subjects, with subsequent improvement in their exercise capacity

Human Regulatory T Cell Suppressive Function Is Independent of Apoptosis Induction in Activated Effector T Cells

CD4(+)CD25(+)FOXP3(+) Regulatory T cells (Treg) play a central role in the immune balance to prevent autoimmune disease. One outstanding question is how Tregs suppress effector immune responses in human. Experiments in mice demonstrated that Treg restrict effector T cell (Teff) responses by deprivation of the growth factor IL-2 through Treg consumption, resulting in apoptosis of Teff.In this study we investigated the relevance of Teff apoptosis induction to human Treg function. To this end, we studied naturally occurring Treg (nTreg) from peripheral blood of healthy donors, and, to investigate Treg function in inflammation in vivo, Treg from synovial fluid of Juvenile Idiopathic Arthritis (JIA) patients (SF-Treg). Both nTreg and SF-Treg suppress Teff proliferation and cytokine production efficiently as predicted. However, in contrast with murine Treg, neither nTreg nor SF-Treg induce apoptosis in Teff. Furthermore, exogenously supplied IL-2 and IL-7 reverse suppression, but do not influence apoptosis of Teff.Our functional data here support that Treg are excellent clinical targets to counteract autoimmune diseases. For optimal functional outcome in human clinical trials, future work should focus on the ability of Treg to suppress proliferation and cytokine production of Teff, rather than induction of Teff apoptosis

Influence of halloysite nanotubes on physical and mechanical properties of cellulose fibres reinforced vinyl ester composites

Natural fibres are generally added to polymer matrix composites to produce materials with the desirable mechanical properties of higher specific strength and higher specific modulus while at the same time to maintain a low density and low cost. The physical and mechanical properties of polymer composites can be enhanced through the addition of nanofillers such as halloysite nanotubes. This article describes the fabrication of vinyl ester eco-composites and eco-nanocomposites and characterizes these samples in terms of water absorption, mechanical and thermal properties. Weight gain test and Fourier transform infrared analysis indicated that 5% halloysite nanotube addition gave favourable reduction in the water absorption and increased the fibre–matrix adhesion leading to improved strength properties in the eco-nanocomposites. However, halloysite nanotube addition resulted in reduced toughness but improved thermal stability