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

A hand hygiene intervention to decrease infections among children attending day care centers: Design of a cluster randomized controlled trial

Background: Day care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers' compliance with HH guidelines in day care centers (DCCs), an intervention has been developed aiming to improve caregivers' and children's HH compliance and decrease infections among children attending DCCs. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention.Methods/design: The intervention will be evaluated in a two-arm cluster randomized controlled trial among 71 DCCs in the Netherlands. In total, 36 DCCs will receive the intervention consisting of four components: 1) HH products (dispensers and refills for paper towels, soap, alcohol-based hand sanitizer, and hand cream); 2) training to educate about the Dutch national HH guidelines; 3) two team training sessions aimed at goal setting and formulating specific HH improvement activities; and 4) reminders and cues to action (posters/stickers). Intervention DCCs will be compared to 35 control DCCs continuing usual practice. The primary outcome measure will be observed HH compliance of caregivers and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the incidence of gastrointestinal and respiratory infections in 600 children attending DCCs, monitored over six months by parents using a calendar to mark th

Burden of paediatric Rotavirus Gastroenteritis (RVGE) and potential benefits of a universal Rotavirus vaccination programme with a pentavalent vaccine in Spain

<p>Abstract</p> <p>Background</p> <p>Rotavirus is the most common cause of gastroenteritis in young children worldwide. The aim of the study was to assess the health outcomes and the economic impact of a universal rotavirus vaccination programme with RotaTeq, the pentavalent rotavirus vaccine, versus no vaccination programme in Spain.</p> <p>Methods</p> <p>A birth cohort was followed up to the age of 5 using a cohort model. Epidemiological parameters were taken from the REVEAL study (a prospective epidemiological study conducted in Spain, 2004-2005) and from the literature. Direct and indirect costs were assessed from the national healthcare payer and societal perspectives by combining health care resource utilisation collected in REVEAL study and unit costs from official sources. RotaTeq per protocol efficacy data was taken from a large worldwide rotavirus clinical trial (70,000 children). Health outcomes included home care cases, General Practioner (GP)/Paediatrician, emergency department visits, hospitalisations and nosocomial infections.</p> <p>Results</p> <p>The model estimates that the introduction of a universal rotavirus vaccination programme with RotaTeq (90% coverage rate) would reduce the rotavirus gastroenteritis (RVGE) burden by 75% in Spain; 53,692 home care cases, 35,187 GP/Paediatrician visits, 34,287 emergency department visits, 10,987 hospitalisations and 2,053 nosocomial infections would be avoided. The introduction of RotaTeq would avoid about 76% of RVGE-related costs from both perspectives: €22 million from the national health system perspective and €38 million from the societal perspective.</p> <p>Conclusions</p> <p>A rotavirus vaccination programme with RotaTeq would reduce significantly the important medical and economic burden of RVGE in Spain.</p

Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

Contains fulltext : 96770.pdf (publisher's version ) (Open Access)BACKGROUND: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies showed inconsistent results for these vaccines because of lack of consensus on the impact. We aimed to investigate which factors had a major impact on cost-effectiveness and were primarily responsible for the large differences in previously estimated cost-effectiveness ratios. METHODS: Based on updated data on health outcomes and cost estimates, we re-assessed the cost-effectiveness of routine paediatric rotavirus vaccination within the National Immunization Program for the Netherlands. Two consensus meetings were organised with national and international experts in the field to achieve consensus and resolve potential controversies. RESULTS: It was estimated that rotavirus vaccination in the Netherlands could avert 34,214 cases of rotavirus gastroenteritis in children aged less than 5 years. Notably, 2,779 hospitalisations were averted of which 315 were extensions of existing hospital stays due to nosocomial rotavirus infection. With a threshold varying from 20K euro - 50K euro per QALY and according to the base-case scenario, the full vaccination costs per child leading to cost-effectiveness was euro 57.76 -euro 77.71. Results were sensitive to the inclusion of potential vaccine induced herd protection, QALY losses and number of deaths associated with rotavirus gastroenteritis. CONCLUSIONS: Our economic analysis indicates that inclusion of rotavirus vaccination in the Dutch National Immunization Program might be cost-effective depending on the cost of the vaccine and the impact of rotavirus gastroenteritis on children's quality of life

Children's hand hygiene behaviour and available facilities: an observational study in Dutch day care centres

Background: Children attending day care centres are at increased risk of infectious diseases, in particular gastrointestinal and respiratory infections. Hand hygiene of both caregivers and children is an effective prevention measure. This study examined hand hygiene behaviour of children attending day care centres, and describes hygiene facilities at day care centres. Methods: Data were collected at 115 Dutch day care centres, among 2318 children cared for by 231 caregivers (August to October 2010). Children's hand hygiene behaviour was observed and data on hand hygiene facilities of the day care centres collected by direct unobtrusive observation. National guidelines indicate hand hygiene is required before eating, after toilet use and after playing outside. Results: Among 1930 observed hand hygiene opportunities for children, overall adherence to hand hygiene guidelines was 31% (95% CI: 29-33%). Adherence after both toilet use and playing outside was 48%. Hands were less frequently washed before eating, where guideline adherence was 15%. In 38% of the playrooms there was no soap within reach of children and 17% had no towel facilities. In over 40% of the playrooms, appropriate hand hygiene facilities for children were lacking. Conclusion: Adequate hand washing facilities were available for children in only half of the participating day care centres in our study and children washed their hands in only 15-48% of the occasions defined by official guidelines. More attention is needed to hand hygiene of children attending day care centres in the prevention of infectious diseases