Harmonisation of TB control in the WHO European region: the history of the Wolfheze Workshops.

In 1990 a workshop was organised in the village of Wolfheze (the Netherlands), where experts discussed the critical interventions that would foster elimination of TB in Europe. This event has been followed by several more over the following two decades to become known as the "Wolfheze Workshops". This article provides a brief overview of the history and the impact the Wolfheze Workshops have had on the commitment of European governments to standardise definitions, recording and reporting systems and, thus, permitted comparison of interventions and improving TB control across borders. The Wolfheze Workshops have been and still are an essential platform for this exchange of experiences, promoting common approaches.

Diagnosis and treatment of tuberculosis in undocumented migrants in low- or intermediate-incidence countries.

SETTING: Countries with low or intermediate tuberculosis (TB) incidence. OBJECTIVES: 1) To gather information on individuals and TB patients who are undocumented migrants and their access to TB diagnostic and treatment services; 2)to discuss interventions to strengthen diagnosis and treatment and 3) to formulate recommendations on how to ensure adequate TB prevention and control. DESIGN: Questionnaires sent to members of the Working Group (WG) on Transborder Migration and TB, managers of national TB programmes and EuroTB correspondents; literature research and development of a paper by a writing committee through consultation. RESULTS: Undocumented migrants represent 5-30% of immigrants and 5-10% of TB cases. Most countries reported full access to diagnosis and treatment, but in practice there were limitations. Most countries also reported that they could and did deport cases who were on TB treatment. A variety of activities to ensure access were reported from different countries. CONCLUSION: The WG recommends that 1) health authorities and/or health staff should ensure easy access to low-threshold facilities where undocumented migrants who are TB suspects can be diagnosed and treated without giving their names and without fear of being reported to the police or migration officials. Health authorities should remind health staff that they have an obligation of confidentiality; 2) each country should ensure that undocumented migrants with TB are not deported until completion of treatment; and 3) authorities and non-governmental sectors should raise awareness among undocumented migrants about TB, emphasising that diagnosis and treatment should be free of charge and wholly independent of migratory status.

[Large-scale outbreak investigation for tuberculosis in Zeist]. / Grootschalig contactonderzoek op tuberculose in Zeist.

Recently a large-scale outbreak investigation was held among customers of a supermarket in the Dutch town of Zeist after an employee was diagnosed with smear-positive pulmonary tuberculosis. About 14,000 people had a tuberculin skin test and an additional 6,000 had a chest X-ray. About 400 positive skin tests and 8 cases of active tuberculosis have been reported so far. Investigation of contacts of infectious tuberculosis cases is an important tool in tuberculosis control in low-prevalence countries. It includes chest X-ray examination for active pulmonary tuberculosis after or instead of tuberculin skin testing, and identifying contacts with latent tuberculosis infection followed by preventive treatment. Investigation of household and other close contacts is highly effective. This may not be true for sporadic contacts who are likely to have a low risk of infection, such as in this investigation, where the prevalence of recent infections estimated from reported data is only 3%. The benefits of detecting these cases must be weighed against the costs of such large-scale operations and the probability of false-positive skin test results.

[Trombiculiasis, and epidemic of prurigo caused by mites]. / Trombidiose, een prurigo-epidemie door mijten.

In four villagers parasitic prurigo caused by the autumnal chigger (Neotrombicula autumnalis) was diagnosed. The clinical picture consisted of intensely itchy, erythematous papules, at sites where clothes fitted tightly or in body folds. Further investigation in the village revealed that in 16 of the 48 homes at least one person in the preceding two months had suffered from prurigo possibly caused by the autumnal chigger. The characteristics of the parasite, the clinical picture, treatment and prevention are discussed.

[Centenary of the Royal Dutch Central Association for the Prevention of Tuberculosis]. / Honderd jaar Koninklijke Nederlandse Centrale Vereniging tot bestrijding der tuberculose (KNCV).

The Royal Dutch Tuberculosis Association (Koninklijke Nederlandse Centrale Vereniging tot bestrijding der Tuberculose (KNCV)) was founded in 1903. Since then various interventions against tuberculosis have been introduced on the basis of medical and technological opportunities and in response to the epidemiological situation. The introduction of effective drugs during the 1940s and 1950s was by far the most important development and led to a sharp decline in the annual rate of infection and to the disappearance of tuberculosis as a common disease. Following the appointment of the independent National Policy Committee for Tuberculosis Control, Royal Dutch Tuberculosis Association could concentrate on its innovating tasks: the development of new interventions based on epidemiological data and scientific research.

[The organization and implementation of influenza vaccination in Groningen, 1993-1996]. / Organisatie en uitvoering van de influenzavaccinatie in Groningen, 1993-1996.

OBJECTIVE: To find out to what extent the recommendations from the standard 'Influenza and influenza vaccination' of the Dutch association of general practitioners (NHG) were implemented by the GPs in the period 1993-1996. DESIGN: Descriptive questionnaire study. SETTING: Municipal Health Services Groningen, the Netherlands. METHOD: All GPs active in the province of Groningen were sent a questionnaire in the period 1993-1996. Practical support of GPs in organizing influenza vaccination was offered as a part of the project 'Preventie: maatwerk' (Prevention made to measure). RESULT: Automated selection of risk patients showed a distinct increase over the years. This increase was greatest in 1996, especially in rural practices. Inviting by personal letter, as recommended in the NHG standard increased to 48% in 1996. Not all GPs organized special vaccination office hours. An increasing number offered vaccination at other times as well. In urban municipalities, vaccine was available in the practice less often. Half the GPs reminded risk patients of the vaccination if they failed to appear. The recorded number of vaccinated patients in Groningen was 9.5% of the population in 1994 (nation-wide: 10.8%), 10.8% in 1995 (nation-wide: 11.5%) and 15.4% in 1996 (nation-wide: 15.2%). CONCLUSION: The attention for programmed prevention in general practice went together with an increase of activities regarding influenza vaccination. Regional monitoring of the influenza vaccination provides data with which the prevention programme can be improved.

[Tuberculosis in alpacas; a zoonosis as an imported disease]. / Tuberculose bij alpaca's; een zoönose als importziekte.

In the Netherlands, in 1988, a micro-epidemic of tuberculosis in alpacas recently imported from Peru prompted health authorities to initiate investigation of human and animal contacts. Although the animal trainer and his assistant suffered from pulmonary tuberculosis, they turned out to be infected by Mycobacterium tuberculosis, while the animals later proved to be infected by M. bovis. The alpacas' caretaker and a laboratory technician present at the autopsy, were probably infected by animal contact. Elsewhere in the country, three more alpacas were reported with tuberculosis at the time; this initiated a large-scale investigation among alpacas, llamas etc., but no further cases were detected. The possibility of imported zoonoses, especially after 1992, is discussed.

[Tuberculosis in asylum seekers in The Netherlands]. / Tuberculose bij asielzoekers in Nederland.

OBJECTIVE: To compare data of some features and treatment results of asylum seekers with TB in whom the diagnosis was made by a roentgenologic examination of the thorax a short time after arrival in the Netherlands with data of other TB-patients. DESIGN: Retrospective. SETTING: The Netherlands. METHOD: Data of patients with tuberculosis are collected in the National Tuberculosis Register. In 1993 this register included data of 1582 patients, among them III asylum seekers in whom TB was diagnosed after obligatory roentgenologic screening a short time after arrival in the Netherlands. The reason for examination, presence of complaints, forms of tuberculosis, presence of bacteriological confirmation, drug-resistance and results of treatment of them were compared with the data of other asylum seekers (n = 169) and other TB-patients (n = 1302). RESULTS: The diagnosis TB in asylum seekers who are screened obligatorily was bacteriologically confirmed in 34 of III (31%) of the cases, while in 72 of 169 (43%) other asylum seekers and in 729 of 1302 (56%) of the other TB-patients (p < 0.001 for the difference between obligatory screened asylum seekers and other TB-patients). Resistance against isoniazide and streptomycin was more frequent in asylum seekers (n = 106; 13% and 19% respectively) than in Dutch patients (n = 338; 2% and 3% respectively) (p < 0.001). Obligatory screened asylum seekers with bacteriologically confirmed TB were cured in 82% of the cases and this did not differ from the other groups. Asylum seekers and other immigrants showed a higher default-rate than Dutch patients did (p < 0.001). CONCLUSION: Among asylum seekers with tuberculosis discovered by the first obligatory screening was a lower percentage of bacteriological confirmation and a higher percentage of drug-resistance and defaulters. The results of treatment of asylum seekers with bacteriologically confirmed TB were good.

[Tuberculosis in imported alpacas--a zoonosis--now what?]. / Tuberculose bij geïmporteerde alpaca's--een zoönose--en verder?

An outbreak of tuberculosis caused by M. bovis in imported Alpaca's in the Netherlands is reported. A review of the outbreak of the disease is followed by a more detailed discussion of the symptoms, diagnostic testing with the tuberculin skin test and the ELISA test, the gross lesions, the bacteriological examinations, the control measures and the legal aspects. As tuberculosis is not referred to in the Live-Stock Act, the control measures had to be based on the humane Control of Infectious Disease and Tracing the Causes of Disease Act. In the discussion, it is advocated to pay attention to more species of animals than only to the traditional live-stock in the proposed Health and Welfare of Animals Act.