Prevalence of SARS-CoV-2 among Belgian workers in long-term care facilities.

BACKGROUND: Healthcare workers (HCWs) can be a source of SARS-CoV-2 within long-term care facilities (LTCFs); therefore, we analysed the data from a testing programme among LTCF employees. AIMS: The aim of this study was to investigate the prevalence of SARS-CoV-2 and its determinants among employees of LTCFs and the risk for fellow workers and residents. METHODS: Testing started at week 15, the first wave's peak, using nasopharyngeal swabs for PCR up to week 23. At the start of the second wave (week 32), testing resumed. RESULTS: A total of 32 457 test results were available from 446 LTCFs: 2% were positive: 1% in men, 2% in women, 2% in HCWs (=having patient contact), 1% in non-HCWs, higher in younger age groups. In total, 30 729 employees were tested once, 823 twice, 66 thrice and 4 four times. Prevalence was 13% during the first week of testing (week 15) and declined to 7% (week 16) to stay at around 1% (from week 17 until week 23). At the start of the second wave (week 31-33), the prevalence was around 3%. In 70% of positive tests, the employee was asymptomatic. CONCLUSIONS: Our study confirms the presence of HCWs with SARS-CoV-2 as a possible source of infection in LTCFs even when the incidence in the general population was low; 70% were asymptomatic. To control the spread of SARS-CoV-2 in LTCFs vaccination, infection prevention and control measures are necessary as well as testing of all LTCF HCWs during possible outbreaks, even if asymptomatic.

Hepatitis E virus infection: an emerging occupational risk?

BACKGROUND: Hepatitis E virus (HEV) infection is endemic in many developing countries, causing substantial morbidity. Transmission is primarily faeco-oral and is associated with both sporadic infections and epidemics in areas where poor sanitation and weak public health infrastructures exist. Recently, it has become clear that HEV is also an endemic disease in industrialized countries. Moreover, a porcine reservoir and growing evidence of zoonotic transmission have been reported in these countries, suggesting the possibility of occupational transmission to man. AIMS: To summarize the current knowledge on the epidemiology and prevention of transmission of HEV infection in occupational settings. METHODS: The following key words were used to explore PubMed: hepatitis E, disease, epidemiology, profession(al), occupation(al). RESULTS: After screening of the results, 107 publications were retained. In non-endemic regions, seroprevalence varied from a few per cent (2-7.8%) in Europe, Japan and South America to 18.2-20.6% in the USA, Russia, UK, southern France and Asia. A meta-analysis of 12 cross-sectional studies evaluating HEV immunoglobulin G (IgG) seroprevalence in individuals occupationally exposed to swine showed greater odds of seropositivity in the exposed group but also a high degree of heterogeneity. A funnel plot suggested publication bias. CONCLUSIONS: There was a significant association between occupational exposure to swine and HEV IgG seroprevalence, but the level of prevalence detected depended also on the type of HEV IgG kits used. Further research, including on mechanisms and risk factors for infection, as well as the development of better serological tests for identification of infection, is required.

Comparative immunogenicity of two vaccination schedules of a combined hepatitis A and B vaccine in healthy volunteers.

In 1996, a combined vaccine against both hepatitis A and B was licensed and commercialized and has been recommended for healthcare personnel in Belgium. This study compares the immunogenicity against hepatitis B virus (HBV) and safety of two vaccination schedules (0-1-12 months and 0-1-6 months) with this vaccine. This is a randomized, stratified and controlled study in healthy adult workers, who are not occupationally exposed to HBV. Seroconversion (≥1 IU/L) and seroprotection (≥10 IU/L) rates were compared using Fisher's exact test; geometric mean concentrations (GMCs) of anti-HBs were compared using one-way ANOVA. All statistical analyses were carried out with SPSS 11 on Apple Macintosh. A total of 399 subjects were enrolled in the study, and 356 were analysed according to the protocol. The rate of ≥10 IU/L at 6 months was 70.6% in the group 0-1-12 and 79.9% in the group 0-1-6; this rate decreased to 55.9% at 12 months in the first group. Seroconversion and seroprotective rates against HBV measured at month 13 in group 0-1-12 (98.9% and 95.6%) and measured at month 7 in group 0-1-6 (99.4% and 97.1%) were not statistically significantly different. GMC of anti-HBs after the 0-1-12 schedule was more than two fold higher than after 0-1-6 schedule (P < 0.001). Reported side effects were comparable in both groups with a slight tendency to fewer side effects in the 0-1-12 group after the third dose. The results from our study show that the completed schedule 0-1-12 offers at least equal protective immunogenicity against HBV as the completed 0-1-6 schedule. People not receiving their third dose at 6 months can be given this dose up to 12 months after the first dose. The drawback of this flexibility, however, is the longer time period before the protection becomes effective.

The occupational risk of Helicobacter pylori infection among workers in institutions for people with intellectual disability.

OBJECTIVES: A cross-sectional study to evaluate the occupational risk for Helicobacter pylori infection, on top of other risk factors, in staff members of institutions for people with intellectual disability. In these institutions, the residents had a documented high prevalence of H pylori infection (86% presenting antibodies). As a control group, the study used administrative workers from other companies. METHODS: All participants completed a questionnaire concerning sociodemographic characteristics, medical history and employment data and they underwent a serology test. RESULTS: 671 staff members of the institutions and 439 subjects in the control group participated in the study. Prevalence of H pylori antibodies was significantly higher in the study group than in the control group (40.6% vs 29.2%; p<0.001). Crude odds ratio for occupational risk was 1.68; adjusting for the confounding effect of age, gender, body mass index, smoking, tropical journeys and number of household members during childhood resulted in an even higher (adjusted) OR of 1.98 (95% CI 1.42 to 2.69). In multiple logistic regression analysis adjusting for variables shown to be confounders, faecal contact continued to be significantly associated with H pylori infection. Attributable risk was 49.5%. CONCLUSIONS: H pylori infection is an occupational risk in healthcare workers working in institutions for people with intellectual disability. We identified faecal contact as an independent occupational risk factor for H pylori infection.

Hepatitis B virus, hepatitis C virus and other blood-borne infections in healthcare workers: guidelines for prevention and management in industrialised countries.

The Viral Hepatitis Prevention Board (VHPB) convened a meeting of international experts from the public and private sectors in order to review and evaluate the epidemiology of blood-borne infections in healthcare workers, to evaluate the transmission of hepatitis B and C viruses as an occupational risk, to discuss primary and secondary prevention measures and to review recommendations for infected healthcare workers and (para)medical students. This VHPB meeting outlined a number of recommendations for the prevention and control of viral hepatitis in the following domains: application of standard precautions, panels for counselling infected healthcare workers and patients, hepatitis B vaccination, restrictions on the practice of exposure-prone procedures by infected healthcare workers, ethical and legal issues, assessment of risk and costs, priority setting by individual countries and the role of the VHPB. Participants also identified a number of terms that need harmonization or standardisation in order to facilitate communication between experts.

Sexual function disorders after local radiotherapy for carcinoma of the prostate.

In order to contribute some insight into the extent to which local radiotherapy for carcinoma of the prostate is followed by disorders in sexual functioning, 18 patients whose age ranged from 60 to 82, were interviewed 4 to 45 months after their Radiotherapy (RT). Our results confirmed the fact that RT was followed by impotence as such in only a minority of cases (3 out of 12 or 0.25). However, when other aspects of sexuality were taken into account, a higher proportion appeared to have problems. In a substantial number of patients, psychogenic factors seemed to be (at least partly) responsible. More attention to these facts and, when necessary, psychiatric assistance, may help reduce the incidence of sexual disorders following RT to the prostate.

Extranodal non-Hodgkin's lymphoma of the head and neck.

Forty-six patients referred to our department between 1970 and 1982 with biopsy proven extranodal non-Hodgkin's lymphoma (NHL) of the head and neck were analysed. The median follow-up was 78 months. As a result of histological revision, six cases were excluded. By retrospective staging, 10 patients were found to have advanced disease (stage IV) at the moment of presentation, and three showed infradiaphragmatical nodes (stage III). All stage I-II patients except one were treated with radiotherapy. The 5-year actuarial relapse-free survival was 50% for the whole group, and 77% for the 26 patients who achieved complete remission after initial treatment. All stage IV patients died from lymphoma. Initial response and localised disease were the most significant prognostic features.

The effects of the specific 5HT(4) receptor agonist, prucalopride, on colonic motility in healthy volunteers.

BACKGROUND: Prucalopride is a selective and specific 5-hydroxytryptamine(4) receptor agonist that is known to increase stool frequency and to accelerate colonic transit. AIM: To investigate the effect of prucalopride on high-amplitude propagated contractions and segmental pressure waves in healthy volunteers. METHODS: After 1 week of dosing (prucalopride or placebo in a double-blind, randomized, crossover fashion), colonic pressures were recorded in 10 healthy subjects using a solid-state pressure catheter with six sensors spaced 10 cm apart. Subjects kept diary records of their bowel habits (frequency, consistency and straining). High-amplitude propagated contractions were analysed visually, comparing their total numbers and using 10-min time windows. Segmental pressure waves were analysed using computer algorithms, quantifying the incidence, amplitude, duration and area under the curve of all detected peaks. RESULTS: When taking prucalopride, stool frequency increased, consistency decreased and subjects strained less. Prucalopride just failed to increase the total number of high-amplitude propagated contractions (P=0.055). The number of 10-min time windows containing high-amplitude propagated contractions was increased by prucalopride (P=0.019). Prucalopride increased the area under the curve per 24 h (P=0.026). CONCLUSIONS: The 5-hydroxytryptamine(4) receptor agonist prucalopride stimulates high-amplitude propagated contractions and increases segmental contractions, which is likely to be the underlying mechanism of its effect on bowel habits in healthy volunteers.

Scintigraphic, spirometric, and roentgenologic effects of radiotherapy on normal lung tissue. Short-term observations in 14 consecutive patients with breast cancer.

The effects of radiotherapy on lung function, ventilation/perfusion scans, and chest radiography were studied prospectively in 15 patients who underwent either modified radical mastectomy or tumorectomy, followed by radiotherapy for breast cancer. In all patients, pulmonary function studies, chest x-ray films, and lung scintigraphic studies were performed prior to and at the end of radiotherapy as well as three months later. No consistent or significant alteration in either parameter was detected. No patient developed clinical symptoms suggestive of radiation-induced lung changes, although in one of them, major radiologic features were found that were consistent with radiation pneumonitis; those changes disappeared completely in the course of the subsequent months. It is concluded that the tangential beam technique for postoperative irradiation as used in these patients is largely safe as regards pulmonary function, perfusion, and ventilation.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in health care workers (HCWs): guidelines for prevention of transmission of HBV and HCV from HCW to patients.

The transmission of viral hepatitis from health care workers (HCW) to patients is of worldwide concern. Since the introduction of serologic testing in the 1970s there have been over 45 reports of hepatitis B virus (HBV) transmission from HCW to patients, which have resulted in more than 400 infected patients. In addition there are six published reports of transmissions of hepatitis C virus (HCV) from HCW to patients resulting in the infection of 14 patients. Additional HCV cases are known of in the US and UK, but unpublished. At present the guidelines for preventing HCW to patient transmission of viral hepatitis vary greatly between countries. It was our aim to reach a Europe-wide consensus on this issue. In order to do this, experts in blood-borne infection, from 16 countries, were questioned on their national protocols. The replies given by participating countries formed the basis of a discussion document. This paper was then discussed at a meeting with each of the participating countries in order to reach a Europe-wide consensus on the identification of infected HCWs, protection of susceptible HCWs, management and treatment options for the infected HCW. The results of that process are discussed and recommendations formed. The guidelines produced aim to reduce the risk of transmission from infected HCWs to patients. The document is designed to complement existing guidelines or form the basis for the development of new guidelines. This guidance is applicable to all HCWs who perform EPP, whether newly appointed or already in post.

Membrane plasma exchange in patients with metastatic cancer.

Seven patients suffering from metastatic cancer and all showing objectively measurable tumours were treated with eight sessions of membrane plasma exchange. No other oncological treatment was administered during the period of plasma exchange. The procedure itself was well tolerated and subjective improvement was reported by some patients. No objective tumour regression was observed. Immune complex-like material and inflammatory proteins were efficiently removed. In some patients a decrease in the number of T lymphocytes, due to relative depletion of T mu cells, was noted.

In search of objective manometric criteria for colonic high-amplitude propagated pressure waves.

Abstract The aims of this study were to explore all characteristics of high-amplitude propagated contractions (HAPCs) that would allow them to be distinguished from nonHAPC colonic pressure waves, and to develop computer algorithms for automated HAPC detection. Colonic manometry recordings obtained from 24 healthy volunteers were used. Automated analysis was performed to detect propagated pressure waves and to determine their amplitude, duration and area under the curve (AUC). For each of these variables distribution plots were made. Automated HAPC counts were compared to visual counts by experienced investigators. Distribution plots of 141093 colonic pressure waves lacked a bimodal pattern, as was also the case for propagated contractions (n = 8758). With increasing high-amplitude thresholds for HAPC detection, a gradual decrease in the automatically detected HAPC number was observed. These findings precluded determination of a threshold. Taking visually detected HAPCs as reference, amplitude thresholds of 100 mmHg in two channels, and 80 mmHg in one channel yielded the highest sensitivity (92%). In conclusion, objective criteria to distinguish HAPCs from other propagated pressure waves on the basis of their amplitude, duration or AUC do not exist. Automated detection of HAPCs using empirically derived criteria leads to an acceptable degree of correlation with visually detected HAPCs.

Fully automated analysis of colonic manometry recordings.

The purpose of this study was to develop a computer program for fully automated analysis of all presently known motor patterns in human colonic motility recordings. Colonic pressure recordings obtained from 24 healthy volunteers were used. Algorithms were developed for the detection and numerical analysis of five types of pressure waves: antegrade, retrograde, simultaneous, high-amplitude and isolated pressure waves. Furthermore, periodical motor activity was quantified. Validation was performed by comparison with visual analysis by two experienced observers. Patterns recorded during day- and night-time were compared using multiple-factor analysis of variance with Bonferroni correction. Automated analysis correlated well with visual peak detection (r = 0.98, P <0.01) and detection of antegrade pressure waves (r = 0.98, P <0.01). Most motor patterns showed a diurnal variation. During the night, prevalences of antegrade (938 vs 455; P <0.05), retrograde (112 vs 81; P <0.05), high-amplitude (12.9 vs 1.3; P <0.05), isolated pressure waves (1114 vs 765; P <0.05), and periodic motor activity were decreased (7.33 vs 4.47%; P <0.05). However, when expressed as percentage of absolute numbers of pressure waves, prevalences remained constant. In conclusion, fully automated analysis of all hitherto described colonic motility patterns is feasible. During the night, overall wave prevalences markedly decreased, but the distribution over the various motor patterns was preserved.

Risk of cytomegalovirus infection among educators and health care personnel serving mentally disabled children.

AIM: To determine the risk of cytomegalovirus (CMV) infection for personnel providing services to young disabled children. METHODS: The prevalence and incidence of CMV in a group of educators were compared with a group of nurses working in homes for the elderly. RESULTS: The prevalence was measured in 283 educators and 294 nurses. Both groups were comparable for well-established risk factors for CMV infection. The prevalence of seropositivity was 15.9% in the educators and 18.4% in the nurses. After a 1-year period 182 of the educators and 157 of the nurses who were initially seronegative for CMV were retested for serologic evidence of CMV infection. The annual conversion rate was 1.03% in educators and 1.42% in nurses. CONCLUSION: The prevalence of CMV antibodies among both educators and nurses did not differ and was lower to that observed in American studies of comparable populations. Annual seroconversion rates were not different between these groups.

Adjuvant radiation after conservative surgery for early breast cancer. Local control and cosmetic outcome.

Between 1980 and 1987, 115 patients with early breast cancer underwent conservative surgery and radiation therapy. Median follow-up from the date of surgery was 48 months. There was local recurrence in 5 of the 115 patients. Of this group, 67 patients were evaluable for cosmetic outcome. The overall cosmetic result was judged by a panel to be excellent or good in 61%, fair in 27%, and poor in 12%. Patients themselves found the cosmetic result to be excellent or good in 94%. Retraction of the inferior border of the breast, surface difference between both breasts, breast induration, scar retraction and telangiectasia correlated with the cosmetic score. Type of surgery, axillary irradiation, use of bolus, and length of follow-up all influenced the cosmetic outcome in a univariate analysis.

Uptake of 13N-ammonia by human tumours as studied by positron emission tomography.

Tumour uptake of 13N-labelled ammonia was studied by means of positron emission computerised axial tomography in 46 patients with various extensive neoplastic conditions. Eleven of the patients have been followed sequentially before, during and after radio- and/or chemotherapeutic treatment. Substantial accumulation of 13NH3 (up to five times the amount found in comparable normal tissues) was noted in some cases of breast cancer and their metastases, as well as in soft tissue sarcomas, in malignant neck nodes secondary to head and neck tumours, in lung tumours and their metastases, in melanomas, in malignant lymphomas, in metastasis prostatic carcinoma and in the case of ovarian carcinoma examined. Little or no extra uptake of 13NH3 was found ion necrotic or non-malignant tumours or in primary brain tumours, or in some primary breast cancer which otherwise appeared well vascularized and actively growing. In those patients who were followed sequentially, 13NH3 uptake could be seen to decrease with tumour regression. However, during the course of a radiotherapeutic treatment a transitory increase of 13NH3 uptake could be observed. If the therapy had not been successful, 13NH3 uptake was found to persist after treatment. Uptake of 13NH3 in tumours is to be regarded as the result of a complex interaction of both circulatory and metabolic influences. Studies using more specific tracers of flow and tissue metabolism will probably help to unravel the contributory physiological components.

Limb conservation in primary bone tumours by resection, extracorporeal irradiation and re-implantation.

En-bloc resection, extracorporeal irradiation and re-implantation of the irradiated bone have been used to treat 15 patients suffering from primary malignant tumours of bone or cartilage and two with benign lesions. This treatment is an alternative to replacement by prosthesis or allograft bridging techniques. After a mean follow-up of over five years results are encouraging, despite some complications and the relatively long period before weight-bearing is allowed.

Kinetics of 13N-ammonia incorporation in human tumours.

After intravenous injection of 13N-labelled ammonia time-activity curves were obtained in a series of malignant neoplasms in man from serial cross-sectional scans through the tumour, using positron emission tomography. Low noise images with virtually no artefacts were obtained using a maximum likelihood reconstruction technique. Tracer concentration was expressed as a fraction of the injected dose ml-1 of tumour tissue. In a first group (eight observations) maximum activity [0.9 to 5.2 (mean: 3.3) X 10(-5) of administered dose ml-1 of tumour tissue] was attained approximately 1 to 3 min post injection. This peak was followed by a clearance phase with a half-time varying between 28.3 and 112 (mean: 73.1) min. In a second group (of six cases) after an initial rapid rise of the activity, no clearance was detectable during the time of observation, tracer concentration remaining in plateau or even continuing to rise slightly. Maximum activity in this group ranged from 1.1 to 5.3 (mean: 2.6) X 10(-5) of the administered dose ml-1 of tissue. So far no relation has been established between the height and/or shape of the 13NH3 time-activity curve and a particular tumour type.

[Preoperative radiotherapy in breast cancer. Description of a clinical trial record and first results]. / La radiothérapie préopératoire dans le cancer du sein. Description d'un protocole d'essai clinique et premiers résultats

The protocol of a clinical trial, studying the value of preoperative radiotherapy (RT) in operable breast cancer is described. Results are compared to those of 2 control groups: patients treated either with surgery only or with surgery + postoperative RT. So far, in each of the 3 groups 250 patients have been entered, their total number being expected to reach about 350 per group. Two year results (on 209 evaluable cases) did not reveal any difference in survival between the groups, but a markedly lowered incidence of locally recurrent disease (from 16% to 4%) in the irradiated patients. No increase in mortality or metastasis was noted after RT. Side effects of RT were considered mild and not of such a degree as to necessitate its discontinuation.

[The Stockholm preoperative radiotherapy of operable breast cancer. Preliminary report]. / L'essai de Stockholm de radiothérapie pré-opératoire dans le cancer du sein opérable. Rapport préliminaire.

The 4 year results of a prospective clinical trial on the treatment of operable breast cancer, comparing the effects of preoperative radiotherapy followed by surgery with those of surgery followed or not by postoperative radiotherapy are presented for patient groups of approximately 100 each. At 4 years 85 per cent survive after preoperative radiotherapy plus surgery, as against 77 per cent after surgery only and 81 per cent after surgery plus postoperative radiotherapy. These differences are not statistically significant. The incidence of local recurrence after radiotherapy was reduced to 1/4 of that seen after surgery only. The radiation could be shown to induce temporary damage in a number of immunological parameters. No correlation could be demonstrated between these findings and the clinical course of the disease.