ABSTRACT
Recommendations of first choice antibiotic therapy need to be based on actual antibiotic susceptibility data. We determined the antibiotic susceptibility of E. coli in uncomplicated UTI among women and compared the results with 2004 and 2009. In 30 sentinel general practitioner practices of Nivel Primary Care database, urine samples were collected from women with symptoms of uncomplicated UTI. Patient characteristics, E. coli susceptibility, and ESBL production were analyzed. Six hundred eighty-nine urine samples were collected; E. coli was the most isolated uropathogen (83%). Antibiotic susceptibility was stable over time except for ciprofloxacin (96% in 2004, 97% in 2009, and 94% in 2014; P < 0.05). The susceptibility to co-amoxiclav was 88%, 87%, and 92% in 2004, 2009, and 2014, respectively. The prevalence of ESBL-producing E. coli increased from 0.1% in 2004 to 2.2% in 2014 (P < 0.05). Regional differences in antibiotic susceptibility for co-trimoxazole were found being the highest in the west (88%) and the lowest in the north (72%, P = 0.021). Ciprofloxacin susceptibility was related to antibiotic use in the past 3 months (97% no use versus 90% use, P = 0.002) and age > 70 years (P = 0.005). In 2014, prescription of fosfomycin increased compared to 2009 (14.3% versus 5.6%) at the expense of co-amoxiclav, co-trimoxazole, and fluoroquinolones (P < 0.05). The susceptibility percentages to most antimicrobial agents tested were stable over 10 years' period although the prevalence of E. coli and ESBLs significantly increased. Performance of a survey with regular intervals is warranted.
Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Microbial , Escherichia coli Infections/microbiology , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Urinary Tract Infections/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Child , Escherichia coli/enzymology , Escherichia coli Infections/drug therapy , Escherichia coli Infections/epidemiology , Female , General Practice/statistics & numerical data , Humans , Microbial Sensitivity Tests , Middle Aged , Netherlands/epidemiology , Prevalence , Urinary Tract Infections/urine , Young Adult , beta-Lactamases/metabolismABSTRACT
BACKGROUND: In the Netherlands, general practitioners (GPs) and community nurses play a central role in the palliative care for home-dwelling patients with advanced cancer and their relatives. To optimize the palliative care provision at home, it is important to have insight in the elements that patients and relatives consider essential for high-quality palliative care, and whether these essentials are present in the actual care they receive. METHODS: Qualitative semi-structured interviews were conducted with 13 patients with advanced cancer and 14 relatives. The participants discussed their experiences with the care and support they received from the GP and community nurses, and their views on met and unmet needs. Interview data were analysed according to the principles of thematic analysis. RESULTS: Patients as well as relatives considered it important that their GP and community nursing staff are medically proficient, available, person-focused and proactive. Also, proper information transfer between care professionals and clear procedures when asking for certain resources or services were considered essential for good palliative care at home. Most interviewees indicated that these essential elements were generally present in the care they received. However, the requirements of 'proper information transfer between professionals' and 'clear and rapid procedures' were mentioned as more difficult to meet in actual practice. Patients and relatives also emphasized that an alert and assertive attitude on their own part was vital in ensuring they received the care they need. They expressed worries about other people who are less vigilant regarding the care they receive, or who have no family to support them in this. CONCLUSIONS: Medical proficiency, availability, a focus on the person, proper information transfer between professionals, clear procedures and proactivity on the part of GPs and community nursing staff are considered essential for good palliative care at home. Improvements are particularly warranted with regard to collaboration and information transfer between professionals, and current bureaucratic procedures. It is important for care professionals to ensure that the identified essential elements for high-quality palliative care at home are met, particularly for patients and relatives who are not so alert and assertive.
Subject(s)
General Practitioners , Home Care Services/organization & administration , Neoplasms/therapy , Nurses, Community Health/organization & administration , Palliative Care/organization & administration , Quality of Health Care/organization & administration , Aged , Aged, 80 and over , Clinical Competence , Communication , Female , Home Care Services/standards , Humans , Interprofessional Relations , Interviews as Topic , Male , Middle Aged , Netherlands , Nurse's Role , Palliative Care/standards , Patient-Centered Care/standards , Physician's Role , Qualitative Research , Quality of Health Care/standards , Terminal Care/organization & administration , Time FactorsABSTRACT
BACKGROUND: Whether the incidence of eating disorders in Western, industrialized countries has changed over time has been the subject of much debate. The purpose of this primary-care study was to examine changes in the incidence of eating disorders in The Netherlands during the 1980s, 1990s and 2000s. METHOD: A nationwide network of general practitioners (GPs), serving a representative sample (~1%) of the total Dutch population, recorded newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) in their practice during 1985-1989, 1995-1999, and 2005-2009. GPs are key players in the Dutch healthcare system, as their written referral is mandatory in order to get access to specialized (mental) healthcare, covered by health insurance. Health insurance is virtually universal in The Netherlands (99% of the population). A substantial number of GPs participated in all three study periods, during which the same case identification criteria were used and the same psychiatrist was responsible for making the final diagnoses. Incidence rates were calculated and for comparison between periods, incidence rate ratios. RESULTS: The overall incidence rate of BN decreased significantly in the past three decades (from 8.6 per 100,000 person-years in 1985-1989 to 6.1 in 1995-1999, and 3.2 in 2005-2009). The overall incidence of AN remained fairly stable during three decades, i.e. 7.4 per 100,000 person-years in 1985-1989, 7.8 in 1995-1999, and 6.0 in 2005-2009. CONCLUSIONS: The incidence rate of BN decreased significantly over the past three decades, while the overall incidence rate of AN remained stable.
Subject(s)
Anorexia Nervosa/epidemiology , Bulimia Nervosa/epidemiology , Adolescent , Adult , Age Distribution , Child , Child, Preschool , Databases, Factual , Female , Humans , Incidence , Male , Middle Aged , Netherlands/epidemiology , Primary Health Care , Referral and Consultation , Sex Distribution , Young AdultABSTRACT
OBJECTIVE: Cancer and its treatment often have a profound impact on patients, leading to increased health care use in the years after diagnosis. Social support is an important determinant of health care use. Partners of cancer patients may not always be able to provide all support patients need and patients may then revert to professional health care. We examined whether partners' health and the support they provide affect the use of general practitioner (GP) care in cancer patients. METHODS: Cancer patients aged ≥18, diagnosed <20 years ago with a cancer type with a 5-year survival rate >20% and no distant metastases were sent a questionnaire, along with their partners. Patients' self-reported recent use of GP care, i.e. whether they had discussed health problems with the GP in the past year, was assessed. Partner support as perceived by the patient was measured on three scales: Active engagement, protective buffering and overprotection. RESULTS: We included 219 patients and partners. Many patients discussed physical and emotional problems with their GP (60% and 28% of patients, respectively). Patients were less likely to discuss physical problems when they experienced active engagement and protective buffering, the latter only for females. CONCLUSION: Partner support affects use of GP care in cancer patients. GPs should therefore pay attention to the support style of the partner. GPs could ask about the support provided by the partner and inform both patients and partners about support groups where they can share experiences.
Subject(s)
General Practitioners/statistics & numerical data , Neoplasms/psychology , Sexual Partners/psychology , Social Support , Spouses/psychology , Stress, Psychological/etiology , Adolescent , Adult , Aged , Female , Health Care Surveys , Health Status , Humans , Male , Middle Aged , Neoplasms/diagnosis , Perception , Quality of Life , Surveys and Questionnaires , Young AdultABSTRACT
In 2009 two notable outbreaks, Q fever and the novel influenza A(H1N1)pdm09, occurred in The Netherlands. Using a composite health measure, disability-adjusted life years (DALYs), the outbreaks were quantified and compared. DALYs were calculated using standardized methodology incorporating age- and sex-stratified data in a disease progression model; years lost due to disability and years of life lost were computed by outcome. Nationally, influenza A(H1N1)pdm09 caused more DALYs (24 484) than Q fever (5797). However, Q fever was 8·28 times more severe [497 DALYs/1000 symptomatic cases (DP1SC)] than A(H1N1)pdm09 (60 DP1SC). The A(H1N1)pdm09 burden is largely due to mortality while the Q fever burden is due primarily to long-term sequelae. Intervention prioritization for influenza should support patients in a critical condition while for Q fever it should target immediate containment and support for patients with long-term sequelae. Burden estimates provide guidance for focusing intervention options during outbreaks of infectious diseases.
Subject(s)
Disabled Persons/statistics & numerical data , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/epidemiology , Q Fever/epidemiology , Quality-Adjusted Life Years , Adult , Communicable Disease Control , Databases, Factual , Disease Outbreaks , Female , Humans , Influenza, Human/virology , Male , Netherlands/epidemiology , Prevalence , Q Fever/diagnosis , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Survival RateABSTRACT
Enterovirus D68 (EV-D68) continued to circulate in a seasonal pattern in the Netherlands, after the outbreak in 2010. Outpatient EV-D68 cases, mainly in the under 20 and 5059 years age groups, presented with relatively mild respiratory disease. Hospital-based enterovirus surveillance identified more severe cases, mainly in children under 10 years of age. Dutch partial VP1 genomic region sequences from 2012 through 2014 were distributed over three sublineages similar to EV-D68 from the outbreak in the US in 2014.
Subject(s)
Enterovirus D, Human/classification , Enterovirus D, Human/isolation & purification , Enterovirus Infections/virology , Sentinel Surveillance , Adolescent , Adult , Age Distribution , Aged , Child , Child, Preschool , Disease Outbreaks , Enterovirus D, Human/genetics , Enterovirus Infections/epidemiology , Hospitalization/statistics & numerical data , Humans , Infant , Male , Middle Aged , Netherlands/epidemiology , Phylogeny , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/virology , Retrospective Studies , Seasons , Sequence Analysis, DNA , Sex Distribution , Young AdultABSTRACT
This study assessed the antimicrobial resistance and population structure of Staphylococcus aureus isolated from general practice (GP) patients and nursing home (NH) residents in the province of Limburg (near the border with Germany and Belgium) in comparison with those obtained in the remaining provinces of the Netherlands. A total of 617 and 418 S. aureus isolates were isolated from 2,691 to 1,351 nasal swabs from GP patients and NH residents, respectively. Quantitative antibiotic susceptibility testing was performed using a microbroth dilution method. Putative methicillin-resistant S. aureus (MRSA) isolates were tested for the presence of the mecA gene and spa typing was performed on all S. aureus isolates. No significant differences in the prevalence of resistance were found between the two groups of GP isolates, but the isolates from the NH residents showed a lower resistance for trimethoprim-sulfamethoxazole (p = 0.003) in Limburg province compared with the remaining provinces in the Netherlands. Among the isolates from NH residents in Limburg province, the prevalence of spa-CC 084 was higher (p = 0.003) and that of spa-CC 002 was lower (p = 0.01) compared with isolates from NHs in the remaining provinces of the Netherlands. We observed no differences in resistance and population structure between S. aureus isolates from GP patients in Limburg and the remaining provinces of the Netherlands, and only a few differences were observed between the NH populations. There was no higher prevalence of resistance among the GP and NH isolates from Limburg compared with the remaining provinces.
Subject(s)
Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Anti-Bacterial Agents/pharmacology , Belgium/epidemiology , Carrier State/epidemiology , Carrier State/microbiology , Chi-Square Distribution , Cross-Sectional Studies , Drug Resistance, Bacterial , General Practice , Germany/epidemiology , Humans , Microbial Sensitivity Tests , Nasal Cavity/microbiology , Netherlands/epidemiology , Nursing Homes , Prevalence , Staphylococcus aureus/genetics , Staphylococcus aureus/isolation & purificationABSTRACT
BACKGROUND: The disease burden of the 2009 influenza pandemic has been debated but reliable estimates are lacking. To guide future policy and control, these estimates are necessary. This study uses burden of disease measurements to assess the contribution of the pandemic influenza A(H1N1) virus to the overall burden of disease in the Netherlands. METHODS: The burden of disease caused by 2009 pandemic influenza was estimated by calculating Disability Adjusted Life Years (DALY), a composite measure that combines incidence, sequelae and mortality associated with a disease, taking duration and severity into account. Available influenza surveillance data sources (primary care sentinel surveillance, notification data on hospitalizations and deaths and death registries) were used. Besides a baseline scenario, five alternative scenarios were used to assess effects of changing values of input parameters. RESULTS: The baseline scenario showed a loss of 5800 DALY for the Netherlands (35 DALY per 100 000 population). This corresponds to 0.13% of the estimated annual disease burden in the Netherlands and is comparable to the estimated disease burden of seasonal influenza, despite a different age distribution in incidence and mortality of the pandemic compared to seasonal influenza. CONCLUSIONS: This disease burden estimate confirmed that, although there was a higher mortality observed among young people, the 2009 pandemic was overall a mild influenza epidemic. The disease burden of this pandemic was comparable to the burden of seasonal influenza in the Netherlands.
Subject(s)
Cost of Illness , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/complications , Influenza, Human/mortality , Adolescent , Adult , Child , Child, Preschool , Disabled Persons , Female , Humans , Infant , Influenza, Human/physiopathology , Male , Middle Aged , Netherlands/epidemiology , Pandemics , Registries , Severity of Illness Index , Young AdultABSTRACT
Large Q-fever outbreaks were reported in The Netherlands from May 2007 to 2009, with dairy-goat farms as the putative source. Since Q-fever outbreaks at such farms were first reported in 2005, we explored whether there was evidence of human outbreaks before May 2007. Space-time scan statistics were used to look for clusters of lower-respiratory infections (LRIs), hepatitis, and/or endocarditis in hospitalizations, 2005-2007. We assessed whether these were plausibly caused by Q fever, using patients' age, discharge diagnoses, indications for other causes, and overlap with reported Q fever in goats/humans. For seven detected LRI clusters and one hepatitis cluster, we considered Q fever a plausible cause. One of these clusters reflected the recognized May 2007 outbreak. Real-time syndromic surveillance would have detected four of the other clusters in 2007, one in 2006 and two in 2005, which might have resulted in detection of Q-fever outbreaks up to 2 years earlier.
Subject(s)
Goat Diseases/epidemiology , Q Fever/veterinary , Adolescent , Adult , Aged , Animals , Child , Child, Preschool , Cluster Analysis , Goat Diseases/microbiology , Goat Diseases/transmission , Goats , Hospitals , Humans , Infant , Infant, Newborn , Middle Aged , Netherlands/epidemiology , Population Surveillance , Q Fever/epidemiology , Q Fever/transmission , Retrospective Studies , Time Factors , Young Adult , ZoonosesABSTRACT
OBJECTIVES: To optimize empirical treatment of urinary tract infections (UTIs), regular evaluation of the antibiotic susceptibility of the most common uropathogen, Escherichia coli, is necessary. We compared the antibiotic prescription rate for UTIs in women and the E. coli antibiotic susceptibility results, including the prevalence of extended-spectrum ß-lactamase (ESBL)-producing strains, in 2009 with data collected 5 years earlier. PATIENTS AND METHODS: Urinary samples from female patients with symptoms of uncomplicated UTI in 42 general practices were collected over a 6 month period. Uropathogens were identified and the antibiotic susceptibility of E. coli was determined. RESULTS: We analysed 970 urine cultures, of which 785 (81%) were considered positive (≥ 10(3) cfu/mL). E. coli accounted for 72% of the isolates. ESBLs showed an increase between the two surveys (0.1% versus 1%; P < 0.001), while no difference in antibiotic susceptibility to the commonly used antimicrobial agents for UTIs was observed. A significantly lower susceptibility rate to co-amoxiclav was observed in the eastern region of the Netherlands, as compared with the northern region (80% versus 92%; P <â 0.05). Consistent with national guidelines, the prescription rate of trimethoprim decreased over time (19% versus 5%; P â< 0.05) whereas nitrofurantoin and fosfomycin rates showed an increase (58% versus 66% and 0% versus 6% respectively, both P â< 0.05). CONCLUSIONS: Over a 5 year period, the antibiotic susceptibility of uropathogenic E. coli did not change in female patients with uncomplicated UTI in the Netherlands, but ESBL prevalence increased. With respect to the prescription of antimicrobial agents, compliance with national UTI guidelines was good.
Subject(s)
Anti-Bacterial Agents/pharmacology , Escherichia coli Infections/microbiology , Urinary Tract Infections/microbiology , Uropathogenic Escherichia coli/drug effects , Adolescent , Adult , Aged , Aged, 80 and over , Child , Drug Prescriptions/standards , Drug Prescriptions/statistics & numerical data , Drug Utilization/statistics & numerical data , Female , General Practice , Guideline Adherence/statistics & numerical data , Humans , Microbial Sensitivity Tests , Middle Aged , Netherlands , Time Factors , Uropathogenic Escherichia coli/isolation & purification , Young AdultABSTRACT
BACKGROUND: Surveillance of acute respiratory infections (ARI) in the Netherlands and other European countries is based mostly on primary care data, with little insight into the severe spectrum of the disease. We compared time-trends for ARI in secondary care with influenza-like illness (ILI), ARI and pneumonia in primary care, and crude mortality, in order to assess the value of routinely collected data on respiratory infections in hospitals and the added value of severe acute respiratory infections (SARI) surveillance. METHODS: We calculated incidence of ARI in secondary care, ILI, ARI, and pneumonia in primary care, and crude mortality using five historical databases (2008-2016). RESULTS: Over eight years, seasonal incidence peaks of ARI in secondary care occurred earlier than ILI and ARI incidence peaks in primary care, except during the 2009 influenza A(H1N1) pandemic and post-pandemic season. The median time-lag between ARI in secondary care and ILI, ARI and pneumonia in primary care was 6.5 weeks, 7 weeks, and 1 week, respectively. Crude mortality lagged a median 5 weeks behind ARI in secondary care. CONCLUSION: This observational study demonstrates that routinely collected data can be used for describing trends of ARI in secondary care and may be suitable for near real-time SARI surveillance. In most seasons, the incidence peaks for ARI in secondary care preceded the peaks in primary care and crude mortality with a considerable time-lag. It would be of great value to add microbiological test results to the incidence data to better explain the difference in time-lag between these surveillance systems.
Subject(s)
Influenza A Virus, H1N1 Subtype , Influenza, Human , Respiratory Tract Infections , Humans , Influenza, Human/epidemiology , Netherlands/epidemiology , Respiratory Tract Infections/epidemiology , SeasonsABSTRACT
Influenza epidemics annually cause substantial morbidity and mortality. For this reason, vaccination is offered yearly to persons with an elevated risk for complications. Assessments of the impact of vaccination are, however, hampered by year-to-year variation in epidemic size and vaccine effectiveness. We estimate the impact of the current vaccination programme comparing simulations with vaccination to counterfactual simulations without vaccination. The simulations rely on an age- and risk-structured transmission model that tracks the build-up and loss of immunity over successive seasons, and that allows the vaccine match to vary between seasons. The model parameters are estimated with a particle Monte Carlo method and approximate Bayesian computation, using epidemiological data on vaccine effectiveness and epidemic size in the Netherlands over a period of 11 years. The number of infections, hospitalisations and deaths vary greatly between years because waning of immunity and vaccine match may differ every season, which is in line with observed variation in influenza epidemic sizes. At an overall coverage of 21%, vaccination has averted on average 13% (7.2-19%, 95% range) of infections, 24% (16-36%) of hospitalisations, and 35% (16-50%) of deaths. This suggests that vaccination is mainly effective in protecting vaccinees from infection rather than reducing transmission. As the Dutch population continues to grow and age, the vaccination programme is projected (up to 2025) to gain in impact, despite a decreasing infection attack rate.
Subject(s)
Immunization Programs/statistics & numerical data , Influenza Vaccines/therapeutic use , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , Bayes Theorem , Child , Child, Preschool , Epidemics , Humans , Immunization Programs/methods , Infant , Middle Aged , Netherlands/epidemiology , Seasons , Young AdultABSTRACT
The first signs of influenza activity during the 2007/'08 influenza season in the Netherlands were sporadic isolations of influenza viruses between week 40 and week 52 of 2007. The frequency of virus isolations and clinical influenza activity increased after week 1 of 2008 and peaked around week 9. In this week, 7.2 patients with influenza-like illness were recorded per 10,000 inhabitants. The influenza epidemic was caused primarily by influenza A/H1N1 viruses and influenza B viruses. Two antigenically distinct variants of influenza A/H1N1 viruses were isolated, which resembled the 2007/'08 vaccine reference strain A/Solomon Islands/3/06 and the new vaccine reference strain A/Brisbane/59/07, respectively. The most remarkable finding was that 27% of the A/H1N1 viruses isolated in the Netherlands during the 2007/'08 epidemic were resistant to the neuraminidase inhibitor oseltamivir. The isolated influenza B viruses originated from the B/Yamagata/16/88 lineage and did not match the vaccine strain, which originated from a different and antigenically distinct lineage of influenza B viruses (B/Victoria/2/87). Only a small number of influenza A/H3N2 viruses was isolated, which were related to the vaccine strain for this subtype (A/Wisconsin/67/05). Thus in contrast to previous influenza seasons, A/H3N2 viruses did not play a major role in the 2007/'08 influenza season in the Netherlands. For the 2008/'09 influenza season, the World Health Organization has recommended the following vaccine composition: A/Brisbane/59/07 (H1N1), A/Brisbane/10/07 (H3N2) and B/Florida/4/06.
Subject(s)
Drug Resistance, Viral , Influenza A Virus, H1N1 Subtype/immunology , Influenza A virus/immunology , Influenza Vaccines/immunology , Influenza, Human , Humans , Influenza A Virus, H1N1 Subtype/genetics , Influenza A virus/genetics , Influenza B virus/genetics , Influenza B virus/immunology , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Influenza, Human/virology , Netherlands , Oseltamivir/therapeutic useABSTRACT
The influenza epidemic of 2006/'07 began late in the season, like the two previous influenza epidemics. In week 8 a peak of modest height was reached. As usual, the causal strains were mainly A/H3N2 viruses and to a lesser extent A/H1N1 and B viruses. A new A/H1N1 virus variant has emerged, an event that on average takes place only every 10 years. However, almost all A/H1N1 virus isolates belonged to the old variant and were similar to the vaccine virus. The A/H3N2 virus isolates appeared to deviate from the vaccine strain, but after antigenic cartographic analysis and correction for low avidity they proved also closely related to the vaccine strain. The few type B virus isolates belonged to the B/Yamagata/16/88 lineage, whereas the used B vaccine virus had been chosen from the B/Victoria/2/87 lineage. The vaccine therefore will have provided almost optimal protection against the circulating influenza A/H1N1 and A/H3N2 viruses but not against the influenza B viruses. For the 2007/'08 influenza season the World Health Organization has recommended the following vaccine composition: A/Solomon Islands/3/06 (H1N1) (new), A/Wisconsin/67/05 (H3N2), and B/Malaysia/2506/04.
Subject(s)
Influenza Vaccines/immunology , Influenza, Human/prevention & control , Influenza, Human/virology , Global Health , Humans , Influenza A virus/immunology , Influenza B virus/immunology , Influenza, Human/epidemiology , Netherlands/epidemiology , Population SurveillanceABSTRACT
OBJECTIVE: To investigate the relationship between circulating influenza virus A types and subtypes and influenza B lineages, their match with the vaccine and the effectiveness of the influenza vaccine (IVE). DESIGN: Test negative case control study. METHOD: We used data from the Dutch Sentinel Practices of the Netherlands Institute for Health Services Research (NIVEL) Primary Care Database. Participating general practitioners took nose and throat swabs for viral studies from patients with influenza-like illness or another acute respiratory infection. Cases were those patients whose samples were positive for an influenza virus and controls were those whose samples were negative for influenza virus. We determined the IVE of 11 influenza seasons 2003/2004 to 2013/2014, for all seasons together and stratified by influenza virus type and to vaccine match or mismatch. RESULTS: Over all seasons, the IVE was 29% (95% CI:11-43). In seven of the 11 seasons there was a mismatch between vaccine and circulating virus type. The IVE was 40% (95% CI: 18-56) for those seasons in which there was a vaccine match, and 20% (95% CI: - 5-38) for seasons with a mismatch. When the influenza A/H3N2 virus was dominant, the IVE was 38% (95% CI: 14-55). The IVE against the influenza virus A/H1N1, A/H1N1/pdm09 and against both influenza B lineages was 77% (95% CI: 37-92), 47% (95% CI: 22-64) and 64% (95% CI: 50-74), respectively. CONCLUSION: The IVE was particularly low when there was a mismatch between the vaccine and the circulating virus type and when A/H3N2 was the dominant influenza subtype.
ABSTRACT
The first sign of influenza activity in the Netherlands during the 2005-2006 influenza season was the isolation of influenza viruses in the last week of 2005. From Week 1 of 2006 onwards, an increase in clinical influenza activity was also observed that did not return to baseline levels until Week 15. Two waves of influenza activity were observed with peak incidences of 13.8 and 9.8 influenza-like illnesses per 10,000 inhabitants on Weeks 7 and 12, respectively. The first wave of influenza was caused primarily by influenza B viruses, whereas the second wave was caused predominantly by influenza A/H3N2 viruses. The influenza B viruses appeared to belong to two different phylogenetic lineages and were antigenically distinguishable from the vaccine strain. The isolated influenza A/H3N2 viruses were closely related to the vaccine strain for this subtype and only minor antigenic differences with the vaccine strain were observed for a limited number of isolates. Only a small number of influenza A/H1N1 viruses were isolated, which all closely resembled the H1N1 vaccine strain. For the 2006-2007 influenza season, the World Health Organization has recommended the following vaccine composition: A/Wisconsin/67/05 (H3N2), A/New Caledonia/20/99 (H1N1) and B/Malaysia/2506/05.
Subject(s)
Disease Outbreaks/prevention & control , Influenza A Virus, H1N1 Subtype/immunology , Influenza A Virus, H3N2 Subtype/immunology , Influenza B virus/immunology , Influenza Vaccines , Influenza, Human/prevention & control , Forecasting , Global Health , Humans , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza A Virus, H3N2 Subtype/isolation & purification , Influenza B virus/isolation & purification , Influenza Vaccines/immunology , Influenza, Human/virology , Netherlands , SeasonsABSTRACT
OBJECTIVE: We investigated trends in suicidal behaviour as reported by Dutch general practices from 1983 to 2013. Also, we analysed the relationship with patient characteristics and with the financial crisis of 2008. DESIGN: Retrospective observational study. METHOD: We estimated age-adjusted and gender-specific trends in suicides (342) and attempted suicides (1614), as registered in 1983-2013 under ICPC code P77 by 40 Dutch general practices participating in the NIVEL Primary Care Database sentinel station. Secondary outcomes, on the basis of supplementary questions in the GP Information System (Huisartsen Informatie Systeem), were the relationship between suicidal behaviour, earlier treatments and patient characteristics. Also, we analysed separate frequencies for the periods 1983-2007 and 2008-2013. RESULTS: Join-point analyses revealed a significant rise in male suicides from 2008 (b = 0.32, SE = 0.1, p = 0.008), and an increase in male suicide attempts since 2009 (b = 0.19, SE = 0.04, p < 0.001). Female suicidal behaviour showed a steady decrease in 1989-2013: b = -0.03, SE = 0.007, p < 0.0001 for female suicide, b = -0.02, SE = 0.002, p < 0.001 for female attempts. Almost half of the suicidal patients had visited their GP one month before the event. In 31% of these patients, the GP had recognized suicidal behaviour. CONCLUSIONS: Since 2008, there was a rise in the male suicide rate while female suicide behaviour has continued to decline. Training in the early recognition of suicide ideation in depressive patients might improve suicide prevention in primary care.
Subject(s)
General Practice/statistics & numerical data , Suicide/statistics & numerical data , Adult , Female , Humans , Male , Middle Aged , Netherlands , Retrospective Studies , Sex Factors , Suicide/psychology , Suicide, Attempted/psychology , Suicide, Attempted/statistics & numerical dataABSTRACT
OBJECTIVES: Prior research has shown that Dutch general practitioners (GPs) do not always offer HIV testing and the number of undiagnosed HIV patients remains high. We aimed to further investigate the frequency and reasons for (not) testing for HIV and the contribution of GPs to the diagnosis of HIV infections in the Netherlands. DESIGN: Observational study. SETTING: (1) Dutch primary care network of 42-45 sentinel practices where report forms during sexually transmitted infection (STI)-related consultations were routinely collected, 2008-2013. (2) Dutch observational cohort with medical data of HIV-positive patients in HIV care, 2008-2013. OUTCOME MEASURES: The proportion of STI-related consultations in patients from high-risk groups tested for HIV, with additional information requested from GPs on HIV testing preconsultation or postconsultation for whom HIV testing was indicated, but not performed. Next, information was collected on the profile of HIV-positive patients entering specialised HIV care following diagnosis by GPs. RESULTS: Initially, an HIV test was reported (360/907) in 40% of STI-related consultations in high-risk groups. Additionally, in 26% of consultations an HIV test had been performed in previous or follow-up consultations or at different STI-care facilities. The main reasons for not testing were perceived insignificant risk; 'too' recent risk according to GPs or the reluctance of patients. The initiative of the patient was a strong determinant for HIV testing. GPs diagnosed about one third of all newly found cases of HIV. Compared with STI clinics, HIV-positive patients diagnosed in general practice were more likely to be older, female, heterosexual male or sub-Saharan African. CONCLUSIONS: In one-third of the STI-related consultations of persons from high-risk groups, no HIV test was performed in primary care, which is lower than previously reported. Risk-based testing has intrinsic limitations and implementation of new additional strategies in primary care is warranted.
Subject(s)
General Practitioners , HIV Infections/diagnosis , Referral and Consultation , Female , Humans , Male , Medical Records/standards , Netherlands , Physician's Role , Risk-Taking , Surveys and Questionnaires , Unsafe SexABSTRACT
A healthy 5-year-old child was brought to the general practitioner with priapism that had been observed for a few days, without any other symptoms. Angiography revealed an arteriovenous fistula originating from the left A. dorsalis penis, which was successfully embolised. The diagnosis was 'high flow' priapism. A possible cause in the anamnesis was a fall from a swing two weeks before the embolisation. The doctor's delay was caused by unfamiliarity with this rare disorder; due to the risk of impotence (impotentia coeundi), it is an emergency situation.