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1.
J Gen Virol ; 97(7): 1500-1510, 2016 07.
Article in English | MEDLINE | ID: mdl-27075118

ABSTRACT

Puumala hantavirus (PUUV) is the most common and widespread hantavirus in Europe and is associated with a mild form of haemorrhagic fever with renal syndrome in humans, called nephropathia epidemica. This study presents the molecular characterization of PUUV circulating in bank voles in two regions of the Netherlands. Most human cases of hantavirus infection are from these two regions. Phylogenetic analysis of the (partial) S, M and L-segments indicated that the Dutch strains belong to the CE lineage, which includes PUUV strains from France, Germany and Belgium. We have identified two distinct groups of PUUV, corresponding with their geographic origin and with adjoining regions in neighbouring countries.


Subject(s)
Arvicolinae/virology , Hemorrhagic Fever with Renal Syndrome/virology , Puumala virus/classification , Puumala virus/genetics , Animals , Base Sequence , Genetic Variation/genetics , Humans , Netherlands , RNA, Viral/genetics , Sequence Analysis, RNA
2.
Eur J Clin Microbiol Infect Dis ; 35(10): 1691-700, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27372926

ABSTRACT

Acute gastroenteritis (AGE) morbidity remains high amongst preschool children, posing a significant societal burden. Empirical data on AGE-causing agents is needed to gauge their clinical relevance and identify agent-specific targets for control. We assessed the prevalence, risk factors and association with symptoms for enteropathogens in households with preschool children. A monthly-repeated cross-sectional survey of enteropathogens in households with preschool children was performed. A parent-child pair per household (n = 907 households) provided faecal samples and reported their symptoms and potential risk exposures. Samples were tested by multiplex reverse transcription polymerase chain reaction (RT-PCR) for 19 enteropathogens. Associations were assessed using logistic regression. 28.3 % of children (n = 981) and 15.6 % of parents (n = 971) carried pathogenic bacteria and/or Escherichia coli-associated pathogenicity genes, and 6.5 % and 3.3 % carried viruses, respectively. Giardia lamblia (4.6 % of children, 2.5 % of parents) and Dientamoeba fragilis (36 %, 39 %, respectively) were the main parasites, and were associated with pet exposure. Living in rural areas was associated with carriage of pathogenic E. coli, norovirus I and D. fragilis. Pathogenic E. coli was associated with summertime and livestock exposure. Attending day-care centres increased the risk of carrying norovirus, sapovirus and G. lamblia. Viruses occurred mainly in winter and were associated with AGE symptoms. Child-parent associations were found for bacterial pathogenicity genes, viruses, G. lamblia and D. fragilis. Enteropathogens spread widely in households with preschool children, particularly viruses, which more often cause symptoms. While bacteria predominate during summer and in those exposed to livestock, viruses predominate in wintertime and, like G. lamblia, are widespread amongst day-care centre attendees.


Subject(s)
Bacteria/isolation & purification , Family Health , Gastroenteritis/epidemiology , Gastroenteritis/etiology , Parasites/isolation & purification , Viruses/isolation & purification , Adult , Animals , Bacteria/classification , Child, Preschool , Cross-Sectional Studies , Disease Transmission, Infectious , Family Characteristics , Feces/microbiology , Feces/parasitology , Feces/virology , Female , Humans , Infant , Male , Multiplex Polymerase Chain Reaction , Parasites/classification , Prevalence , Risk Factors , Seasons , Surveys and Questionnaires , Viruses/classification
3.
Epidemiol Infect ; 144(12): 2527-39, 2016 09.
Article in English | MEDLINE | ID: mdl-27483376

ABSTRACT

Insights into transmission dynamics of enteropathogens in children attending daycare are limited. Here we aimed at identifying daycare centre (DCC) characteristics associated with time-clustered occurrence of enteropathogens in DCC-attending children. For this purpose, we used the KIzSS network, which comprises 43 DCCs that participated in infectious disease surveillance in The Netherlands during February 2010-February 2013. Space-time scan statistics were used to identify clusters of rotavirus, norovirus, astrovirus, Giardia lamblia and Cryptosporidium spp. in a two-dimensional DCC characteristic space constructed using canonical correlation analysis. Logistic regression models were then used to further identify DCC characteristics associated with increased or decreased odds for clustering of enteropathogens. Factors associated with increased odds for enteropathogen clustering in DCCs were having indoor/outdoor paddling pools or sandpits, owning animals, high numbers of attending children, and reporting outbreaks to local health authorities. Factors associated with decreased odds for enteropathogen clustering in DCCs were cleaning child potties in designated waste disposal stations, cleaning vomit with chlorine-based products, daily cleaning of toys, extra cleaning of toys during a suspected outbreak, and excluding children with gastroenteritis. These factors provide targets for reducing the burden of gastrointestinal morbidity associated with time-clustered occurrence of major enteropathogens in DCC attendees.


Subject(s)
Child Day Care Centers/statistics & numerical data , Disease Outbreaks , Gastroenteritis/epidemiology , Astroviridae/physiology , Astroviridae Infections/epidemiology , Astroviridae Infections/virology , Caliciviridae Infections/epidemiology , Caliciviridae Infections/virology , Child Day Care Centers/standards , Child, Preschool , Cluster Analysis , Cryptosporidiosis/epidemiology , Cryptosporidium/physiology , Gastroenteritis/parasitology , Gastroenteritis/virology , Giardia lamblia/physiology , Giardiasis/epidemiology , Humans , Infant , Netherlands/epidemiology , Norovirus/physiology , Prevalence , Risk Factors , Rotavirus/physiology , Rotavirus Infections/epidemiology , Rotavirus Infections/virology
4.
Epidemiol Infect ; 143(8): 1710-7, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25336060

ABSTRACT

Norovirus is the most frequent cause of acute infectious gastroenteritis and it is difficult to control in crowded environments like hospitals and nursing homes. Transmission depends on oral intake of virus deposited in the environment by infectious subjects. Data from volunteer studies indicate that virus concentrations in stool are highly variable, but systematic studies of the time-course of shedding and its individual variation are lacking. This paper quantifies norovirus shedding in a large population of 102 subjects, including asymptomatic shedders, and uses a longitudinal model to generalize shedding patterns. Enhanced surveillance for studies of transmission of norovirus in hospital outbreaks has yielded a considerable number of faecal samples from symptomatic and asymptomatic shedders, both from patients and staff. Norovirus concentrations were determined by real-time PCR. A quantitative dynamic model was fitted to the shedding data, in a multilevel Bayesian framework, to study the time-course of shedding and its variation. The results indicate that shedding in asymptomatic subjects is similar to that in symptomatic infections, both showing considerable variation in peak levels (average 105-109 /g faeces) as well as duration of virus shedding (average 8-60 days). Patients appear to shed higher numbers of virus than staff, for slightly longer durations, but the differences are too small to be significant. Given equal shedding, the greater contribution of symptomatic cases to transmission must be caused by their higher efficiency in spreading these viruses. The results of this study will be helpful for risk studies that need to quantify the deposition of virus in the environment.


Subject(s)
Asymptomatic Infections , Caliciviridae Infections/virology , Disease Outbreaks , Feces/virology , Gastroenteritis/virology , Norovirus/genetics , RNA, Viral/analysis , Virus Shedding/physiology , Adolescent , Adult , Aged , Aged, 80 and over , Bayes Theorem , Caliciviridae Infections/epidemiology , Caliciviridae Infections/transmission , Cohort Studies , Female , Gastroenteritis/epidemiology , Health Personnel/statistics & numerical data , Hospitals , Humans , Infectious Disease Transmission, Patient-to-Professional , Infectious Disease Transmission, Professional-to-Patient , Longitudinal Studies , Male , Middle Aged , Multilevel Analysis , Nursing Homes , Real-Time Polymerase Chain Reaction , Young Adult
5.
Euro Surveill ; 20(26)2015 Jul 02.
Article in English | MEDLINE | ID: mdl-26159308

ABSTRACT

In the winter of 2014/15 a novel GII.P17-GII.17 norovirus strain (GII.17 Kawasaki 2014) emerged, as a major cause of gastroenteritis outbreaks in China and Japan. Since their emergence these novel GII.P17-GII.17 viruses have replaced the previously dominant GII.4 genotype Sydney 2012 variant in some areas in Asia but were only detected in a limited number of cases on other continents. This perspective provides an overview of the available information on GII.17 viruses in order to gain insight in the viral and host characteristics of this norovirus genotype. We further discuss the emergence of this novel GII.P17-GII.17 norovirus in context of current knowledge on the epidemiology of noroviruses. It remains to be seen if the currently dominant norovirus strain GII.4 Sydney 2012 will be replaced in other parts of the world. Nevertheless, the public health community and surveillance systems need to be prepared in case of a potential increase of norovirus activity in the next seasons caused by this novel GII.P17-GII.17 norovirus.


Subject(s)
Caliciviridae Infections/virology , Communicable Diseases, Emerging/virology , Disease Outbreaks , Gastroenteritis/virology , Genetic Variation , Norovirus/classification , Norovirus/genetics , Caliciviridae Infections/epidemiology , China/epidemiology , Communicable Diseases, Emerging/genetics , Female , Gastroenteritis/epidemiology , Genotype , Humans , Molecular Epidemiology , Norovirus/isolation & purification , Phylogeny , Seasons
6.
Euro Surveill ; 20(29): 21192, 2015 Jul 23.
Article in English | MEDLINE | ID: mdl-26227370

ABSTRACT

In May 2013, Italy declared a national outbreak of hepatitis A, which also affected several foreign tourists who had recently visited the country. Molecular investigations identified some cases as infected with an identical strain of hepatitis A virus subgenotype IA. After additional European Union/European Economic Area (EU/EEA) countries reported locally acquired and travel-related cases associated with the same outbreak, an international outbreak investigation team was convened, a European outbreak case definition was issued and harmonisation of the national epidemiological and microbiological investigations was encouraged. From January 2013 to August 2014, 1,589 hepatitis A cases were reported associated with the multistate outbreak; 1,102 (70%) of the cases were hospitalised for a median time of six days; two related deaths were reported. Epidemiological and microbiological investigations implicated mixed frozen berries as the vehicle of infection of the outbreak. In order to control the spread of the outbreak, suspected or contaminated food batches were recalled, the public was recommended to heat-treat berries, and post-exposure prophylaxis of contacts was performed. The outbreak highlighted how large food-borne hepatitis A outbreaks may affect the increasingly susceptible EU/EEA general population and how, with the growing international food trade, frozen berries are a potential high-risk food.


Subject(s)
Disease Outbreaks , Food Contamination , Foodborne Diseases/epidemiology , Fruit/poisoning , Hepatitis A virus/genetics , Hepatitis A/epidemiology , Adolescent , Adult , Child, Preschool , Contact Tracing , Epidemiologic Studies , Europe/epidemiology , European Union , Female , Foodborne Diseases/diagnosis , Foodborne Diseases/virology , Frozen Foods/poisoning , Frozen Foods/virology , Fruit/virology , Hepatitis A/virology , Hepatitis A virus/isolation & purification , Humans , Male , Middle Aged , Surveys and Questionnaires
7.
Euro Surveill ; 19(43)2014 Oct 30.
Article in English | MEDLINE | ID: mdl-25375899

ABSTRACT

An unexpected drop in rotavirus (RV) detections was observed in the Netherlands in 2014, without RV vaccination. The estimated decrease in RV detections and gastroenteritis consultations in under five year-olds, in January-April 2014, compared to the same months in previous years, was 72% and 36%, respectively. The low birth rate, mild winter, high RV incidence in the previous year and the introduction of RV vaccination in neighbouring countries may have contributed to this decrease.


Subject(s)
Referral and Consultation/statistics & numerical data , Rotavirus Infections/epidemiology , Rotavirus/isolation & purification , Child, Preschool , Female , Gastroenteritis/epidemiology , Gastroenteritis/virology , Humans , Incidence , Infant , Male , Netherlands/epidemiology , Rotavirus Infections/diagnosis , Rotavirus Infections/virology , Rotavirus Vaccines , Seasons , Sentinel Surveillance , Vaccination/statistics & numerical data
8.
Epidemiol Infect ; 141(3): 549-55, 2013 Mar.
Article in English | MEDLINE | ID: mdl-22584109

ABSTRACT

Using polymerase chain reaction (PCR) to detect faecal hepatitis A virus (HAV) can be a useful tool for investigating HAV outbreaks, especially in low-endemic countries. We describe the use of faecal HAV PCR as a non-invasive tool for screening. Two Dutch children visiting different daycare centres were diagnosed with hepatitis A in 2011. A systematic contact investigation was started in the daycare centres and relevant contacts were screened. The faecal HAV PCR test was used to screen the children. The employees were screened with a serum IgM. The faecal HAV PCR test proved to be an appropriate tool for screening. The screening of a total of 135 children and employees in the daycare centres resulted in evidence of eight asymptomatic infections and transmission to three related daycare centres. Control measures were taken including immunization. Compared to an epidemiological investigation without screening, 144 extra contacts were vaccinated based on the screening results. This most likely led to improved prevention of expansion of the outbreak.


Subject(s)
Contact Tracing , Disease Outbreaks/prevention & control , Hepatitis A Virus, Human/isolation & purification , Hepatitis A/diagnosis , Hepatitis A/epidemiology , Polymerase Chain Reaction , Adolescent , Adult , Child , Child Day Care Centers , Child, Preschool , Feces/virology , Female , Hepatitis A/virology , Hepatitis A Virus, Human/genetics , Humans , Infant , Male , Mass Screening/methods , Molecular Epidemiology , Molecular Typing , Netherlands/epidemiology , Young Adult
10.
Euro Surveill ; 18(4): 20387, 2013 Jan 24.
Article in English | MEDLINE | ID: mdl-23369392

ABSTRACT

Laboratory-based surveillance, one of the pillars of monitoring infectious disease trends, relies on data produced in clinical and/or public health laboratories. Currently, diagnostic laboratories worldwide submit strains or samples to a relatively small number of reference laboratories for characterisation and typing. However, with the introduction of molecular diagnostic methods and sequencing in most of the larger diagnostic and university hospital centres in high-income countries, the distinction between diagnostic and reference/public health laboratory functions has become less clear-cut. Given these developments, new ways of networking and data sharing are needed. Assuming that clinical and public health laboratories may be able to use the same data for their own purposes when sequence-based testing and typing are used, we explored ways to develop a collaborative approach and a jointly owned database (TYPENED) in the Netherlands. The rationale was that sequence data - whether produced to support clinical care or for surveillance -can be aggregated to meet both needs. Here we describe the development of the TYPENED approach and supporting infrastructure, and the implementation of a pilot laboratory network sharing enterovirus sequences and metadata.


Subject(s)
Databases, Nucleic Acid , Laboratories , Population Surveillance/methods , Public Health , Clinical Laboratory Information Systems , Communicable Disease Control/trends , Communicable Diseases/diagnosis , Communicable Diseases/epidemiology , Cooperative Behavior , Enterovirus/genetics , Humans , Information Dissemination , Molecular Sequence Data , Netherlands , Pilot Projects
11.
Vaccine ; 39(45): 6671-6681, 2021 10 29.
Article in English | MEDLINE | ID: mdl-34635375

ABSTRACT

BACKGROUND: Universal mass vaccination (UMV) against rotavirus has been implemented in many but not all European countries. This study investigated the impact of UMV on rotavirus incidence trends by comparing European countries with UMV: Belgium, England/Wales and Germany versus countries without UMV: Denmark and the Netherlands. METHODS: For this observational retrospective cohort study, time series data (2001-2016) on rotavirus detections, meteorological factors and population demographics were collected. For each country, several meteorological and population factors were investigated as possible predictors of rotavirus incidence. The final set of predictors were incorporated in negative binomial models accounting for seasonality and serial autocorrelation, and time-varying incidence rate ratios (IRR) were calculated for each age group and country separately. The overall vaccination impact two years after vaccine implementation was estimated by pooling the results using a random effects meta-analyses. Independent t-tests were used to compare annual epidemics in the pre-vaccination and post-vaccination era to explore any changes in the timing of rotavirus epidemics. RESULTS: The population size and several meteorological factors were predictors for the rotavirus epidemiology. Overall, we estimated a 42% (95%-CI 23;56%) reduction in rotavirus incidence attributable to UMV. Strongest reductions were observed for age-groups 0-, 1- and 2-years (IRR 0.47, 0.48 and 0.63, respectively). No herd effect induced by UMV in neighbouring countries was observed. In all UMV countries, the start and/or stop and corresponding peak of the rotavirus season was delayed by 4-7 weeks. CONCLUSIONS: The introduction of rotavirus UMV resulted in an overall reduction of 42% in rotavirus incidence in Western European countries two years after vaccine introduction and caused a change in seasonal pattern. No herd effect induced by UMV neighbouring countries was observed for Denmark and the Netherlands.


Subject(s)
Gastroenteritis , Rotavirus Infections , Rotavirus Vaccines , Rotavirus , Europe/epidemiology , Hospitalization , Humans , Infant , Infant, Newborn , Retrospective Studies , Rotavirus Infections/epidemiology , Rotavirus Infections/prevention & control , Vaccination
12.
Euro Surveill ; 15(11)2010 Mar 18.
Article in English | MEDLINE | ID: mdl-20338146

ABSTRACT

As of 1 March 2010, a total of 11 primary cases with onset of symptoms between 31 December 2009 and 10 February 2010, have been identified with identical hepatitis A genotype IB strains in the Netherlands. A relation with Australian and French foodborne outbreaks occurring in 2009 and 2010 is suspected. Ten of the 11 primary cases indicated that they had consumed one or more products containing semi-dried tomatoes during their incubation period.


Subject(s)
Food Contamination/analysis , Foodborne Diseases/epidemiology , Hepatitis A virus/isolation & purification , Hepatitis A/epidemiology , Hepatitis A/etiology , Adult , Disease Notification , Female , Genotype , Hepatitis A virus/genetics , Humans , Male , Middle Aged , Netherlands/epidemiology , Population Surveillance , Young Adult
13.
Euro Surveill ; 15(20)2010 May 20.
Article in English | MEDLINE | ID: mdl-20504389

ABSTRACT

Between 31 December 2009 and 10 February 2010, 13 patients were infected by an identical hepatitis A virus strain not previously detected in the Netherlands. They had not been abroad and were widely distributed over the Netherlands. A case-control study including 12 cases and 44 controls identified semi-dried tomatoes in oil as the source of the outbreak (odds ratio: 20.0; 95% confidence interval: 1.5-274). The virus was not detected in any of 81 tested food samples. International trace-back is still ongoing.


Subject(s)
Food Contamination/analysis , Hepatitis A virus/isolation & purification , Hepatitis A/epidemiology , Solanum lycopersicum/microbiology , Adult , Case-Control Studies , Disease Outbreaks , Female , Hepatitis A/etiology , Humans , Male , Middle Aged , Netherlands/epidemiology , Surveys and Questionnaires , Young Adult
14.
J Clin Virol ; 131: 104610, 2020 10.
Article in English | MEDLINE | ID: mdl-32871544

ABSTRACT

BACKGROUND: We describe a patient who was planned to receive a kidney transplant from his wife. Both were infected with Hepatitis A virus (HAV) two weeks prior to the planned transplantation. Due to prolonged shedding of HAV (up until 126 days) we decided to postpone the kidney transplant in order to prevent long term complications. OBJECTIVES: The main question in this case was is there a higher risk of a complicated course of HAV-infection after kidney transplantation? We discuss the need for upscale of preventative measures of HAV infections in solid organ transplant candidates. STUDY DESIGN: We performed a literature study on risks of a complicated course of HAV in solid organ transplant recipients and performed a seroprevalence study on anti-HAV in a cohort of 106 hemodialysis patients. RESULTS: Little is known whether HAV infection in solid organ transplant patients causes a more aggressive course of diseases. However, HAV infections in these populations are associated with increased risk of liver failure. CONCLUSIONS: This case highlights the need of scaling up preventative measures against HAV infections in solid organ transplant candidates.


Subject(s)
Hepatitis A/complications , Kidney Transplantation , Hepatitis A/virology , Hepatitis A virus/immunology , Hepatitis A virus/isolation & purification , Humans , Renal Dialysis/statistics & numerical data , Risk Factors , Seroepidemiologic Studies , Time-to-Treatment , Transplant Recipients , Virus Shedding
15.
J Virol ; 82(12): 6078-83, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18400867

ABSTRACT

A longstanding enigmatic feature of the group 1 coronaviruses is the uncleaved phenotype of their spike protein, an exceptional property among class I fusion proteins. Here, however, we show that some group 1 coronavirus spike proteins carry a furin enzyme recognition motif and can actually be cleaved, as demonstrated for a feline coronavirus. Interestingly, this feature can be lost during cell culture adaptation by a single mutation in the cleavage motif; this, however, preserves a heparan sulfate binding motif and renders infection by the virus heparan sulfate dependent. We identified a similar cell culture adaptation for the human coronavirus OC43.


Subject(s)
Adaptation, Physiological , Furin/physiology , Heparitin Sulfate/metabolism , Membrane Glycoproteins/metabolism , Viral Envelope Proteins/metabolism , Amino Acid Sequence , Animals , Cats , Cell Line , Humans , Membrane Glycoproteins/chemistry , Molecular Sequence Data , Spike Glycoprotein, Coronavirus , Viral Envelope Proteins/chemistry
16.
J Hosp Infect ; 71(3): 199-205, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19147255

ABSTRACT

We report a retrospective analysis of norovirus (NoV) infections occurring in patients of a tertiary care hospital during five winter seasons (2002/03 to 2006/07). Data were compared with national surveillance data and with corresponding data for rotavirus. Between July 2002 and June 2007, faecal specimens from 221 (9.0%) of 2458 hospital patients with diarrhoea tested positive for NoV. The incidence in children varied from 2.52 per 1000 admissions in 2004/05 (when testing began to be performed routinely) to 11.9 per 1000 admissions in 2006/07, while the incidence in adults remained stable (mean: 1.49 per 1000 admissions). Two genotypes predominated during the study period: GIIb strains occurred mainly in children below the age of two-and-a-half years [odds ratio (OR): 14.7; P<0.0001] whereas GII.4 strains affected all age groups. Compared with rotavirus infections, NoV infections in children were more often hospital-acquired (59% vs 39%, OR: 2.29; P<0.01). Among these cases we identified 22 clusters of NoV infection among inpatients. Twelve of 53 patients from whom follow-up samples were available demonstrated long-term virus shedding. We report a dynamic pattern of sporadic NoV infections in large hospitals, with frequent nosocomial transmission and with the predominance of GIIb-related strains in children. Effective prevention strategies are required to reduce the impact of sporadic NoV infection in vulnerable patients.


Subject(s)
Caliciviridae Infections/epidemiology , Cross Infection/epidemiology , Disease Outbreaks , Gastroenteritis/epidemiology , Norovirus/isolation & purification , Adolescent , Age Distribution , Caliciviridae Infections/genetics , Caliciviridae Infections/transmission , Child , Child, Preschool , Cross Infection/transmission , Cross Infection/virology , Gastroenteritis/virology , Genotype , Humans , Incidence , Infant , Infant, Newborn , Longitudinal Studies , Netherlands/epidemiology , Norovirus/genetics , Retrospective Studies , Young Adult
17.
Epidemiol Infect ; 137(12): 1722-33, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19426572

ABSTRACT

Effective infection control measures during norovirus outbreaks are urgently needed in places where vulnerable individuals gather. In the present study, the effect of a number of measures was investigated in daily practice. Forty-nine Dutch nursing homes were monitored prospectively for norovirus outbreaks during two winter seasons. A total of 37 norovirus outbreaks were registered. Control measures were most effective when implemented within 3 days after onset of disease of the first patient. Measures targeted at reduced transmission between persons, via aerosols, and via contaminated surfaces reduced illness in staff and in residents. Reducing illness in staff results in fewer costs for sick leave and substitution of staff and less disruption in the care of residents. The effect of control measures on outbreak duration was limited. This is the first intervention study examining the effect of control measures. Further research is needed to extend and refine the conclusions.


Subject(s)
Caliciviridae Infections/epidemiology , Infection Control/methods , Infection Control/organization & administration , Norovirus , Nursing Homes , Disease Outbreaks/prevention & control , Health Personnel , Humans , Seasons , Visitors to Patients
18.
Euro Surveill ; 14(3)2009 Jan 22.
Article in English | MEDLINE | ID: mdl-19161728

ABSTRACT

An outbreak of hepatitis A has been ongoing in Latvia with 2,817 confirmed cases reported between 20 November 2007 and 31 December 2008. Initially the spread of infection was due to transmission among drug users and other high-risk groups, as well as several outbreaks in Riga (affecting a school and a restaurant), but in the second half of the year led to a community-wide increase in the number of cases. Molecular analysis of 100 strains showed that 95 belonged to genotype IA, of which 89 were identical and six were single nucleotide variants of the same sequence.


Subject(s)
Disease Outbreaks/statistics & numerical data , Hepatitis A/epidemiology , Population Surveillance , Risk Assessment/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Incidence , Infant , Latvia/epidemiology , Male , Middle Aged , Risk Factors , Young Adult
19.
Clin Microbiol Infect ; 25(8): 1039.e7-1039.e13, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30553029

ABSTRACT

OBJECTIVES: This study aimed to (i) determine risk factors for enteropathogen co-infections, (ii) determine whether enteropathogen co-infections influence gastroenteritis risk, and (iii) determine whether enteropathogen co-infection occurred randomly in preschool children. METHODS: A monthly-repeated cross-sectional survey in Dutch children aged 0-48 months was conducted during October 2012 to October 2014. A total of 981 stool samples were collected along with questionnaires collecting data on gastrointestinal symptoms and potential risk factors; 822 samples were successfully tested for 19 enteropathogens using real-time multiplex PCRs. Logistic regression analysis assessed co-infections in relation to gastroenteritis and potential risk factors. RESULTS: In all, 598/822 (72.7%) stool samples tested positive for at least one enteropathogen, of which 290 (48.5%) were positive for two or more enteropathogens. Risk factors for two or more enteropathogen co-infections were young age (<12 months, OR 1.9, 95% CI 1.1-3.3; 13-36 months, OR 1.7, 95% CI 1.1-2.5, versus 37-48 months), day-care attendance (OR 1.8, 95% CI 1.3-2.5), households with three or more children versus those with one child (OR 1.7, 95% CI 1.1-2.8). Stool samples collected in spring less often had two or more enteropathogens versus summer (OR 0.4, 95% CI 0.2-0.7). Food allergy was a risk factor for three or more enteropathogen co-infections (OR 3.2, 95% CI 1.1-8.9). The frequency of co-infection was higher than expected for norovirus GI/norovirus GII, Clostridium difficile/norovirus GI, C. difficile/rotavirus, astrovirus/Dientamoeba fragilis, atypical enteropathogenic Escherichia coli/adenovirus, typical enteropathogenic E. coli/adenovirus, and enteroaggregative E. coli/astrovirus. No co-infection was associated with increased gastroenteritis risk. CONCLUSIONS: Risk factors for enteropathogen co-infections were identified and specific enteropathogens co-occurred significantly more often than expected by chance. Enteropathogen co-infections were not associated with increased gastroenteritis risk, calling into question their clinical relevance in preschool children.


Subject(s)
Coinfection/epidemiology , Gastroenteritis/epidemiology , Child, Preschool , Cross-Sectional Studies , Dientamoebiasis/epidemiology , Enteropathogenic Escherichia coli , Escherichia coli Infections/epidemiology , Family Characteristics , Feces/microbiology , Feces/parasitology , Feces/virology , Female , Gastroenteritis/microbiology , Gastroenteritis/parasitology , Gastroenteritis/virology , Humans , Infant , Infant, Newborn , Male , Netherlands/epidemiology , Risk Factors , Rotavirus Infections/epidemiology
20.
J Clin Microbiol ; 46(9): 2959-65, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18650354

ABSTRACT

The Foodborne Viruses in Europe network has developed integrated epidemiological and virological outbreak reporting with aggregation and sharing of data through a joint database. We analyzed data from reported outbreaks of norovirus (NoV)-caused gastroenteritis from 13 European countries (July 2001 to July 2006) for trends in time and indications of different epidemiology of genotypes and variants. Of the 13 countries participating in this surveillance network, 11 were capable of collecting integrated epidemiological and virological surveillance data and 10 countries reported outbreaks throughout the entire period. Large differences in the numbers and rates of reported outbreaks per country were observed, reflecting the differences in the focus and coverage of national surveillance systems. GII.4 strains predominated throughout the 5-year surveillance period, but the proportion of outbreaks associated with GII.4 rose remarkably during years in which NoV activity was particularly high. Spring and summer peaks indicated the emergence of genetically distinct variants within GII.4 across Europe and were followed by increased NoV activity during the 2002-2003 and 2004-2005 winter seasons. GII.4 viruses predominated in health care settings and in person-to-person transmission. The consecutive emergence of new GII.4 variants is highly indicative of immune-driven selection. Their predominance in health care settings suggests properties that facilitate transmission in settings with a high concentration of people such as higher virus loads in excreta or a higher incidence of vomiting. Understanding the mechanisms driving the changes in epidemiology and clinical impact of these rapidly evolving RNA viruses is essential to design effective intervention and prevention measures.


Subject(s)
Caliciviridae Infections/epidemiology , Disease Outbreaks , Foodborne Diseases/epidemiology , Gastroenteritis/epidemiology , Norovirus , Caliciviridae Infections/transmission , Caliciviridae Infections/virology , Disease Notification , Europe/epidemiology , Foodborne Diseases/virology , Gastroenteritis/virology , Genotype , Humans , Multivariate Analysis , Norovirus/genetics
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