RESUMEN
OBJECTIVES: Since few pandemics have occurred since the Spanish influenza pandemic, we should learn from every (mild) pandemic that occurs. The objective of this study was to report on general practitioners' and practice assistants' acceptance of the chosen national policy, and experiences in the Netherlands during the influenza A(H1N1)pdm09 pandemic. METHODS: Data on experience and acceptance of the chosen national policy were obtained by structured questionnaires for general practitioners (n = 372) and practice assistants (n = 503) in April 2010. RESULTS: The primary policy chosen for general practice was not always accepted and complied with by general practitioners, although the communication (of changes) and collaboration with involved organisations were rated as positive. In particular, the advised personal protective measures were difficult to implement in daily work and thus not executed by 44% of general practitioners. Half of the general practitioners were not satisfied with the patient information provided by the government. The influenza A(H1N1) pandemic highly impacted on general practitioners' and practice assistants' workloads, which was not always deemed to be adequately compensated. DISCUSSION: Involvement of general practitioners in future infectious disease outbreaks is essential. This study addresses issues in the pandemic policy which might be critical in a more severe pandemic.
Asunto(s)
Médicos Generales/psicología , Gripe Humana/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Vacunación/legislación & jurisprudencia , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Médicos Generales/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Encuestas y Cuestionarios , Vacunación/estadística & datos numéricosRESUMEN
BACKGROUND: In 2011, a unique Q fever vaccination campaign targeted people at risk for chronic Q fever in the southeast of the Netherlands. General practitioners referred patients with defined cardiovascular risk-conditions (age >15 years). Prevalence rates of those risk-conditions were lacking, standing in the way of adequate planning and coverage estimation. We aimed to obtain prevalence rates retrospectively in order to estimate coverage of the Q fever vaccination campaign. METHODS: With broad search terms for these predefined risk-conditions, we extracted patient-records from a large longitudinal general-practice research-database in the Netherlands (IPCI-database). After validation of these records, obtained prevalence rates (stratified for age and sex) extrapolated to the Q fever high-incidence area population, gave an approximation of the size of the targeted patient-group. Coverage calculation addressed people actually screened by a pre-vaccination Q fever skin test and serology (coverage) and patients referred by their general practitioners (adjusted-coverage) in the 2011 campaign. RESULTS: Our prevalence estimate of any risk-condition was 3.1% (lower-upper limits 2.9-3.3%). For heart valve defects, aorta aneurysm/prosthesis, congenital anomalies and endocarditis, prevalence was 2.4%, 0.6%, 0.4% and 0.1%, respectively. Estimated number of eligible people in the Q fever high-incidence area was 11,724 (10,965-12,532). With 1330 people screened for vaccination, coverage of the vaccination campaign was 11%. For referred people, the adjusted coverage was 18%. Coverage was lowest among the very-old and highest for people aged 50-70 years. CONCLUSION: The estimated coverage of the vaccination campaign was limited. This should be interpreted in the light of the complexity of this target-group with much co-morbidity, and of the vaccine that required invasive pre-vaccination screening. Calculation of prevalence rates of risk-conditions based on the IPCI-database was feasible. This procedure proved an efficient tool for future use, when prevalence estimates for policy, implementation or surveillance of subgroup-vaccination or other health-care interventions are needed.
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Fiebre Q/epidemiología , Fiebre Q/prevención & control , Vacunación , Adulto , Bases de Datos Factuales , Femenino , Geografía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Vigilancia de la Población , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
BACKGROUND: Between 2007 and 2011 the Netherlands was faced with an unprecedented Q fever outbreak with more than 4000 people affected. Dairy goats were considered the main source of infection. In addition to taking veterinary measures, the Dutch government offered an unlicensed vaccine against the causative bacterium Coxiella burnetii to patient groups at high-risk of Q fever complications. This article describes the complexity of the vaccination program for Q fever in 2010-2011. METHODS: High-risk patients were selected and referred mainly by their general practitioner to a publicly funded centralized screening and vaccination program. In addition, cardiovascular specialists and the public were informed. Patients were screened for previous infection with C. burnetii by serology and skin-tests. Patients who tested positive were excluded from vaccination. RESULTS: Of the 2741 referred high-risk patients (1669 male, 1957 from the high-risk area), 955 were excluded because vaccination was considered unnecessary or the distance to the vaccination clinic too far. 388 (22% of those screened) were excluded because of a positive skin-test or serology. 1368 patients (77% of those screened) were vaccinated between January and June 2011. Two-thirds of the vaccinees reported an adverse event. 89 patients (6.6%) reported serious adverse events. In just one patient, with an injection site reaction, a possible causal relationship was considered. CONCLUSION: This Q fever vaccination program posed challenges to the Dutch Health Care system. Creating clarity on the roles and responsibilities of those involved precluded timely vaccination. Targeting the high-risk population through GPs was challenging but appeared to be efficient. The vaccination was considered to be safe and compliance of the screened patients was high.
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Vacunas Bacterianas/administración & dosificación , Coxiella burnetii/inmunología , Enfermedades de las Cabras/epidemiología , Vacunación Masiva/organización & administración , Fiebre Q/epidemiología , Fiebre Q/prevención & control , Animales , Vacunas Bacterianas/inmunología , Brotes de Enfermedades , Enfermedades Endémicas , Femenino , Enfermedades de las Cabras/microbiología , Cabras , Humanos , Masculino , Vacunación Masiva/métodos , Persona de Mediana Edad , Países Bajos/epidemiología , Fiebre Q/inmunología , Fiebre Q/veterinaria , Factores de Riesgo , Zoonosis/epidemiología , Zoonosis/inmunología , Zoonosis/prevención & controlRESUMEN
The emergence of Schmallenberg virus (SBV), a novel orthobunyavirus, in ruminants in Europe triggered a joint veterinary and public health response to address the possible consequences to human health. Use of a risk profiling algorithm enabled the conclusion that the risk for zoonotic transmission of SBV could not be excluded completely. Self-reported health problems were monitored, and a serologic study was initiated among persons living and/or working on SBV-affected farms. In the study set-up, we addressed the vector and direct transmission routes for putative zoonotic transfer. In total, 69 sheep farms, 4 goat farms, and 50 cattle farms were included. No evidence for SBV-neutralizing antibodies was found in serum of 301 participants. The lack of evidence for zoonotic transmission from either syndromic illness monitoring or serologic testing of presumably highly exposed persons suggests that the public health risk for SBV, given the current situation, is absent or extremely low.
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Infecciones por Bunyaviridae/transmisión , Enfermedades Transmisibles Emergentes/transmisión , Orthobunyavirus/aislamiento & purificación , Zoonosis/transmisión , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Infecciones por Bunyaviridae/epidemiología , Infecciones por Bunyaviridae/veterinaria , Bovinos , Enfermedades de los Bovinos/epidemiología , Enfermedades de los Bovinos/transmisión , Enfermedades Transmisibles Emergentes/epidemiología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Orthobunyavirus/clasificación , Vigilancia de la Población , Riesgo , Rumiantes , Estudios Seroepidemiológicos , Adulto Joven , Zoonosis/epidemiologíaRESUMEN
BACKGROUND: To guide policy and control measures, decent scientific data are needed for a comprehensive assessment of epidemiological, clinical and virological characteristics of the First Few hundred (FF100) cases. We discuss the feasibility of the FF100 approach during the 2009 pandemic and the added value compared with alternative data sources available. METHODS: The pandemic preparedness plan enabled us to perform a case-control study, assessing patient characteristics and risk factors for experiencing symptomatic influenza A(H1N1)2009 infection and providing insight into transmission. We assessed to what extent timely and novel data were generated compared to other available data sources. RESULTS: In May-December 2009, a total of 68 cases and 48 controls were included in the study. Underlying non-respiratory diseases were significantly more common among cases compared to controls, while a protective effect was found for frequent hand washing. Seroconversion was found for 7/30 controls (23%), and persisting high titers for 4/30 controls (13%). The labour-intensive study design resulted in slow and restricted recruitment. CONCLUSIONS: The findings of our case-control study gave new insights in transmission risks and possible interventions for improved control. Nevertheless, the FF100 approach lacked timeliness and power due to limited recruitment. For future pandemics we suggest pooling data from several countries, to enable collecting sufficient data in a relatively short period.
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After an imported case of Marburg hemorrhagic fever was reported in 2008 in the Netherlands, control measures to prevent transmission were implemented. To evaluate consequences of these measures, we administered a structured questionnaire to 130 contacts classified as either having high-risk or low-risk exposure to body fluids of the case-patient; 77 (59.2%) of 130 contacts responded. A total of 67 (87.0%) of 77 respondents agreed that temperature monitoring and reporting was necessary, significantly more often among high-risk than low-risk contacts (p<0.001). Strict compliance with daily temperature monitoring decreased from 80.5% (62/77) during week 1 to 66.2% (51/77) during week 3. Contacts expressed concern about development of Marburg hemorrhagic fever (58.4%, 45/77) and infecting a family member (40.2%, 31/77). High-risk contacts had significantly higher scores on psychological impact scales (p<0.001) during and after the monitoring period. Public health authorities should specifically address consequences of control measures on the daily life of contacts.
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Trazado de Contacto , Personal de Salud/psicología , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Enfermedad del Virus de Marburg/prevención & control , Enfermedad del Virus de Marburg/transmisión , Adulto , Anciano , Animales , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Exposición Profesional , Estudios Retrospectivos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
The clinical dynamics of influenza A(H1N1) 2009 infections in 61 laboratory-confirmed Dutch cases were examined. An episode lasted a median of 7·5 days of which 2 days included fever. Respiratory symptoms resolved slowly, while systemic symptoms peaked early in the episode and disappeared quickly. Severity of each symptom was rated highest in the first few days. Furthermore, diarrhoea was negatively associated with viral load, but not with faecal excretion of influenza virus. Cases with comorbidities appeared to have higher viral loads than the cases without, suggesting a less effective immune response. These results complement information obtained through traditional surveillance.
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Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Diarrea/etiología , Diarrea/virología , Brotes de Enfermedades , Femenino , Humanos , Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H1N1 del Virus de la Influenza A/fisiología , Gripe Humana/complicaciones , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pandemias , Carga Viral , Adulto JovenRESUMEN
BACKGROUND: In contrast to seasonal influenza epidemics, where the majority of deaths occur amongst elderly, a considerable part of the 2009 pandemic influenza related deaths concerned relatively young people. In the Netherlands, all deaths associated with laboratory-confirmed influenza A(H1N1) 2009 virus infection had to be notified, both during the 2009-2010 pandemic season and the 2010-2011 influenza season. To assess whether and to what extent pandemic mortality patterns were reverting back to seasonal patterns, a retrospective analyses of all notified fatal cases associated with laboratory-confirmed influenza A(H1N1) 2009 virus infection was performed. METHODS: The notification database, including detailed information about the clinical characteristics of all notified deaths, was used to perform a comprehensive analysis of all deceased patients with a laboratory-confirmed influenza A(H1N1) 2009 virus infection. Characteristics of the fatalities with respect to age and underlying medical conditions were analysed, comparing the 2009-2010 pandemic and the 2010-2011 influenza season. RESULTS: A total of 65 fatalities with a laboratory-confirmed influenza A(H1N1) 2009 virus infection were notified in 2009-2010 and 38 in 2010-2011. During the pandemic season, the population mortality rates peaked in persons aged 0-15 and 55-64 years. In the 2010-2011 influenza season, peaks in mortality were seen in persons aged 0-15 and 75-84 years. During the 2010-2011 influenza season, the height of first peak was lower compared to that during the pandemic season. Underlying immunological disorders were more common in the pandemic season compared to the 2010-2011 season (p = 0.02), and cardiovascular disorders were more common in the 2010-2011 season (p = 0.005). CONCLUSIONS: The mortality pattern in the 2010-2011 influenza season still resembled the 2009-2010 pandemic season with a peak in relatively young age groups, but concurrently a clear shift toward seasonal patterns was seen, with a peak in mortality in the elderly, i.e. ≥ 75 years of age.
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Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/mortalidad , Adolescente , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Brotes de Enfermedades , Humanos , Lactante , Recién Nacido , Gripe Humana/virología , Persona de Mediana Edad , Países Bajos/epidemiología , Estudios Retrospectivos , Estaciones del AñoRESUMEN
Enhanced surveillance of infections due to the pandemic A(H1N1) influenza virus, which included monitoring for antiviral resistance, was carried out in the Netherlands from late April 2009 through late May 2010. More than 1100 instances of infection with the pandemic A(H1N1) influenza virus from 2009 and 2010 [A(H1N1) 2009] distributed across this period were analyzed. Of these, 19 cases of oseltamivir-resistant virus harboring the H275Y mutation in the neuraminidase (NA) were detected. The mean 50% inhibitory concentration (IC50) levels for oseltamivir- and zanamivir-susceptible A(H1N1) 2009 viruses were 1.4-fold and 2-fold, respectively, lower than for the seasonal A(H1N1) influenza viruses from 2007/2008; for oseltamivir-resistant A(H1N1) 2009 virus the IC50 was 2.9-fold lower. Eighteen of the 19 patients with oseltamivir-resistant virus showed prolonged shedding of the virus and developed resistance while on oseltamivir therapy. Sixteen of these 18 patients had an immunodeficiency, of whom 11 had a hematologic disorder. The two other patients had another underlying disease. Six of the patients who had an underlying disease died; of these, five had received cytostatic or immunosuppressive therapy. No indications for onward transmission of resistant viruses were found. This study showed that the main association for the emergence of cases of oseltamivir-resistant A(H1N1) 2009 virus was receiving antiviral therapy and having drug-induced immunosuppression or an hematologic disorder. Except for a single case of a resistant virus not linked to oseltamivir therapy, the absence of detection of resistant variants in community specimens and in specimens from contacts of cases with resistant virus suggested that the spread of resistant A(H1N1) 2009 virus was limited. Containment may have been the cumulative result of impaired NA function, successful isolation of the patients, and prophylactic measures to limit exposure.
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Farmacorresistencia Viral , Subtipo H1N1 del Virus de la Influenza A/efectos de los fármacos , Gripe Humana/tratamiento farmacológico , Gripe Humana/epidemiología , Oseltamivir/uso terapéutico , Pandemias , Adolescente , Adulto , Anciano , Animales , Línea Celular , Niño , Preescolar , Femenino , Humanos , Lactante , Subtipo H1N1 del Virus de la Influenza A/clasificación , Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H1N1 del Virus de la Influenza A/fisiología , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Mutación , Países Bajos/epidemiología , Neuraminidasa/genética , Neuraminidasa/metabolismo , Filogenia , Vigilancia de Guardia , Proteínas Virales/genética , Proteínas Virales/metabolismo , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the long-term protection following hepatitis B vaccination and assess whether revaccination is necessary after 15 years for those who have an increased occupational risk of hepatitis B infection. DESIGN: Systematic literature review METHOD: Medline was searched for English language publications from the period 2002-2008 concerning vaccination against the hepatitis B virus. We included follow-up studies in which the interval between vaccination and titre measurement was at least 4 years. RESULTS: The 22 articles included describe 30 studies. Post-vaccination titre measurement was performed in 10 studies. Four of these described a change from negative to positive testing for anti-hepatitis B core antigen (anti-HBc) (seroconversion) in 0.64% of the 1,880 subjects tested. In the 20 studies in which no post-vaccination titre measurement was carried out, seroconversion was observed for anti-HBc and for hepatitis B surface antigens (HBsAg) in 1.0% and 1.78% of the vaccinees, respectively. These studies were predominantly carried out in high-endemic regions, mostly in newborns of HBsAg positive mothers. Seroconversions were not accompanied by clinical signs or symptoms. In 6 studies there was a follow-up of more than 15 years; the maximum was 23 years. Seroconversions did not appear specifically after a long period of time but were observed independent of time after vaccination. CONCLUSION: Seroconversions occur in < 1% of successfully vaccinated subjects and do not increase after a period of 15 years following vaccination. In all the 23 years of experience with hepatitis B vaccination, it seems to have provided protection. This also applies to those at increased risk. Revaccination after successful vaccination would therefore not seem to be necessary, even after a period of 15 years.