Rabid puppy-dog imported into the Netherlands from Morocco via Spain, February 2012.

In February 2012 a rabid puppy dog was imported into Amsterdam, the Netherlands from Morocco via Spain. In a joint action between the Netherlands' Food and Consumer Product Safety Authority, the Public Health Service of Amsterdam and the Centre for Infectious Disease Control all exposed human and animal contacts were traced and, when necessary, provided with post-exposure prophylaxis. During the importation, the international legislations with respect to vaccination requirements were not fully obeyed by veterinarians and custom services.

Impact of the 2009 influenza A(H1N1) pandemic on public health workers in the Netherlands.

A cross-sectional study was undertaken to analyse the impact of the 2009 influenza A(H1N1) pandemic on frontline public health workers in the Netherlands and to consider its implications for future pandemics. A structured, self-administered questionnaire was made available online (26 March to 26 May 2010) for frontline public health workers employed by the communicable disease departments of the public health services in the Netherlands (n=302). A total of 166 questionnaires (55%) were completed. The majority of respondents reported an increased workload, perceived as too busy (117 respondents, 70.5%) or extreme (13 respondents, 7.8%). Most respondents were not anxious about becoming infected (only seven were regularly concerned). The overall compliance with the control measures was good. The case definition was strictly applied by 110 of the 166 respondents (66%); 56 of 141 (39.7%) consistently consulted the Preparedness and Response Unit within a centralised assessment system, while 68 of 141 (48.2%) consulted the unit only at the beginning of the pandemic. Of 145 respondents with available data, 128 (88.3%) always used personal protective equipment. Reported adherence to the advice to discuss the various isolation measures with patients and their contacts was between 71% and 98.7%. Our study shows that the surveyed frontline public health workers considered the workload to be high during the first 3.5 months of the pandemic and their level of anxiety about becoming infected was reported to be low. During the pandemic, these workers were able to accommodate what they considered to be an excessive workload, even though initially their assignments were unfamiliar to them.

Surveillance of hospitalisations for 2009 pandemic influenza A(H1N1) in the Netherlands, 5 June - 31 December 2009.

We analysed and reported on a weekly basis clinical and epidemiological characteristics of patients hospitalised in the Netherlands for the 2009 pandemic influenza A(H1N1) using information from the national mandatory notification system. The notification criteria changed on 15 August 2009 from all possible, probable and confirmed cases to only laboratory-confirmed pandemic influenza hospitalisations and deaths. In the period of comprehensive case-based surveillance (until 15 August), 2% (35/1,622) of the patients with pandemic influenza were hospitalised. From 5 June to 31 December 2009, a total of 2,181 patients were hospitalised. Of these, 10% (219/2,181) were admitted to an intensive care unit (ICU) and 53 died. Among non-ICU hospitalised patients, 56% (961/1,722) had an underlying medical condition compared with 70% (147/211) of the patients in ICU and 46 of the 51 fatal cases for whom this information was reported. Most common complications were dehydration among non-ICU hospitalised patients and acute respiratory distress syndrome among patients in ICU and patients who died. Children under the age of five years had the highest age-specific hospitalisation rate (62.7/100,000), but relatively few were admitted to an ICU (1.7/100,000). Characteristics and admission rates of hospitalised patients were comparable with reports from other countries and previous influenza seasons. The national notification system was well suited to provide weekly updates of relevant monitoring information on the severity of the pandemic for professionals, decision makers, the media and the public, and could be rapidly adapted to changing information requirements.

A prolonged outbreak of Salmonella Typhimurium infection related to an uncommon vehicle: hard cheese made from raw milk.

In 2006, in The Netherlands, an outbreak of Salmonella Typhimurium phage type 561 (STM DT7, corresponding to the rare DT7 in the international typing scheme) was detected, accumulating to over 200 cases. By telephone interviews, data were collected from all laboratory-confirmed cases. In addition, in August 2006, a case-control study was performed in a subset of cases. Environmental and microbiological investigation was performed on a suspected dairy farm. In the case-control study (51 cases, 105 matched controls), hard cheese purchased from a farm, specifically farm X, and from a market stall were found to be associated with infection. The dairy production room of farm X tested STM DT7-positive in August. However, it was only in November, after earlier unsuccessful attempts, that a low-level contamination was confirmed in the hard farmhouse cheese, triggering control measures. A timely and adequate response was hampered during this outbreak for several reasons. Measures for improvement in handling future similar incidents are discussed.

Import of norovirus infections in the Netherlands and Ireland following pilgrimages to Lourdes, 2008--preliminary report.

Between mid-September and 19 October 2008, nine clusters of norovirus infection involving around 90 primary cases and over a hundred secondary cases were identified in patients from the Netherlands, Ireland, Italy and France, linked to pilgrimage to Lourdes, France.