[A midwife involved in patients with puerperal fever in three different hospitals]. / Een verloskundige betrokken bij patiënten met kraamvrouwenkoorts in drie verschillende ziekenhuizen.

In three hospitals three women aged 34, 33 and 25 years respectively, developed fever following delivery; in two of them a beta-haemolytic streptococcus of Lancefield group A (GAS) was cultured. Between the time of transmission of the infective agent of the first and the third patients there was a period of ten days. Because the intervals between the emergence of cases were relatively long, the suspicion of a common vector, i.e. the midwife, was raised only after some time. The midwife who had been present at all three deliveries turned out to be negative for GAS carriership on three occasions. However, cultures taken from her son and partner were positive for GAS carriership. A number of typing systems were unable to distinguish the GAS-isolates from the first two patients and from the son. After the midwife and her family members had been treated, no new cases occurred. This case illustrates the importance of keeping midwives as well as the department of public health informed of a rise in the number of cases of puerperal fever, whether the cases involve more than one hospital or not, in order to prevent a potential epidemic. Only then can a common source be looked for and the epidemic contained.

[Typhoid fever in Amsterdam, 1991-2000, and the simplification of the national protocol for source and contact tracing]. / Buiktyfus in Amsterdam, 1991-2000, en vereenvoudiging van het landelijk protocol voor bron- en contactopsporing.

OBJECTIVE: To determine the incidence of patients reported with typhoid fever in Amsterdam (1991-2000) and to evaluate the contact tracing for those patients with the specific objective of examining whether contact tracing can be simplified. DESIGN: Retrospective. METHOD: From an automated database, data were collected on all reported typhoid fever patients in Amsterdam during the period 1991-2000 and on their contact persons. RESULTS: One hundred and one patients with typhoid fever were reported during the study period, and Salmonella typhi infection was diagnosed in 12 of the 281 household contacts. For 96 of the 101 index patients, travelling abroad was the most likely source of infection. In 8 of the 12 contact persons with an S. typhi infection, the index person was the most likely source of infection, which is equivalent to a secondary transmission rate of 2.8% (8/277). Seven of the 8 secondary infected persons had symptoms indicative of typhoid fever infection and S. typhi was found in all their first stool samples. CONCLUSION: Supported by these results, the national guidelines for source and contact tracing in the case of typhoid fever have been amended. In the case of index patients with bad toilet hygiene or who are responsible for food preparation, the faeces of all household contacts must be examined once. If the contact persons have symptoms indicative of an S. typhi infection and/or if their work involves food preparation, their faeces should also be tested once. The changes to the national protocol will markedly reduce the labour-intensity of tracing and testing the contacts of patients with typhoid fever, thereby maintaining the quality of the process. Tracing the source of infection in the case of patients with typhoid fever will also remain important in the future in order to detect potential transmission within the Netherlands at an early stage.

[An outbreak of vomiting and diarrhea in a nursing home caused by the Norwalk-like virus: implications of the Dutch law on infectious diseases and new diagnostic options]. / Een uitbraak van braken en diarree in een verpleeghuis, veroorzaakt door het Norwalk-achtig virus, in het licht van de infectieziektenwet en nieuwe diagnostische mogelijkheden.

Several residents on a psychogeriatric ward developed vomiting and diarrhoea within a short time of each other. The causal factor was the highly contagious Norwalk-like virus (NLV) with a high rate of infection amongst both residents and staff (84%). This virus is the most frequent cause of gastroenteritis in institutions. The illness is self-limiting and can be transmitted from person to person. In weakened individuals the course can be serious. The virus can be detected in faeces with modern molecular-biological techniques (reverse transcriptase PCR). The revised law on infectious diseases ('Infectieziektenwet') was established in the Netherlands in 1999. This law requires major outbreaks of infectious diseases in institutions as described here to be reported to the Municipal Health Service. Together with this agency, strategies to prevent further spread of the disease can be implemented.