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Naar aanleiding van de vuurwerkramp in Enschede op 13 mei 2000 vond 2 tot 3 weken later een uitgebreid gezondheidsonderzoek onder de getroffenen plaats. Eind 2001, circa 18 maanden na de ramp, is het vragenlijstonderzoek herhaald en circa 75% (N=2851) van de getroffenen uit het eerste onderzoek heeft opnieuw deelgenomen. Nieuw in dit onderzoek zijn de vergelijkingsgroepen, d.w.z. dat de gezondheid van de getroffenen is vergeleken met personen die de ramp niet mee hebben gemaakt. Bij alle deelnemende getroffenen zijn veel lichamelijke en psychische klachten 18 maanden na de ramp afgenomen ten opzichte van het eerste onderzoek, 2-3 weken na de ramp. Hoewel veel getroffenen hersteld zijn van hun klachten, hebben de getroffenen woonachtig in Enschede meer lichamelijke en psychische klachten dan de vergelijkingsgroepen. Getroffenen die een dierbare hebben verloren, waarvan het huis zwaar is beschadigd door de ramp of die tijdens de ramp erg verward waren, hebben meer klachten dan degenen waarvoor dat niet geldt. Getroffen allochtone bewoners rapporteren meer klachten dan allochtone bewoners uit de vergelijkingsgroep. Van de getroffen bewoners met ernstige psychische klachten zijn tweemaal zoveel mensen terecht gekomen in de geestelijke gezondheidszorg ten opzichte van de bewoners met ernstige psychische klachten in de vergelijkingsgroep. De inspanningen in Enschede om nazorg te verlenen lijken dus succesvol. De uitkomsten van het tweede gezondheidsonderzoek maken het mogelijk de nazorg nog gerichter in te zetten. Dankzij het onderzoek is een scherp beeld ontstaan van groepen getroffenen die zorg en aandacht nodig hebben.

On May 13th, 2000, a firework storage facility with 177 tons of heavy fireworks exploded in a residential area in Enschede, The Netherlands. The series of three explosions and subsequent fire killed 22 and injured over 900 people and about 400 homes were destroyed. The Dutch government declared this a national disaster and a survey was launched to study potential exposure to substances and psycho-trauma, and to assess current physical and psychological health of victims and relief workers, as part of a larger health care programme for the victims. The data collection was performed between 30th May and 7th June, and the first results were reported within 8 weeks of the disaster. This report addresses the assessment of the somatic and psychological health status among the full study population of 4000 residents and relief workers. This questionnaire survey shows that the firework disaster has a large impact on the health status of the victims. 2-3 weeks after the explosion at least 50% of these people report somatical and emotional problems, e.g. sleeping problems, restrictions in daily functioning, anxiety, depression and lack of confidence. Especially residents and to a lesser degree relief workers from the disaster area and from Enschede report a poor perceived health after the disaster, even if their health status before the disaster, age, sex, education and etnicity is taken into account. The perceived health status of relief workers from outside of Enschede is on average better than that of the other groups, both before and after the explosion. Victims which lost their homes, loved-ones or victims which were injured report 2-3 times more somatical and emotional problems then victims without these experiences.

Avian flu epidemic 2003: public health consequences.Risk factors, health, well-being, health care needs and preventive measures during the H7N7 avian flu outbreak control in the Netherlands.An estimated thousand people, possibly more have been infected with avian flu during the outbreak in the Netherlands in 2003. One third of the poultry farmers whose holdings were cleared reported stress reactions, fatigue and depressive symptoms. The large spread of the virus underscores the importance of the measures to prevent poultry-to-human transmission in people handling infected poultry. The possible uncertainty, stress and anxiety associated with the avian flu control demand specific health care attention. A total of 453 people reported with health complaints, predominantly conjunctivitis. Antibodies were found in 59% of infected poultry workers' family members. Of the 500 tested persons who had handled infected poultry, about 50% showed an antibody response. The poultry farmers and workers complied insufficiently with the preventive measures. The antiviral drug oseltamivir protected against infection, whereas mouth and nose masks did not. The attention for support, information and respectful treatment of poultry farmers and workers during the clearances worked quite well. Externally hired veterinarians experienced their activities as emotionally aggravating more often than other professionals. About a quarter of the poultry farmers worried about the survival of their holding and the sector as a whole; 16% felt a need for additional support, help or health care because of the avian flu. They consulted agricultural care providers and family doctors, and less frequently mental health care providers.

Health status of those affected by the firework disaster in Enschede, four years later.Among the group of affected residents with severe damage to their homes, recovery from health problems did not continue in the period from 18 months to four years after the disaster. The current health problems are of a chronic nature. Affected rescue workers four years after the disaster did not unambiguously report more health or work-related problems than unaffected rescue workers.The presence of chronic health problems in particular groups of affected residents is of importance to the health care providers in Enschede. They can direct their follow-up care toward these specific groups.Native Dutch residents with severe damage to their homes reported health problems 1.5 to 2 times more often than unaffected native Dutch residents of Tilburg. Native Dutch residents without severely damaged homes had scarcely more health problems than the native Dutch in Tilburg. Affected (first- and second-generation) immigrant residents, independent of whether their homes sustained serious damage, reported 1.5 to 3 times more health problems than the unaffected immigrants in Tilburg. Among 80-90% of all affected residents with health problems, the complaints appeared to be chronic: residents had reported the same health problems in earlier surveys.While some groups of affected residents still reported work-related problems four years after the disaster, residents of Enschede were not more likely to be receiving disability benefits than the unaffected residents of Tilburg.Among affected residents with psychological symptoms, 70-83% have had contact with mental health care professionals at some point in the past four years; a minority (25-40%) has ongoing contact.

After a disaster, it is essential to determine possible exposure to hazardous chemicals or radiation among the survivors. Adequate information on possible (negative) health effects due to exposure may limit unnecessary stress. Insight into health status and the health care needs of survivors is important information that is crucial in order to improve the health of survivors after disasters. Other information needs from a disaster health impact assessment were insight into risk factors for common persistent health problems, and the efficacy of interventions such as health research after disasters. These information needs were reported in an investigation to explore the needs, expectations and experiences of health care providers, health insurers, policy makers and survivors. These results will help the Center for Health Impact Assessment of Disasters (CGOR) in preparing and supporting health impact assessments after disasters. In this report, the information needs of the interviewees were linked to objectives and corresponding types of health research or surveillance. In addition, the best time for collecting different data for the information needs after a disaster is discussed. Possible objectives for health impact assessment include: to optimize aftercare, to fill in the knowledge gap on risk factors and to evaluate to which extent the objectives of disaster health impact assessment have been met.