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The recent advice on vaccination against cervical cancer from the Health Council of the Netherlands and the decision by the Minister of Health, Welfare and Sport to implement the vaccination within the National Immunisation Programme by September 2009, has been criticized by a group of authors because five of seven criteria for vaccination in public programmes are considered not to have been met; notably with respect to efficacy and safety. It appears that the available scientific data have been weighted differently by the Health Council committee and the criticising group of authors. In the original advisory report, the committee of the Health Council lists all uncertainties, and argues that a linked monitoring programme will provide public vaccination with sufficient warranties for efficacy and safety. Thus, new opportunities for primary prevention can be taken, and a significant health benefit is likely to be gained. On the other hand, postponing a decision until all uncertainties have been resolved will postpone a significant potential health benefit for many years.

--Each year, 600-700 women in the Netherlands are diagnosed with cervical cancer. Over the last 10 years, an average of 250 women have died annually due to cervical cancer. --Gardasil, the first vaccine for Human papillomavirus (HPV), was recently approved in Europe for the prevention of cervical cancer. --The availability of a vaccine for HPV prompts the question whether it should be included in the Dutch National Immunisation Programme. --At the end of 2006, the Medicines Evaluation Board, the Health Council of the Netherlands and the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment organised a workshop for experts in the field to answer that question. --The HPV vaccine provides protection against HPV-16 and HPV-18, which cause approximately 70% of cervical cancers. --Because the efficacy of vaccination is only evident after many years, preserving good participation in the screening programme is essential. --The current screening could be improved by introducing an HPV test combined with self-sampling for women who do not participate in screening. --Vaccination is unarguably an important development. However, there are still several unanswered questions regarding vaccination and its actual protection, duration of protection, long-term safety and cost-effectiveness. --April 1st, 2008, the Health Council of the Netherlands had recommended including HPV vaccination in the National Immunisation Programme.

The Health Council of the Netherlands (Gezondheidsraad) assessed the vaccination of infants against both group-C meningococci and pneumococci in terms of general criteria and basic principles for inclusion in the national vaccination programme. Vaccination against meningococci C in the Netherlands is expected to prevent about 300 cases of meningococcal disease (meningitis or sepsis), 22 deaths and 12 cases of severe lasting problems (neurological problems or amputations) per year. Vaccination against pneumococci may prevent about 100 cases of meningitis or sepsis, 3200 cases of pneumonia, 36,000 cases of acute otitis media, 11 deaths, 11 cases of severe permanent damage (neurological problems, deafness) per year. The Health Council advised implementing vaccination against group-C meningococci as soon as possible, through 2 injections at the ages of 5 and 6 months or through 1 injection shortly after the child's first birthday, and to carry out a catch-up programme for all children and adolescents up to and including 18 years of age. The council also advised starting a vaccination programme against pneumococci, at ages 2, 3 and 4 months, as soon as the current vaccinations against diphtheria, tetanus, pertussis and polio and against Haemophilus influenzae type b are combined into 1 injection (in 2002 or 2003). In view of the concentration of pneumococci disease in the first years of life, a catch-up programme is not indicated in this case. The Health Council emphasised the importance of microbiological and clinical monitoring of potential adverse effects and of public education programmes. The cost of vaccination against group-C meningococci is comparable to that of other accepted programmes for primary prevention. Compared to other programmes and at the current vaccine price, the cost of vaccination against pneumococci is high.

An abrupt decrease of the number of reported new AIDS cases took place in the first half of 1997 in the Netherlands. This decrease was most prominent in homosexual/bisexual men and intravenous drug users, and less conspicuous in heterosexual men and women. The number of heterosexual patients with a non-Dutch nationality even increased compared with the first half of 1996. The most probable explanation of these observations is the introduction of improved treatment possibilities for HIV-infected people starting July 1996, which lead to a longer incubation period. Owing to these developments monitoring the HIV/AIDS epidemic in the Netherlands will depend more and more on HIV status surveillance instead of on registration of new AIDS cases.

Objective: To document the recent developments in the course of the AIDS epidemic in the Netherlands, 1982-1995., Design: Descriptive., Setting: National Institute of Public Health and Environment, Bilthoven, Municipal Health Service, Amsterdam, and Inspectorate of Public Health, Rijswijk, the Netherlands., Method: Based on the new AIDS patients reported to the Inspectorate of Public Health, the incidence figures were calculated by risk group (homo/bisexual men, intravenous drug users and heterosexual men and women), by birth cohort defined by 5 successive years of birth, and by nationality, in order to characterise sub-epidemics., Results: Among homo/bisexual men AIDS incidence has been stabilizing in recent years. Among intravenous drug users and heterosexuals incidence continues to rise but at a low level compared with homo/bisexual men. Among homo/bisexual men and intravenous drug users mean age at AIDS diagnosis is rising in conjunction with reduced incidence among young persons born in 1965-1969 when compared with the incidence among persons born in 1960-1964 when at the same age. By contrast, among heterosexuals a decline in mean age at diagnosis is observed and this decline coincides with undiminished rise of incidence among persons born in 1965-1969. Among heterosexual patients an increasing and disproportionate number have the nationality of a sub-Saharan African country., Conclusion: Future AIDS incidence among homo/bisexual men and intravenous drug users will probably be lower than it currently is. Regarding heterosexuals the undiminished growth of the number of young AIDS patients and the increasing proportion of patients from abroad make such an assessment more difficult.

Objectives: To assess the prevalence of HIV infection among intravenous (IDU) and non-intravenous drug users in Heerlen and Maastricht (Southern Netherlands), to detect subgroups of IDU with a higher risk of HIV infection, and to assess the risk of further spread of HIV., Design: Cross-sectional study., Setting: Heerlen, Kerkrade, Brunssum and Maastricht, the Netherlands., Methods: Between August 15 and November 25, 1994, a saliva specimen and a short questionnaire were obtained from 449 drug users (340 IDU) in Heerlen (and environs) and Maastricht. Participants were recruited through methadone care (54%), syringe exchange (16%), a street prostitution project (3%), street recruitment (23%) and other drug users (4%)., Results: Of the 340 IDU 33 were infected (prevalence: 10% (95% confidence interval: 7-13)), among the 109 non-IDU no infections were found (0% (0-3)). IDU making use of the syringe exchange had a higher prevalence (odds ratio 3.13 (1.37-7.61)). In logistic regression analysis, this finding could not be explained by selection on more risky injecting. One in five currently injecting IDU reported having used someone else's used needle or syringe in the last 6 months. One in five IDU had a non-drug user as steady sexual partner. In sexual contacts between steady partners condom use was low. On the basis of self-reported serostatus it appeared that some infections have taken place in the last two years., Conclusions: The prevalence of HIV infections among IDU in Heerlen and Maastricht is about 10%. IDU using the syringe exchange have a higher prevalence. This means this prevention reaches the high-risk group, but probably can not avoid all infections. The risk of further spread among IDU is high. The risk of spread to non-IDU and non-drug users is present.

Objective: Description of the epidemiology and transmission categories of AIDS in the Netherlands., Design: Descriptive., Setting: The Netherlands., Method: Analysis of all registered AIDS patients until 31 December 1993. Trends in the composition of this population were studied with respect to age and sex, risk groups, geographic distribution across the country, heterosexual transmission, AIDS-defining diseases and reporting pattern., Results: From the first patient in 1982 until December 31, 1993, a cumulative total of 2912 patients was diagnosed and reported in the Netherlands (2995 when corrected for reporting delay). The numbers of reported AIDS cases in the Netherlands are smaller than previously predicted by mathematical models. The proportion of homosexual men in the incidence of AIDS dropped from 89 to 73 per cent, the proportions of intravenous drug users and heterosexual transmission rose to 11 per cent each. Patients in the category of heterosexual transmission are mainly individuals from countries where heterosexual contact is the dominant mode of transmission and their sex partners, and to a lesser extent the sex partners of intravenous drug users (whether or not in relation to prostitution). The proportion of women is rising (229 patients or 8 per cent by December 1993), with most cases transmitted initially by intravenous drug use but later by heterosexual contact., Conclusion: The number of AIDS cases in all risk groups combined is levelling off. However, more detailed analysis shows that the numbers of cases of heterosexual transmission and those in young homosexual men are still rising. For a better quantitation of the quality of the AIDS data, specific research into underreporting and non-diagnosis of AIDS cases in the Netherlands is warranted.

An outbreak of mainly extrapulmonary tuberculosis (TB) in a group of about 550 patients with rheumatoid arthritis (RA) is described. These patients had been attending the practice of a former general practitioner who treated cases of rheumatoid arthritis with phenylbutazone and steroids. The number of diagnosed TB cases was 55. Six cases had a contagious lung localisation. The possible sources of the outbreak were analysed. Both a visit on a same day as a sputum positive patient (chi 2-trend: 20.4; p < 0.001) and the administration of steroids (odds ratio (OR): 36.2; 95% confidence interval (CI): 8.8-313) were independent risk factors. There also appeared to be a relationship between TB and RA (OR: 4.4; 95%-BI: 2.2-9.1). Exogenous re(infection) and endogenous reactivation are possible causes of this outbreak.

In the Netherlands by the 1st of January 1990 1074 AIDS patients have been reported to the Department of the Chief Medical Officer. In the last few years the proportion of intravenous drug users increased and the proportion of homo/bisexual men decreased. After adjustment for the effect of delay in reporting the total number of AIDS patients by 1st January 1990 is estimated to be 1173. It appears that the reporting delay outside Amsterdam is longer than in this city. The time required for doubling of the half-yearly incidence of new AIDS patients (doubling time, dt) increased from 9 months in the beginning of the epidemic to 34 months. It is expected on the assumption of constant dt that 1120 new AIDS patients will be diagnosed in 1990 and 1991 together. The present growth among the homo/bisexual men (dt 34 months) is smaller than the one among the intravenous drug users (dt 23 months). The growth in Amsterdam (dt 36 months) is less than that in the rest of the Netherlands (dt 32 months). Based on the course of the AIDS epidemic the number of HIV infected (including the AIDS patients) is estimated as 9,000-12,000 by the 1st of January 1990.