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Background: The SARS outbreak served to test both local and international outbreak management and risk communication practices., Purpose: The study compares SARS knowledge, perceptions, behaviors, and information between Finns and the Dutch during the SARS outbreak in 2003., Method: The participants of the study, who used a modified SARS Psychosocial Research Consortium survey, were drawn from Internet panels in Finland (n = 308) and the Netherlands (n = 373) in June 2003. Multiple logistic regression analyses were used to calculate odds ratios (with 95% confidence intervals) to compare Finns with the Dutch for various levels of perceptions and behaviors., Results: Adjusted for age, education, and income, Finns were more likely to be knowledgeable and worried about SARS as well as to have low perceived comparative SARS risk and poor personal efficacy beliefs about preventing SARS. Finns were also more likely than the Dutch to have high confidence in physicians on SARS issues but less likely to have received information from the Internet and have confidence in Internet information., Conclusions: The study shed light on how two European populations differed substantially regarding lay responses to SARS. Understanding these differences is needed in formulating and executing communication and outbreak management.

Purpose: To study the levels of perceived threat, perceived severity, perceived vulnerability, response efficacy, and self-efficacy for severe acute respiratory syndrome (SARS) and eight other diseases in five European and three Asian countries., Method: A computer-assisted phone survey was conducted among 3,436 respondents. The questionnaire focused on perceived threat, vulnerability, severity, response efficacy, and self-efficacy related to SARS and eight other diseases., Results: Perceived threat of SARS in case of an outbreak in the country was higher than that of other diseases. Perceived vulnerability of SARS was at an intermediate level and perceived severity was high compared to other diseases. Perceived threat for SARS varied between countries in Europe and Asia with a higher perceived severity of SARS in Europe and a higher perceived vulnerability in Asia. Response efficacy and self-efficacy for SARS were higher in Asia compared to Europe. In multiple linear regression analyses, country was strongly associated with perceived threat., Conclusions: The relatively high perceived threat for SARS indicates that it is seen as a public health risk and offers a basis for communication in case of an outbreak. The strong association between perceived threat and country and different regional patterns require further research.

Background: Although the SARS outbreak involved few probable cases of infection in Europe, swift international spread of infections raised the possibility of outbreaks. In particular, SARS presented a sociopsychological and economic threat to European Chinese communities because of their close links with the outbreak's origins., Methods: A qualitative study was conducted among Chinese residents in the United Kingdom and the Netherlands to identify the origins of SARS risk perceptions and their impact on precautionary actions and adverse consequences from the perspective of vulnerable communities living in unaffected regions. Analysis was informed by protection motivation theory., Results: Results revealed that information from affected Asia influenced risk perceptions and protective behavior among the Chinese in Europe when more relevant local information was absent. When high risk perceptions were combined with low efficacy regarding precautionary measures, avoidance-based precautionary action appeared to dominate responses to SARS. These actions may have contributed to the adverse impacts of SARS on the communities., Conclusions: Experiences of European Chinese communities suggest that practical and timely information, and consistent implementation of protective measures from central governments are essential to protect vulnerable populations in unaffected regions from unnecessary alarm and harm during outbreaks of emerging infections.

Background: Ethnic minorities in Europe such as the Chinese may need a special strategy with regard to risk communication about emerging infectious diseases. To engage them in precautionary actions, it is important to know their information sources, knowledge, and health beliefs., Purpose: This study's purpose is to study the use of information sources, knowledge, and health beliefs related to SARS and avian flu of Chinese people in the UK and The Netherlands, and to make comparisons with the general population in these countries., Method: Results of a self-administered questionnaire among 300 British/Dutch Chinese were compared to data obtained from a computer-assisted phone survey among the general population (n = 800)., Results: British/Dutch Chinese got most information about emerging diseases from family and friends, followed by Chinese media and British/Dutch TV. They had less confidence than general groups in their doctor, government agencies, and consumer/patient interest groups. Their knowledge of SARS was high. They had a lower perceived threat than general populations with regard to SARS and avian flu due to a lower perceived severity. They had higher self-efficacy beliefs regarding SARS and avian flu., Conclusion: In case of new outbreaks of SARS/avian flu in China, local authorities in the UK and The Netherlands can best reach Chinese people through informal networks and British/Dutch TV, while trying to improve confidence in information from the government. In communications, the severity of the disease rather than the susceptibility appears to need most attention.

Faced with an epidemic of an infectious disease, persons may take precautionary actions to try to reduce their risk. Such actions include avoiding situations that persons perceive to be risky, which can have negative health and economic effects. Therefore, we conducted a population-based survey of persons' precautionary actions in response to a hypothetical influenza pandemic. For the 5 European and 3 Asian regions that had been affected by severe acute respiratory syndrome, the pattern of reported precautionary action was broadly similar across the regions; approximately 75% of respondents reported that they would avoid public transportation and 20%-30% would try to stay indoors. Some regional differences were noted; Europeans were more likely than Asians to avoid places of entertainment, and Asians were more likely to avoid seeing physicians. This international survey provides insight into what might be expected during an influenza pandemic.

From the end of January to mid-June 2004 (weeks 5-24) a hepatitis A virus (HAV) outbreak occurred among a homeless and drug user community in Rotterdam, The Netherlands. To prevent further spread of the virus within this group and to the general population, the Municipal Health Service of Rotterdam organized a mass vaccination campaign during which 83% (1,515/1,800) of the homeless people were vaccinated. As part of a national HAV typing study, blood and/or fecal samples of 30 Rotterdam HAV IgM+ patients who fell ill during the period of 1 September 2003-1 December 2004 were tested. The tests included RT-PCR and sequencing at the VP3-VP1 and VP1-P2a regions of the HAV genome. It was found that 12 homeless people, one family member of a homeless person and two people without a known risk were infected with a unique subtype 3a strain. Four of the homeless patients became ill after vaccination and were probably infected at the time. This study shows that Dutch homeless people and drug users involved in HAV outbreaks should be offered HAV vaccine actively to prevent further spread of the infection. Furthermore, it was shown by molecular techniques that the unique subtype 3a strain was not found before the Rotterdam outbreak or afterwards, indicating that the mass vaccination campaign was successful.

Severe acute respiratory syndrome (SARS)-related risk perceptions, knowledge, precautionary actions, and information sources were studied in the Netherlands during the 2003 SARS outbreak. Although respondents were highly aware of the SARS outbreak, the outbreak did not result in unnecessary precautionary actions or fears.

The number of cases of syphilis in Rotterdam has increased dramatically since 1995. The prevalence of early syphilis in 1997 was highest among street prostitutes (16%). Some prostitutes could not be reached for further evaluation and treatment, probably due to their addiction to hard drugs. Prophylactic treatment for syphilis was given to most street prostitutes in a cruising zone during a screening programme for sexually transmitted diseases (STD) in January 1997. Since then, STD checkups were performed regularly in the cruising zone. The prevalence of early syphilis in the cruising zone dropped to 1.3% in 1998. The total number of reported cases of syphilis in Rotterdam also decreased sharply in 1998.

An unexpectedly large number of hepatitis A virus (HAV) infections were notified among homosexual men in Rotterdam in the first five months of 1998. A case control study was conducted to investigate the hypothesis that this outbreak was associated with sexual practices and to collect information with which to focus preventive activities. Notified cases and controls selected from male members of a gay sports club completed anonymous questionnaires about known risk factors for HAV infection and sexual behaviour. Single variable analysis showed that HAV infection was associated with sexual contact with anonymous sex partners (odds ratio (OR) 4.6; 95% confidence interval (CI) 1.0-23.2) and with visits to 'darkrooms' in gay bars (OR 6.2; 95% CI 1.5-26.8). A negative association with travel abroad to western countries was observed (OR 0.4; 95% CI 0.1-1.3). The associations with visits to darkrooms (OR = 9.2; 95% CI 1.6-52.4) and travel abroad to western countries (OR 0.1; 95% CI 0.02-0.9) remained significant in a multivariable logistic regression analysis. This risk group was targeted for health education and vaccination and darkroom owners were advised to provide hygiene facilities.