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Background: The COVID-19 pandemic is affecting nations globally, but with an impact exhibiting significant spatial and temporal variation at the sub-national level. Identifying and disentangling the drivers of resulting hospitalisation incidence at the local scale is key to predict, mitigate and manage epidemic surges, but also to develop targeted measures. However, this type of analysis is often not possible because of the lack of spatially-explicit health data and spatial uncertainties associated with infection., Methods: To overcome these limitations, we propose an analytical framework to investigate potential drivers of the spatio-temporal heterogeneity in COVID-19 hospitalisation incidence when data are only available at the hospital level. Specifically, the approach is based on the delimitation of hospital catchment areas, which allows analysing associations between hospitalisation incidence and spatial or temporal covariates. We illustrate and apply our analytical framework to Belgium, a country heavily impacted by two COVID-19 epidemic waves in 2020, both in terms of mortality and hospitalisation incidence., Results: Our spatial analyses reveal an association between the hospitalisation incidence and the local density of nursing home residents, which confirms the important impact of COVID-19 in elderly communities of Belgium. Our temporal analyses further indicate a pronounced seasonality in hospitalisation incidence associated with the seasonality of weather variables. Taking advantage of these associations, we discuss the feasibility of predictive models based on machine learning to predict future hospitalisation incidence., Conclusion: Our reproducible analytical workflow allows performing spatially-explicit analyses of data aggregated at the hospital level and can be used to explore potential drivers and dynamic of COVID-19 hospitalisation incidence at regional or national scales.

Background: Near-hanging experiences are life-threatening events about which few data are available., Research Question: What are the outcomes and early predictors of hospital mortality in critically ill patients who have undergone a near-hanging experience?, Study Design and Methods: Adult patients who were resuscitated successfully after suicidal near-hanging injury admitted to 31 university or university-affiliated ICUs in France and Belgium between 1992 and 2014 were studied retrospectively. Patients were identified by searching the hospital databases for International Statistical Classification of Diseases and Related Health Problems, 9th and 10th revisions, codes and hospital charts for hanging. Logistic multivariate regression was performed to identify factors associated vital and functional outcomes at hospital discharge as the primary end points. Secondary outcomes were evaluation of temporal trends and identification of predictors of hospital mortality., Results: Of the 886 patients (181 women and 705 men; median age, 43 years; interquartile range, 34-52 years), 266 (30.0%) had attempted suicide previously, 600 (67.7%) had a diagnosed mental illness, and 55 (6.2%) attempted hanging while hospitalized. Median time from hanging awareness to unhanging was 0 min (interquartile range [IQR], 0-0; range, 0-82 min). Median Glasgow Coma Scale score was 3 (IQR, 3-5) at ICU admission. Hanging induced cardiac arrest in 450 of 886 patients (50.8%). Overall, 497 of 886 patients (56.1%) were alive at hospital discharge, including 479 of 497 patients (96.4%) with a favorable neurocognitive outcome (defined as a Glasgow Outcome Scale score of 4 or 5). By multivariate analysis, factors associated with hospital mortality were hanging-induced cardiac arrest (OR, 19.50; 95% CI, 7.21-60.90; P < .00001) and findings at ICU admission of glycemia level > 1.4 g/L (OR, 4.34; 95% CI, 1.82-10.81; P = .0007) and of lactate level > 3.5 mmol/L (OR, 9.98; 95% CI, 4.17-25.36; P < .00001)., Interpretation: The findings from this large multicenter retrospective cohort emphasize the very high mortality after hanging injury chiefly because of hanging-induced cardiac arrest. However, patients who survive near-hanging experiences achieve excellent neurocognitive recovery. Studies of early neuroprotective strategies for patients who have undergone near-hanging experiences are warranted., Trial Registry: ClinicalTrials.gov; No.: NCT04096976; URL: www.clinicaltrials.gov., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to describe the clinical and biological features of Mevalonate kinase deficiency (MKD) in patients diagnosed in adulthood. This is a French and Belgian observational retrospective study from 2000 to 2014. To constitute the cohort, we cross-check the genetic and biochemical databases. The clinical, enzymatic, and genetic data were gathered from medical records. Twenty-three patients were analyzed. The mean age at diagnosis was 40 years, with a mean age at onset of symptoms of 3 years. All symptomatic patients had fever. Febrile attacks were mostly associated with arthralgia (90.9%); lymphadenopathy, abdominal pain, and skin lesions (86.4%); pharyngitis (63.6%); cough (59.1%); diarrhea, and hepatosplenomegaly (50.0%). Seven patients had psychiatric symptoms (31.8%). One patient developed recurrent seizures. Three patients experienced renal involvement (13.6%). Two patients had angiomyolipoma (9.1%). All but one tested patients had elevated serum immunoglobulin (Ig) D level. Twenty-one patients had genetic diagnosis; most of them were compound heterozygote (76.2%). p.Val377Ile was the most prevalent mutation. Structural articular damages and systemic AA amyloidosis were the 2 most serious complications. More than 65% of patients displayed decrease in severity and frequency of attacks with increasing age, but only 35% achieved remission. MKD diagnosed in adulthood shared clinical and genetic features with classical pediatric disease. An elevated IgD concentration is a good marker for MKD in adults. Despite a decrease of severity and frequency of attacks with age, only one-third of patients achieved spontaneous remission.

Purpose: Over the last two decades, noninvasive ventilation (NIV) has been proposed in various causes of acute respiratory failure (ARF) but some indications are debated. Current trends in NIV use are unknown., Methods: Comparison of three multicenter prospective audits including all patients receiving mechanical ventilation and conducted in 1997, 2002, and 2011 in francophone countries., Results: Among the 4132 patients enrolled, 2094 (51%) required ventilatory support for ARF and 2038 (49 %) for non-respiratory conditions. Overall NIV use was markedly increased in 2010/11 compared to 1997 and 2002 (37% of mechanically ventilated patients vs. 16% and 28%, P < 0.05). In 2010/11, the use of first-line NIV for ARF had reached a plateau (24% vs. 16% and 23%, P < 0.05) whereas pre-ICU and post-extubation NIV had substantially increased (11% vs. 4% and 11% vs. 7%, respectively, P < 0.05). First-line NIV remained stable in acute-on-chronic RF, continued to increase in cardiogenic pulmonary edema, but decreased in de novo ARF (16% in 2010/11 vs. 23% in 2002, P < 0.05). The NIV success rate increased from 56% in 2002 to 70% in 2010/11 and remained the lowest in de novo ARF. NIV failure in de novo ARF was associated with increased mortality in 2002 but not in 2010/11. Mortality decreased over time, and overall, NIV use was associated with a lower mortality., Conclusion: Increases in NIV use and success rate, an overall decrease in mortality, and a decrease of the adverse impact NIV failure has in de novo ARF suggest better patient selection and greater proficiency of staff in administering NIV., Trial Registration: Clinicaltrials.gov Identifier NCT01449331.

Predicting metal concentrations in surface waters is an important step in the understanding and ultimately the assessment of the ecological risk associated with metal contamination. In terms of risk an essential piece of information is the accurate knowledge of the partitioning of the metals between the dissolved and particulate phases, as the former species are generally regarded as the most bioavailable and thus harmful form. As a first step towards the understanding and prediction of metal speciation in the Scheldt Estuary (Belgium, the Netherlands), we carried out a detailed analysis of a historical dataset covering the period 1982-2011. This study reports on the results for two selected metals: Cu and Cd. Data analysis revealed that both the total metal concentration and the metal partitioning coefficient (Kd) could be predicted using relatively simple empirical functions of environmental variables such as salinity and suspended particulate matter concentration (SPM). The validity of these functions has been assessed by their application to salinity and SPM fields simulated by the hydro-environmental model SLIM. The high-resolution total and dissolved metal concentrations reconstructed using this approach, compared surprisingly well with an independent set of validation measurements. These first results from the combined mechanistic-empirical model approach suggest that it may be an interesting tool for risk assessment studies, e.g. to help identify conditions associated with elevated (dissolved) metal concentrations., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: The incidence of tick-borne diseases is increasing in Europe. Sub national information on tick distribution, ecology and vector status is often lacking. However, precise location of infection risk can lead to better targeted prevention measures, surveillance and control., Methods: In this context, the current paper compiled geolocated tick occurrences in Belgium, a country where tick-borne disease has received little attention, in order to highlight the potential value of spatial approaches and draw some recommendations for future research priorities., Results: Mapping of 89,289 ticks over 654 sites revealed that ticks such as Ixodes ricinus and Ixodes hexagonus are largely present while Dermacentor reticulatus has a patchy distribution. Suspected hot spots of tick diversity might favor pathogen exchanges and suspected hot spots of I. ricinus abundance might increase human-vector contact locally. This underlines the necessity to map pathogens and ticks in detail. While I. ricinus is the main vector, I. hexagonus is a vector and reservoir of Borrelia burgdorferi s.l., which is active the whole year and is also found in urban settings. This and other nidiculous species bite humans less frequently, but seem to harbour pathogens. Their role in maintaining a pathogenic cycle within the wildlife merits investigation as they might facilitate transmission to humans if co-occurring with I. ricinus. Many micro-organisms are found abroad in tick species present in Belgium. Most have not been recorded locally but have not been searched for. Some are transmitted directly at the time of the bite, suggesting promotion of tick avoidance additionally to tick removal., Conclusion: This countrywide approach to tick-borne diseases has helped delineate recommendations for future research priorities necessary to design public health policies aimed at spatially integrating the major components of the ecological cycle of tick-borne diseases. A systematic survey of tick species and associated pathogens is called for in Europe, as well as better characterisation of species interaction in the ecology of tick-borne diseases, those being all tick species, pathogens, hosts and other species which might play a role in tick-borne diseases complex ecosystems.

A methodology is developed to quantify the uncertainty in a pesticide leaching assessment arising from the spatial variability of non-georeferenced parameters. A Monte Carlo analysis of atrazine leaching is performed in the Dyle river catchment (Belgium) with pesticide half-life (DT50) and topsoil organic matter (OM) content as uncertain input parameters. Atrazine DT50 is taken as a non-georeferenced parameter, so that DT50 values sampled from the input distribution are randomly allocated in the study area for every simulation. Organic matter content is a georeferenced parameter, so that a fixed uncertainty distribution is given at each location. Spatially variable DT50 values are found to have a significant influence on the amount of simulated leaching. In the stochastic simulation, concentrations exist above the regulatory level of 0.1 microg L(-1), but virtually no leaching occurs in the deterministic simulation. It is axiomatic that substance parameters (DT50, sorption coefficient, etc.) are spatially variable, but pesticide registration procedures currently ignore this fact. Including this spatial variability in future registration policies would have significant consequences on the amount and pattern of leaching simulated, especially if risk assessments are implemented in a spatially distributed way.

This article aims to determine the location and the length of road sections characterized by a concentration of accidents (black zones). Two methods are compared: one based on a local decomposition of a global autocorrelation index, the other on kernel estimation. After explanation, both methods are applied and compared in terms of operational results, respective advantages and shortcomings, as well as underlying conceptual elements. The operationality of both methods is illustrated by an application to one Belgian road.

In June 1999, the dioxin crisis, caused by dioxin-contaminated feed components, exploded in Belgium, resulting in withdrawal of chicken and eggs from the market. Through the sentinel surveillance system, a decrease in Campylobacter infections during June 1999 was noticed. A model was generated with the reports from preceding years (1994 to 1998), and a prediction of the number of infections in 1999 was calculated. The model shows a significant decline (40%) in the number of infections, mainly because of the withdrawal of poultry. The use of a disaster as an epidemiologic tool offers a unique opportunity to observe exceptional changes in the occurrence of infections or other diseases.

During a period of increasing meningococcal disease incidence in Belgium, all 538 serogroup B and all 87 serogroup C strains isolated between 1996 and 1998 were investigated by PCR with the arbitrary primer D8635, which is able to identify lineage III strains. In all, 399 strains (64%) were attributed to lineage III on the basis of PCR-based typing. Since their introduction in the Belgian population in the early 1990s, lineage III strains have become increasingly variable in phenotype. Currently, they are represented by strains belonging to 38 different phenotypes, of which 25 were not found in the period 1990-1995. The 87 serogroup C strains were further investigated by pulsed-field gel electrophoresis (PFGE), and a subset of 30 strains was also investigated by multilocus sequence typing (MLST). Strains of phenotype C:2b:P1.5,2, which currently constitute the majority of the serogroup C strains, were demonstrated to belong to cluster A4. Comparison of the discriminatory ability of D8635-primed PCR, PFGE and MLST revealed that D8635-primed PCR was the least discriminatory method and PFGE the most discriminatory method. However, the MLST data were more readily interpreted than the PFGE fingerprint patterns and can be compared easily with data obtained in other studies. In conclusion, the ongoing increase of meningococcal disease in Belgium could be attributed not only to the further expansion of lineage III, but also to the introduction of C:2b:P1.5,2 strains of cluster A4 in to the Belgian population.

In May 1995, the Scientific Institute of Public Health was informed of an outbreak of gastrointestinal illness in a congregational school in the Brussels area. The field investigation identified 24 cases with mild to severe gastrointestinal and general symptoms of acute bacterial enterocolitis. Campylobacter coli was detected in the stools of 5 patients. A retrospective cohort study suggested that a mixed salad (containing ham and feta cheese) was the probable source of infection, but the route of contamination remained unknown. The rapid investigation of such episodes of collective foodborne infections is essential for the implementation of adequate control measures.

Five hundred clinical group A streptococcal (GAS) isolates were collected in Belgium during the period 1 Nov. 1993 to 31 Oct. 1994. Clinical and laboratory data were recorded and isolates were characterised. The presence of the genes encoding streptococcal pyrogenic exotoxin types A (speA), B (speB), C (speC), F (speF) and streptococcal superantigen (ssa) were determined by PCR to target specific sequences. These isolates were also emm-typed and analysed by pulsed-field gel electrophoresis (PFGE) of genomic macrorestriction fragments with the enzyme SmaI. In total, 136 unrelated GAS PFGE types were identified and genetic diversity was clearly demonstrated. Two GAS PFGE types predominated; a first PFGE type comprised 66 (13.2%) emm1 isolates characterised by speA-, speB+, speC-, speF+ and ssa-; the second PFGE type comprised 44 (8.8%) emm12 isolates characterised by speA-, speB+, speC+ (or speC-), speF+ and ssa-. Indistinguishable PFGE types were observed among both invasive and non-invasive isolates. Ten different PFGE types were found among 11 streptococcal toxic shock syndrome (STSS) isolates, and five of these lacked speA. Twenty-five (34.7%) of 72 invasive isolates gave negative results for speA, speC and ssa. This retrospective study confirmed the observation that the dissemination of one specific clone cannot be associated with invasive GAS disease and posed a question regarding the role of SPE A as a major virulence factor. Other streptococcal virulence factors in conjunction with host factors may determine the outcome of invasive GAS infection.

Puumala is the most common hantavirus serotype in Europe and is spread mainly by the red bank vole. Between 1 July 1992 and 31 January 1994, an outbreak of Puumala virus-induced nephropathia epidemica (NE) occurred in the Belgian Ardennes. Serologically confirmed cases (n = 41) were compared with two groups of asymptomatic seronegative controls. Risks identified included sighting of living rodents, exposure to rodent droppings, and trapping rodents during the 4 weeks preceding onset of symptoms. Activities during this 4-week period that presented the greatest risk were woodcutting, reopening of a nonaerated room, and strenuous physical effort. This is the first case-control study on risk factors for NE in Europe. In comparison with the American form of hantavirus pulmonary syndrome, which is spread by deer mice, professional activity appears to be a more important risk factor for acquisition of hantavirus in Europe.

Objective: To investigate relationships between the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and the use of different classes of antimicrobials in Belgian hospitals., Design: Using Pearson correlation coefficients, the number of new nosocomial MRSA-colonized or -infected patients in the second half of 1994 and the first half of 1995 reported by the national MRSA surveillance program was compared with use of various antimicrobial classes as reported by the National Institute for Sickness and Disability Insurance. Relationships between different classes of antimicrobials were evaluated in a correlation matrix. MRSA incidence, antimicrobial use, and potential confounding factors were included in a multiple linear regression analysis., Setting: 50 hospitals in Belgium., Results: The use of a number of different classes of antimicrobials was interrelated. In the multivariate analysis, the incidence of nosocomial MRSA increased with increasing use of ceftazidime and cefsulodin (P=.0003), amoxicillin with clavulanic acid (P=.02), and quinolones (P=.005). No association was found between MRSA incidence and total antimicrobial use., Conclusions: The relationships between antimicrobial use and MRSA are complex. Interventions aimed at promoting more rational prescribing patterns should be supported by adequate experimental and epidemiological evidence. Advice for preventing and controlling MRSA has focused mainly on hygienic measures and precautions to avoid cross-transmission; the role of relieving antimicrobial pressure needs to be clarified.

The main results of the bloodstream infection (BSI) component of the Belgian National Programme for the Surveillance of Hospital Infections (NSIH project) are reported. From October 1992 to September 1996, 117 hospitals (59.1% of Belgian acute-care institutions) reported 13678 nosocomial BSIs. The incidence was 7.05 BSI episodes per 10000 patient-days. The incidence of BSI increased with hospital size and over time. Bloodstream infections were secondary to an infectious body site in 40.3% of the episodes, catheter-related in 23.5%, and of unknown origin in 36.2%. The associated in-hospital mortality was 31.4% and was highest in BSIs secondary to a respiratory tract infection (49.3%). In intensive care units, the incidence of BSI was 38.5 per 10000 patient-days. Coagulase-negative staphylococci were the most prevalent microorganisms (22%), followed by Staphylococcus aureus (14.1%) and Escherichia coli (13.5%). In catheter-related BSIs, these proportions were 41.9%, 18.8%, and 2.3%, respectively. The proportion of polymicrobial episodes was 9.9%. Methicillin resistance in Staphylococcus aureus was 22.3%. With its high participation rate, the NSIH project has characterized the epidemiology of nosocomial BSIs in Belgium during the period studied.

In November and December 1995 a computer assisted telephone interview (CATI) was organized in order to measure the rate of participation in cervical cancer screening among a sample of 1,477 women between 18 and 69 years old, residing in the Flemish Region and selected by random digit dialling. Associations between screening status and a set of explanatory variables (demographic, socioeconomic determinants and exposition to primary risk factors for cervical cancer) were studied by logistic regression modelling. The screening coverage meaning the percentage of women screened less than 3 years ago, increases sharply up to 25 years and remains higher than 85% up to 40 years; from then it decreases progressively. Socioeconomically deprived groups and single women are less likely to have a smear taken. Notable regional differences exist. Over-screening (interval between Papanicolaou smears less than 3 years) is an important phenomenon among screened women especially within the younger age groups. The prevalence of risk factors (sexual intercourse at young age, multiple sex partners, contraceptive pill use, smoking) has increased over time but women at higher risk are generally better screened. This survey provides useful baseline information necessary to monitor the achievement of some main objectives, formulated by the Europe Against Cancer programme and also included in Flemish public health policy.

In most European countries there are research institutes with responsibilities similar to those of the I.H.E. in Belgium. In English they are generally called "National Institute of Public Health". However, these Institutes are quite different from one country to another, because they are the result of general political factors as well as of the specific epidemiological context of each country. The evolution of the I.H.E., which for decades had research activities which are now the responsibility of three different political levels (Federal/Regions/Communities), has been strongly influenced by the profound institutional reforms which took place in Belgium since 1970. The accompanying difficulties and changes are described. More details are given concerning the specific tasks and responsibilities of the institute, its structure, perspectives for its future and the planned merging with the Pasteur Institute.