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During early summer 2019, the Netherlands experienced an outbreak of the exotic oak processionary caterpillar. The vast number of caterpillars, which live in large nests on oak trees before they turn into moths, possess thousands of small, barbed hairs (setae) that are disseminated with the wind. The hairs cause a range of primarily dermatologic problems. However, Dutch ophthalmologists started reporting patients with ophthalmologic complaints caused by the penetrating hairs of the oak processionary caterpillar. This paper focuses on the ophthalmologic complications caused by the caterpillar hairs. We collected a series of four cases with reports ranging from a corneal erosion with hairs lodged into the cornea, to a sterile endophthalmitis in which hairs were found in the vitreous. A literature review for similar cases was performed using the PubMed and Embase database. Together with the Dutch Ophthalmic Society (Nederlands Oogheelkundig Gezelschap, NOG), a national survey was issued to determine the scale of this new problem. This showed that oak processionary caterpillar related complaints are primarily limited to the south of the Netherlands. Suggested ophthalmic treatment guidelines are presented. With the next summer at the doorstep, and limited preventative measures against the caterpillar hairs, we expect a new wave of ophthalmologic complaints coming year as well. [ABSTRACT FROM AUTHOR]

Many people are no longer familiar with the diseases that are part of the Dutch National Immunisation Programme (NIP). The protection given by the NIP has ensured that these diseases, most of them serious, have largely disappeared. The NIP has developed gradually, but in retrospect it was in 1957 that what we now know as the NIP started. Over the years, the NIP has gradually expanded to include various vaccines such as live attenuated vaccines, conjugate vaccines and vaccines that offer protection against chronic viral infections. Currently, the NIP offers protection against twelve different diseases. Occasionally the Netherlands still sees minor outbreaks of those diseases included in the NIP programme, generally among non-vaccinated people. It is important that the NIP is retained; stopping vaccination always leads to the return of the disease. The question is: can good protection be maintained with fewer injections? This subject is on the agenda of the Health Council Of The Netherlands for discussion in 2022.

Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR)., Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests., Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively)., Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

The national vaccination rate in young children in the Netherlands has decreased in recent years. This has led to social and political discussions, for instance about compulsory vaccination for children in child-care. The national commission on child-care and vaccination has advised that vaccination should be made compulsory when the rate of vaccination has declined to a pre-determined lower threshold, to be determined by the government. A frequently quoted lower threshold is 95%. The idea behind this is the concept of a critical vaccination rate, a threshold needed for elimination of an infection in a large, well-mixed population. In this article we argue why the critical vaccination rate does not offer a scientific basis for a lower threshold to the national vaccination rate.

Background: Despite the increasing use of pre- and post-hydration protocols and low osmolar instead of high osmolar iodine containing contrast media, the incidence of contrast induced nephropathy (CIN) is still significant. There is evidence that contrast media cause ischemia reperfusion injury of the renal medulla. Remote ischemic preconditioning (RIPC) is a non-invasive, safe, and low cost method to reduce ischemia reperfusion injury. The aim of this study is to investigate whether RIPC, as an adjunct to standard preventive measures, reduces contrast induced acute kidney injury in patients at risk of CIN., Methods: The RIPCIN study is a multicenter, single blinded, randomized controlled trial in which 76 patients at risk of CIN received standard hydration combined with RIPC or hydration with sham preconditioning. RIPC was applied by four cycles of 5 min ischemia and 5 min reperfusion of the forearm. The primary outcome measure was the change in serum creatinine from baseline to 48 to 72 hours after contrast administration., Results: With regard to the primary endpoint, no significant effect of RIPC was found. CIN occurred in four patients (2 sham and 2 RIPC). A pre-defined subgroup analysis of patients with a Mehran risk score ≥11, showed a significantly reduced change in serum creatinine from baseline to 48 to 72 hours in patients allocated to the RIPC group (Δ creatinine -3.3 ± 9.8 μmol/L) compared with the sham group (Δ creatinine +17.8 ± 20.1 μmol/L)., Conclusion: RIPC, as an adjunct to standard preventive measures, does not improve serum creatinine levels after contrast administration in patients at risk of CIN according to the Dutch guideline. However, the present data indicate that RIPC might have beneficial effects in patients at a high or very high risk of CIN (Mehran score ≥ 11). The RIPCIN study is registered at: http://www.controlled-trials.com/ISRCTN76496973., (Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Recent studies investigating early graft function (EGF) after living donor kidney transplantation (LDKT) identified prolonged warm ischemia time (WIT) as a risk factor for the occurrence of poor EGF. The latter is associated with long-term graft loss; therefore the question arises whether prolonged WIT affects long-term outcomes in LDKT., Methods: Data were collected on 472 consecutive adult LDKTs. Patients were divided according to the total WIT into 3 groups with short (<30 minutes), intermediate (30-45 minutes), or prolonged (>45 minutes) WIT., Results: Of all patients, 193 (40.9%) experienced short, 249 (52.8%) intermediate, and 30 (6.4%) prolonged WIT. Prolonged WIT was a significant risk factor for the occurrence of poor EGF with an adjusted odds ratio of 4.252 (95% confidence interval [CI), 1.914 -9.447). Long-term graft survival was impaired in patients with prolonged WIT, with an adjusted hazard ratio of 3.163 (95% CI, 1.202-8.321). Multivariate analysis revealed determinants of prolonged WIT, including laparoscopic procurement, recipient overweight, right donor kidney, and multiple renal arteries., Conclusion: Prolonged WIT impairs long-term graft survival in LDKT. This finding underlines the need to develop strategies to avoid the occurrence of prolonged WIT in LDKT., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The Dutch Public Health Act, which came into force on 1 December 2008, replaces the existing laws concerning the combating of infectious diseases. Important changes have been incorporated in the new Public Health Act in comparison with the previous law on infectious diseases. Diseases which are probably infectious in nature and caused by as yet unknown pathogens are now notifiable, laboratories also have a nominal duty of notification and the list of notifiable diseases has been extended with 10 new infectious diseases. The provisions in the law comply with the International Health Regulations of the World Health Organization. The Centre for Infectious Disease Control Netherlands at the Dutch National Institute for Public Health and the Environment (RIVM) has issued a booklet for all Dutch physicians and laboratories providing background information on notifiable diseases. This can be useful in daily practice for helping to decide whether a disorder or cluster of infections is notifiable.

Climate change is associated with changes in the occurrence of arthropod-borne diseases. It is difficult to foresee which arthropod-borne diseases will appear in the Netherlands due to climate change. Climate change influences the prevalence of ticks and may lead to a further increase in Lyme disease and an increased risk of the introduction of rickettsioses. With further warming of the climate there is a real possibility of settlement of the mosquito Aedes albopictus and introduction of the sandfly in the Netherlands. Whether this will lead to circulation of micro-organisms transmitted by these vectors (e.g. West Nile virus, Dengue virus, Leishmania) is not clear. Continued vigilance is necessary, even for vector-borne diseases that appear to be less relevant for the Netherlands.

The Netherlands' Infectious diseases Surveillance Information System (ISIS) was developed 12 years ago as an early warning system for the country. The initial objective was to establish a surveillance system that gathered the test results of all microorganisms from all medical microbiology laboratories (MMLs) in the Netherlands on a daily basis in order to create an early warning system. This paper analyses the most important results of a recent evaluation of the system. The evaluation was based on an analysis of early warning signals to detect outbreaks, number of visits to the ISIS website, and interviews with stakeholders, documentation on the ISIS system, and analyses of the ISIS MML database. While the daily collection of data on all micro-organisms for early warning has been achieved, the connection of all 85 MMLs in the Netherlands to the central ISIS MML database has not been achieved - only 18 MMLs have been connected. This has resulted in a low coverage and non-representative selection of MMLs for the Netherlands and therefore national outbreaks were missed. Data were used to determine trends in antimicrobial resistance over time. The ISIS system was not found suitable for early warning since outbreaks were detected via other systems. However, with some adaptations the ISIS system could be suitable for the surveillance of antimicrobial resistance. Furthermore, the discontinuation of this network would cause the loss of the most important data system for antimicrobial resistance in the Netherlands, since there is no other national system that gathers data on this topic. This evaluation resulted in a restart of the network.

This article describes a retrospective and descriptive study into the added value of ProMED-mail--the global electronic reporting system for outbreaks of emerging infectious diseases and toxins maintained by the International Society for Infectious Diseases--as an early warning system for The Netherlands Early Warning Committee (NEWC). Information about infectious disease events in foreign countries originating from ProMED-mail was retrieved from the reports of the NEWC between May 2006 and June 2007. Each event was analysed in depth in order to determine if it could have been a possible threat to public health in The Netherlands. It was determined whether these events were mentioned in other sources of information used by the NEWC besides ProMED-mail. In addition, we assessed the possible consequences of missing an event when not reading ProMED-mail or of being informed of the event with a time delay. Semi-structured interviews with stakeholders were conducted to explore other functions of ProMED-mail besides early warning. Five out of 25 events reported in ProMED-mail were assessed as a potential threat to The Netherlands, mainly because of the known vulnerability of The Netherlands for vaccine preventable diseases: an outbreak of measles in the United Kingdom and Japan, a case of poliomyelitis in Kenya, and two events concerning Highly Pathogenic Avian Influenza (HPAI) H5N1. The outbreak of measles in Japan and one case of HPAI H5N1 infection in a bird in Germany were only reported by ProMED-mail; the other potential threats were mentioned in other sources with a time delay. ProMED-mail has a limited but real added value over other sources in the early warning of threats. A more specific approach of using ProMED-mail by defining vulnerabilities of a country would be useful and efficient. ProMED-mail is appreciated for providing background and preliminary outbreak information.

Purpose: To compare long-term patency of Heparin-Bonded Dacron (HBD) and Human Umbilical Vein (HUV) vascular prostheses in above-knee femoro-popliteal bypass surgery., Design: A prospective randomized multi-centre clinical trial., Patients and Methods: Femoro-popliteal bypasses were performed in 129 patients between 1996 and 2001. After randomization 70 patients received an HUV and 59 an HBD prosthesis. Patients were followed up every three months during the first postoperative year and yearly thereafter. The median follow-up was 60 months (range 3-96 months). Graft occlusions were detected by duplex scanning, angiography or surgical exploration., Results: The cumulative primary patency rates were 79%, 66% and 58% at 1, 3 and 5 years postoperatively. Primary patency rates for HUV were 74%, 64% and 58% at 1, 3 and 5 years and 84%, 68% and 58% for HBD, respectively (log-rank test, p=0.745). Overall secondary patency rates were 82%, 72% and 61% at 1, 3 and 5 years postoperatively. The overall cumulative limb salvage at 5 years follow-up was 89% (CI 80%-91%) and was not dependent on graft type. Smoking (p=0.019), number of patent crural arteries (p=0.030) and previous cerebro-vascular events (p=0.030) were significant predictors of graft occlusion., Conclusion: There was no difference in long-term graft performance between HUV and HBD for above knee infrainguinal bypass.

Based on the changes in the epidemiology of infectious diseases in the Netherlands in 2000-2005, it is possible to formulate a prediction for the immediate future. Developments that one may expect with a reasonable amount of certainty are a further rise in sexually transmitted diseases, continued vulnerability for infectious diseases for which the State Vaccination Programme distributes vaccines, a slow increase in bacterial resistance, an increase in opportunistic infections, and growing risks for the introduction of new micro-organisms via international travel and trade. Much less certain are the developments surrounding avian influenza A/H5N1, ticks and mosquitoes, the rise and spread of new diseases, and bioterrorism.

Since 2004, outbreaks of fowl plague caused by a highly pathogenic avian influenza virus of the subtype A/H5NI have been reported from various countries in Southeast Asia. To date, 118 cases with 61 deaths have been documented in humans, due to close contact with infected poultry or raw poultry meat. Although efficient human-to-human transmission has not occurred, in a few cases transmission to blood relatives could not be ruled out. In October 2005, outbreaks of A/H5NI in poultry and wild fowl have been confirmed from Turkey, Romania and Russia, due probably to infection via migratory birds. The direct risk of infection in humans in Europe is very low and is associated with direct exposure to infected poultry. In order to address the long-term risk of a pandemic due to recombination of human and avian viruses or to mutations in the avian virus itself, guidelines for pandemic preparedness have been developed and implemented in the Netherlands.

Objective: To establish whether the meetings of the so-called 'early warning committee' recognise all the threats to the public health in the Netherlands caused by infectious diseases., Design: Retrospective and descriptive evaluation., Method: The information about the outbreaks of infectious diseases in the Netherlands and about events in the area of infectious diseases in foreign countries was compared with the domestic and foreign reports discussed in the regular weekly meetings of the Dutch early warning committee. For this purpose, the authors summarized the outbreaks of infectious diseases in the Netherlands in 2002 and 2003 as reported in articles in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine). This summary was then compared with the domestic reports discussed in the meetings of the early warning committee. If an outbreak was not mentioned in the meetings of the early warning committee, the cause for this was established. For the same period, a summary was made of the foreign events in the area of infectious diseases and this was also compared with the foreign reports mentioned in the meetings of the early warning committee. When an event had not been discussed in the meetings of the early warning committee, it was established on the basis of criteria whether the event could have been a threat to public health in the Netherlands., Results: All outbreaks of infectious diseases in the Netherlands had been discussed in the early warning committee. Of the foreign events in 2002, 3 had not been discussed in the committee although they should have been, based on the criteria for a potential threat to the Netherlands: the outbreak of avian influenza A/H5NI in domestic fowl in Hong Kong, the increase among hospitalised patients of carriers of extended-spectrum 3-lactamase producing micro-organisms in Scotland, and outbreaks of measles in several countries. In 2003, all foreign events that could have been a threat to the Netherlands were discussed in the early warning committee., Conclusion: In 2002 and 2003, the meetings of the early warning committee recognised practically all the outbreaks of and threats due to infectious diseases.

Background: Cluster headache (CH) is a comparatively rare, very severe primary headache. Although circumscript and recognisable criteria are available, the diagnosis is often missed or delayed. Besides, while adequate and evidence based treatment is available in diagnosed cases, CH seems to be poorly managed. The authors performed a nationwide survey among CH patients, and looked for factors involved in the diagnostic delay., Methods: The authors performed a nationwide mailing to all Dutch general practitioners (about 5800), and neurologists (about 560) and invited them to refer patients in whom the diagnosis CH was made or considered. Patients could also apply via the Dutch Headache Patients Society. A variety of clinical characteristics were assessed by means of questionnaires. Specifically, patients were asked about the time between their first episode and the diagnosis., Results: The IHS criteria for CH were met by 1429 of 2001 responders, and 1163 of these filled in an extended questionnaire. The male to female ratio was 3.7:1. Mean age at onset was 32 (SD 14) years. Seventy three per cent had episodic CH, 21% had chronic CH, and in 6% the periodicity was undetermined. The time between the first episode and the diagnosis ranged from 1 week to 48 years (median 3 years): 34% had consulted a dentist and 33% an ENT specialist before the diagnosis was established. Among factors that increased the diagnostic delay were the presence of photophobia or phonophobia, nausea, an episodic attack pattern and a low age at onset (p<0.01). Sex or presence of restlessness during episodes did not influence the diagnostic delay., Conclusion: CH remains unrecognised or misdiagnosed in many cases for many years. Photophobia or phonophobia and nausea were in part responsible for this delay, and should be recognised as part of the clinical spectrum of CH. Many patients were first seen by a dentist or ENT specialist for their CH episodes, so more attention should be paid to educate first line physicians to recognise CH, to improve the diagnostic process and so to expose patients to earlier and better treatment of CH.

The Organ Donation Act fills an old gap in the legislation, leading to improvement of the legal position of those involved. Much attention is given to the protection of the potential donor. A new consent procedure is introduced, including the registration of the consent or refusal of all persons aged 18 years or older. Because of the persistent shortage of donor organs the noncommittal nature of organ procurement is changed. Hospitals and nursing homes are obliged to have a protocol for organizing tissue donation. Also, conditions have been created for a just division of the available organs and tissues for transplantation.

If organ donations concern not only the kidneys, but also the liver, pancreas and, sometimes, the heart and (or) lungs, several surgical removal teams, often from different (foreign) transplantation centres, may be involved. This has created organizatory problems resulting in loss of organs for transplantation. In the Nijmegen area since October 1994 a removal team has been active that in the regional donor hospital removes all abdominal organs from the donor on behalf of the various transplantation centres. This regional removal team performed 105 multi-organ explanations in the period from October 1994 to December 1997. The reports that came back from the transplantation centres that had received the organs showed that none of these organs had been lost for transplantation through organizatory problems or anatomical damage. Experiences of operating room staff involved were positive: it was especially the standard surgical techniques and the quiet in the operating room that were appreciated. Special removal teams may greatly improve the evolution of organ donation in the Netherlands.

In asystolic patients, kidney donation is possible by using a non-heart-beating (NHB) donation procedure. This involves in situ perfusion of the kidneys by inserting a catheter into the femoral artery and flushing cold fluid through the kidneys. The introduction of an NHB donation programme leads to ethical questions concerning the guarantees for prudent procedure: How should death of a patient be defined in case of NHB donation? Is there a strict separation of responsibilities of the medical teams in the different phases of the procedure (patient treatment and actual donation procedure)? Are sufficient attention and care given to the relatives? Does the NHB donation procedure not interfere with the care of a patient who is expected to die soon? Extensive discussion with the Medical Ethics Committee of the University Hospital Nijmegen, the Netherlands, has led to a protocol for NHB kidney donation that meets the required guarantees.

Objective: To determine the risk factors that contribute to the transmission and return of scabies in health care institutions., Design: Literature analysis., Setting: Public Health Care Service Midden-Kennemerland. Heemskerk, the Netherlands., Methods: Search of Medline over the years 1976-1996 yielded 34 reports of 44 outbreaks. The contents were qualitatively examined on factors possibly contributing to the transmission and return of scabies in health care institutions., Results: Six such factors that contribute to the transmission and return of scabies in health care institutions were found: (a) among residents in health care institutions a considerable number are, once infested, at risk of developing crusted scabies, (b) many people are exposed through close contact, (c) the generally long diagnostic delay, (d) insufficient survey of the epidemiological problem, (e) treatment failures and (f) incomplete post-intervention monitoring.

Objective: The outcome of renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is evaluated., Patients and Methods: All 7 Dutch transplant centers were invited to review their experience. Among a total of 5791 cadaveric renal transplantations performed between 1978 and 1994, 13 cases (0.2%) in 3 different centres were identified. In 6 cases the vascular reconstruction and transplant operation were performed simultaneously, and in 7 cases separately, with a mean interval of 3.5 yr. The indications for vascular reconstruction were aneurysmal disease in 4 and obstructive disease in 9 cases., Results: The early vascular complications of these procedures were hemorrhage in 4 and renal vein thrombosis in 1 and led to graft loss in 3 cases. The perioperative mortality was 2/13 (15%). The graft and patient survival were 68 and 83% respectively after 1 yr and 17 and 37% after 5 yr. Late mortality was mainly due to cardiovascular disease., Conclusions: Renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is a hazardous procedure with relatively poor short- and long-term results. These observations should be considered in the choice of renal replacement therapy in this special patient population.

Early and late mortality of 313 ICU patients and the quality of life of 118 long term ICU survivors was studied to assess the effectiveness of intensive care for critically ill patients. The survival rate at discharge from the ICU was 76%, falling to 61% at 6 months and to 58% at 1 year. A simplified acute physiology score (SAPS) was recorded on ICU admission, as well as age, length of ICU-stay and the number of complications during intensive care. Information on housing, drug use, hospital admissions, physical condition and functional status 2 years after ICU discharge was collected by means of a questionnaire. No changes in housing occurred, but drug use and the number of hospital admissions were significantly increased. In 21% of the patients a deteriorated physical condition was found, 77% remained unchanged and 2% were improved 2 years after ICU discharge, compared to their condition prior to the acute illness. Major functional impairment was found in 38% of the patients. Although the longterm physical condition and functional status correlated with SAPS and age on ICU admission, the best indicator for quality of life after intensive care proved to be the health status prior to the acute illness.