45 results on '"Cornelia C H, Wielders"'
Search Results
2. Epidemiology of carbapenem-resistant and carbapenemase-producing Enterobacterales in the Netherlands 2017–2019
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Cornelia C. H. Wielders, Leo M. Schouls, Sjoukje H. S. Woudt, Daan W. Notermans, Antoni P. A. Hendrickx, Jacinta Bakker, Ed J. Kuijper, Annelot F. Schoffelen, Sabine C. de Greeff, the Infectious Diseases Surveillance Information System-Antimicrobial Resistance (ISIS-AR) Study Group, and the Dutch CPE Surveillance Study Group
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Enterobacterales ,Carbapenem resistance ,Carbapenemase production ,Surveillance ,Risk factors ,E. coli ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background The Netherlands is currently considered a low endemic country for carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing Enterobacterales (CPE), experiencing only sporadic hospital outbreaks. This study aims to describe susceptibility to carbapenems and the epidemiology of carbapenemase production in Enterobacterales in the Netherlands in 2017–2019. Methods Three complementary nationwide surveillance systems are in place to monitor carbapenem susceptibility in the Netherlands. Routine antimicrobial susceptibility test results from medical microbiology laboratories were used to study phenotypic susceptibility of Escherichia coli and Klebsiella pneumoniae. Pathogen surveillance (of all Enterobacterales species) and mandatory notifications were used to describe the characteristics of CPE positive isolates and affected persons. Results The prevalence of isolates with gradient strip test-confirmed elevated meropenem (> 0.25 mg/L) or imipenem (> 1 mg/L) minimum inhibitory concentration (MIC) in the Netherlands was very low in 2017–2019, with percentages of 0.06% in E. coli and 0.49% in K. pneumoniae, and carbapenem resistances of 0.02% and 0.18%, respectively. A total of 895 unique species/carbapenemase-encoding allele combinations of CPE from 764 persons were submitted between 2017 and 2019, with the annual number of submissions increasing slightly each year. Epidemiological data was available for 660 persons. Screening because of presumed colonisation risk was the reason for sampling in 70.0% (462/660) of persons. Hospitalization abroad was the most common risk factor, being identified in 45.9% of persons. Conclusions Carbapenem resistance of E. coli and K. pneumoniae remains low in the Netherlands. The annual number of CPE isolates slightly increased during the period 2017–2019. Recent hospitalization abroad is the main risk factor for acquisition of CPE.
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- 2022
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3. National surveillance pilot study unveils a multicenter, clonal outbreak of VIM-2-producing Pseudomonas aeruginosa ST111 in the Netherlands between 2015 and 2017
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Jannette Pirzadian, Marjolein C. Persoon, Juliëtte A. Severin, Corné H. W. Klaassen, Sabine C. de Greeff, Marcel G. Mennen, Annelot F. Schoffelen, Cornelia C. H. Wielders, Sandra Witteveen, Marga van Santen-Verheuvel, Leo M. Schouls, Margreet C. Vos, and the Dutch CPE surveillance Study Group
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Medicine ,Science - Abstract
Abstract Verona Integron-encoded Metallo-beta-lactamase (VIM) is the most frequently-encountered carbapenemase in the healthcare-related pathogen Pseudomonas aeruginosa. In the Netherlands, a low-endemic country for antibiotic-resistant bacteria, no national surveillance data on the prevalence of carbapenemase-producing P. aeruginosa (CPPA) was available. Therefore, in 2016, a national surveillance pilot study was initiated to investigate the occurrence, molecular epidemiology, genetic characterization, and resistomes of CPPA among P. aeruginosa isolates submitted by medical microbiology laboratories (MMLs) throughout the country. From 1221 isolates included in the study, 124 (10%) produced carbapenemase (CIM-positive); of these, the majority (95, 77%) were positive for the bla VIM gene using PCR. Sequencing was performed on 112 CIM-positive and 56 CIM-negative isolates (n = 168), and genetic clustering revealed that 75/168 (45%) isolates were highly similar. This genetic cluster, designated Group 1, comprised isolates that belonged to high-risk sequence type ST111/serotype O12, had similar resistomes, and all but two carried the bla VIM-2 allele on an identical class 1 integron. Additionally, Group 1 isolates originated from around the country (i.e. seven provinces) and from multiple MMLs. In conclusion, the Netherlands had experienced a nationwide, inter-institutional, clonal outbreak of VIM-2-producing P. aeruginosa for at least three years, which this pilot study was crucial in identifying. A structured, national surveillance program is strongly advised to monitor the spread of Group 1 CPPA, to identify emerging clones/carbapenemase genes, and to detect transmission in and especially between hospitals in order to control current and future outbreaks.
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- 2021
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4. A mandatory indication-registration tool in hospital electronic medical records enabling systematic evaluation and benchmarking of the quality of antimicrobial use: a feasibility study
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Annemieke K. van den Broek, Berend H. H. Beishuizen, Eric A. F. Haak, Michiel Duyvendak, Jaap ten Oever, Chris Sytsma, Mieke van Triest, Cornelia C. H. Wielders, and Jan M. Prins
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Antibiotic prescribing ,Antibiotic indication ,Antibiotic stewardship ,National surveillance ,Benchmarking ,Quality of care ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Objectives Evaluation of the extent and appropriateness of antimicrobial use is a cornerstone of antibiotic stewardship programs, but it is time-consuming. Documentation of the indication at the moment of prescription might be more time-efficient. We investigated the real-life feasibility of mandatory documentation of the indication for all hospital antibiotic prescriptions for quality evaluation purposes. Methods A mandatory prescription-indication format was implemented in the Electronic Medical Record (EMR) of three hospitals using EPIC or ChipSoft HIX software. We evaluated the retrieved data of all antibiotics (J01) prescribed as empiric therapy in adult patients with respiratory tract infections (RTI) or urinary tract infections (UTI), from January through December 2017 in Hospital A, June through October 2019 in Hospital B and May 2019 through June 2020 in Hospital C. Endpoints were the accuracy of the data, defined as agreement between selected indication for the prescription and the documented indication in the EMR, as assessed by manually screening a representative sample of eligible patient records in the EMR of the three hospitals, and appropriateness of the prescriptions, defined as the prescriptions being in accordance with the national guidelines. Results The datasets of hospitals A, B and C contained 9588, 338 and 5816 empiric antibiotic prescriptions indicated for RTI or UTI, respectively. The selected indication was in accordance with the documented indication in 96.7% (error rate: 10/300), 78.2% (error rate: 53/243), and 86.9% (error rate: 39/298), respectively. A considerable variation in guideline adherence was seen between the hospitals for severe community acquired pneumonia (adherence rate ranged from 35.4 to 53.0%), complicated UTI (40.0–67.1%) and cystitis (5.6–45.3%). Conclusions After local validation of the datasets to verify and optimize accuracy of the data, mandatory documentation of the indication for antibiotics enables a reliable and time-efficient method for systematic registration of the extent and appropriateness of empiric antimicrobial use, which might enable benchmarking both in-hospital and between hospitals.
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- 2021
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5. Impact of Q-fever on physical and psychosocial functioning until 8 years after Coxiella burnetii infection: An integrative data analysis.
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Daphne F M Reukers, Cornelia H M van Jaarsveld, Reinier P Akkermans, Stephan P Keijmel, Gabriella Morroy, Adriana S G van Dam, Peter C Wever, Cornelia C H Wielders, Koos van der Velden, Joris A F van Loenhout, and Jeannine L A Hautvast
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Medicine ,Science - Abstract
BackgroundThis study aimed to determine short- and long-term physical and psychosocial impact of Coxiella burnetii infection in three distinct entities: Q-fever fatigue syndrome (QFS), chronic Q-fever, and patients with past acute Q-fever without QFS or chronic Q-fever.MethodsIntegrative data analysis was performed, combining original data from eight studies measuring quality of life (QoL), fatigue, physical and social functioning with identical validated questionnaires, from three months to eight years after onset infection. Linear trends in each outcome were compared between Q-fever groups using multilevel linear regression analyses to account for repeated measures within patients.ResultsData included 3947 observations of 2313 individual patients (228 QFS, 135 chronic Q-fever and 1950 patients with past acute Q-fever). In the first years following infection, physical and psychosocial impact was highest among QFS patients, and remained high without significant improvements over time. In chronic Q-fever patients, QoL and physical functioning worsened significantly over time. Levels of fatigue and social participation in patients with past acute Q-fever improved significantly over time.ConclusionThe impact differs greatly between the three Q-fever groups. It is important that physicians are aware of these differences, in order to provide relevant care for each patient group.
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- 2022
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6. Mortality associated with carbapenem-susceptible and Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa bacteremia
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Marjolein C. Persoon, Anne F. Voor in’t holt, Cornelia C. H. Wielders, Diederik Gommers, Margreet C. Vos, and Juliëtte A. Severin
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Pseudomonas aeruginosa ,Mortality ,Bacteremia ,Anti-bacterial agents ,Carbapenemase ,Intensive care units ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Studies on various Gram-negative bacteria suggest that resistance to carbapenem antibiotics is responsible for increased mortality in patients; however, results are not conclusive. We first assessed the 28-day in-hospital all-cause mortality in patients with Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa (VIM-PA) bacteremia compared to patients with VIM-negative, carbapenem-susceptible P. aeruginosa (CS-PA) bacteremia. Second, we identified determinants for mortality and survival. Methods All patients with a positive blood culture with VIM-PA or CS-PA between January 2004 and January 2016 were included. Kaplan-Meier survival curves were constructed, and survivors and non-survivors were compared on relevant clinical parameters using univariate analyses, and multivariable analyses using a Cox-proportional hazard model. Results In total, 249 patients were included, of which 58 (23.3%) died. Seventeen out of 40 (42.5%) patients with VIM-PA died, compared to 41 out of 209 (19.6%) patients with CS-PA (difference = 22.9%, P-value = 0.001). Assumed acquisition of the bacterium at the intensive care unit was significantly associated with mortality (HR = 3.32, 95%CI = 1.60–6.87), and having had adequate antibiotic therapy in days 1–14 after the positive blood culture was identified as a determinant for survival (HR = 0.03, 95%CI = 0.01–0.06). VIM-PA vs CS-PA was not identified as an independent risk factor for mortality. Conclusions The crude mortality rate was significantly higher in patients with a VIM-PA bacteremia compared to patients with a CS-PA bacteremia; however, when analyzing the data in a multivariable model this difference was non-significant. Awareness of the presence of P. aeruginosa in the hospital environment that may be transmitted to patients and rapid microbiological diagnostics are essential for timely administration of appropriate antibiotics. Acquisition of P. aeruginosa should be prevented, independent of resistance profile.
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- 2020
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7. A genetic cluster of OXA-244 carbapenemase-producing Escherichia coli ST38 with putative uropathogenicity factors in the Netherlands
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Daan W, Notermans, Annelot F, Schoffelen, Fabian, Landman, Cornelia C H, Wielders, Sandra, Witteveen, Varisha A, Ganesh, Marga, van Santen-Verheuvel, Sabine C, de Greeff, Ed J, Kuijper, Antoni P A, Hendrickx, F S, Stals, Medical Microbiology and Infection Prevention, AII - Infectious diseases, AII - Inflammatory diseases, Elderly care medicine, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, ARD - Amsterdam Reproduction and Development, and Experimental Immunology
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Pharmacology ,Microbiology (medical) ,Infectious Diseases ,Bacterial Proteins ,Escherichia coli ,Humans ,Pharmacology (medical) ,Microbial Sensitivity Tests ,beta-Lactamases ,Escherichia coli Infections ,Netherlands ,Anti-Bacterial Agents - Published
- 2022
8. Use of Antibiotics among Residents Living Close to Poultry or Goat Farms: A Nationwide Analysis in The Netherlands
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Inge Roof, Wim van der Hoek, Lisette Oude Boerrigter, Cornelia C. H. Wielders, and Lidwien A. M. Smit
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antibiotic use ,pneumonia ,livestock ,human ,poultry ,goat ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Prior regional studies found a high risk of pneumonia for people living close to poultry and goat farms. This epidemiological study in the Netherlands used nationwide antibiotic prescription data as a proxy for pneumonia incidence to investigate whether residents of areas with poultry and goat farms use relatively more antibiotics compared to areas without such farms. We used prescription data on antibiotics most commonly prescribed to treat pneumonia in adults and livestock farming data, both with nationwide coverage. Antibiotic use was expressed as defined daily doses per (4-digit Postal Code (PC4) area)-(age group)-(gender)-(month) combination for the year 2015. We assessed the associations between antibiotic use and farm exposure using negative binomial regression. The amoxicillin, doxycycline, and co-amoxiclav use was significantly higher (5–10% difference in use) in PC4 areas with poultry farms present compared to areas without, even after adjusting for age, gender, smoking, socio-economic status, and goat farm presence. The adjusted models showed no associations between antibiotic use and goat farm presence. The variables included in this study could only partly explain the observed regional differences in antibiotic use. This was an ecological study that precludes inference about causal relations. Further research using individual-level data is recommended.
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- 2021
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9. Correction: Time to acquire and lose carriership of ESBL/pAmpC producing E. coli in humans in the Netherlands.
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Peter F M Teunis, Eric G Evers, Paul D Hengeveld, Cindy M Dierikx, Cornelia C H Wielders, and Engeline van Duijkeren
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Medicine ,Science - Abstract
[This corrects the article DOI: 10.1371/journal.pone.0193834.].
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- 2018
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10. Time to acquire and lose carriership of ESBL/pAmpC producing E. coli in humans in the Netherlands.
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Peter F M Teunis, Eric G Evers, Paul D Hengeveld, Cindy M Dierikx, Cornelia C H Wielders, and Engeline van Duijkeren
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Medicine ,Science - Abstract
A subset of the study population from a cross-sectional study of carriership of ESBL/pAmpC-producing E. coli (ESBL-E) in the general population was followed up by five successive samples over an approximate half year period, leading to six samples in 333 persons. Fecal samples were cultured and analyzed for the presence of E. coli types as characterized by MLST, and ESBL/pAmpC genes were analysed by PCR and sequencing. The study included 255 persons who had a negative first sample, to allow observations of acquiring carriership of ESBL-E. Any individual record thus consisted of a series of snapshots of episodes of presence and absence of ESBL-E carriage. A survival model was built to estimate times to acquire or lose carriership, allowing for any combination of ESBL/pAmpC gene and E. coli MLST type. In carriers, the mean time to lose carriership was 1.1 (95% range 0.8-1.6) years. The estimated mean time to acquire carriership was 3.0 (95% range 1.6-6.3) years. Analysis of these times by ESBL/pAmpC gene found substantial variation among resistance genes both in persistence of carriership and in rates of acquiring carriership: blaCTX-M-1, blaCTX-M-14, blaCTX-M-15, blaCTX-M-27 and blaSHV-12 were easily acquired, but blaCTX-M-1 and blaSHV-12 were also easily lost, while blaCTX-M-15, blaCTX-M-27 and blaCMY-2 were more likely to persist. When in addition bacterial host types were included, some combinations appeared more persistent than others (blaCTX-M-1 in ST10 and ST58; blaCTX-M-14, blaCMY-2, and blaSHV-12 in ST69), or were acquired with higher frequency (blaCTX-M-14 in ST38, ST69, and ST131; blaCTX-M-15 and blaCTX-M-27 in ST131; blaSHV-12 in ST69). The relatively short duration of carriership means that when an intervention drastically reduces the exposure of humans to ESBL-E, the prevalence will be halved in 0.66 years. The observed differences between carriage rates of ESBL/pAmpC genes and E. coli strains need further investigation.
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- 2018
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11. National point prevalence study on carriage of multidrug-resistant microorganisms in Dutch long-term care facilities in 2018
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Esther, van Kleef, Cornelia C H, Wielders, Leo M, Schouls, Sabiena G, Feenstra, Cees M P M, Hertogh, Marc J M, Bonten, Yolanda, van Weert, Alma, Tostmann, Mariken, van der Lubben, Sabine C, de Greeff, Elma, Smeets, and Microbes in Health and Disease (MHD)
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0301 basic medicine ,Microbiology (medical) ,Klebsiella pneumoniae ,030106 microbiology ,Population ,Prevalence ,beta-Lactamases/genetics ,beta-Lactamases ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,0302 clinical medicine ,Antibiotic resistance ,Environmental health ,Escherichia coli ,Medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,education ,Escherichia coli Infections ,Pharmacology ,education.field_of_study ,Molecular epidemiology ,biology ,business.industry ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Long-Term Care ,Long-term care ,Escherichia coli/genetics ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Infectious Diseases ,Carriage ,Multilocus sequence typing ,business ,Multilocus Sequence Typing - Abstract
Objectives Long-term care facilities (LTCFs) may act as a reservoir of ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) for hospitals and the general population. In this study, we estimated the prevalence and molecular epidemiology of rectal carriage with ESBL-E and CPE in residents of Dutch LTCFs between March 2018 and December 2018. Methods LTCFs were geographically selected across the country. For each LTCF, a random sample of residents were tested for ESBL-E and CPE in 2018. To identify risk factors for high carriage prevalence and/or individual carriage, characteristics of LTCFs and of a subset of the tested residents were collected. WGS was conducted on isolates from LTCFs with an ESBL-E prevalence of >10% and all CPE isolates to identify institutional clonal transmission. Results A total of 4420 residents of 159 LTCFs were included. The weighted mean ESBL-E prevalence was 8.3% (95% CI: 6.8–10.0) and no CPE were found. In 53 LTCFs (33%), where ESBL-E prevalence was >10%, MLST using WGS (wgMLST) was performed. This included 264 isolates, the majority being Escherichia coli (n = 224) followed by Klebsiella pneumoniae (n = 30). Genetic clusters were identified in more than half (30/53; 57%) of high ESBL-positive LTCFs. Among the E. coli isolates, blaCTX-M-15 (92/224; 41%) and blaCTX-M-27 (40/224; 18%) were the most prevalent ESBL-encoding genes. For K. pneumoniae isolates, the most common was blaCTX-M-15 (23/30; 80%). Conclusions The estimated prevalence of ESBL-E rectal carriage in Dutch LTCFs is 8.3% and resistance is observed mainly in E. coli with predominance of blaCTX-M-15 and blaCTX-M-27. ESBL-E prevalence in LTCFs seems comparable to previously reported prevalence in hospitals and the general population.
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- 2021
12. Incidence and severity of SARS-CoV-2 infection in former Q fever patients as compared to the Dutch population, 2020-2021
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Elisabeth Maria, den Boogert, Marit M A, de Lange, Cornelia C H, Wielders, Ariene, Rietveld, Mirjam J, Knol, and Arianne B, van Gageldonk-Lafeber
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Cohort Studies ,Infectious Diseases ,COVID-19 Testing ,Epidemiology ,SARS-CoV-2 ,Incidence ,COVID-19 ,Humans ,Q Fever ,Retrospective Studies - Abstract
Surveillance data shows a geographical overlap between the early coronavirus disease 2019 (COVID-19) pandemic and the past Q fever epidemic (2007–2010) in the Netherlands. We investigated the relationship between past Q fever and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in 2020/2021, using a retrospective matched cohort study. In January 2021, former Q fever patients received a questionnaire on demographics, SARS-CoV-2 test results and related hospital/intensive care unit (ICU) admissions. SARS-CoV-2 incidence with 95% confidence intervals (CI) in former Q fever patients and standardised incidence ratios (SIR) to compare to the age-standardised SARS-CoV-2 incidence in the general regional population were calculated. Among 890 former Q fever patients (response rate: 68%), 66 had a PCR-confirmed SARS-CoV-2 infection. Of these, nine (14%) were hospitalised and two (3%) were admitted to ICU. From February to June 2020 the SARS-CoV-2 incidence was 1573/100 000 (95% CI 749–2397) in former Q fever patients and 695/100 000 in the general population (SIR 2.26; 95% CI 1.24–3.80). The incidence was not significantly higher from September 2020 to February 2021. We found no sufficient evidence for a difference in SARS-CoV-2 incidence or an increased severity in former Q fever patients vs. the general population during the period with widespread SARS-CoV-2 testing availability (September 2020–February 2021). This indicates that former Q fever patients do not have a higher risk of SARS-CoV-2 infection.
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- 2022
13. Spatial analysis of positive and negative Q fever laboratory results for identifying high- and low-risk areas of infection in the Netherlands
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Elsa J. van den Berg, Cornelia C. H. Wielders, Peter M. Schneeberger, Marjolijn C. Wegdam-Blans, and Wim van der Hoek
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zoonosis ,Coxiella burnetii ,goats ,the Netherlands ,case–control ,risk factors ,epidemiology ,Infectious and parasitic diseases ,RC109-216 - Abstract
Background: The Netherlands faced a large Q fever epidemic from 2007 to 2010, in which thousands of people were tested for the presence of antibodies against Coxiella burnetii as part of individual patient diagnosis. So far, only data of notified cases were used for the identification of high-risk areas, which can lead to misclassification of risk. Therefore, we identified high- and low-risk areas based on laboratory test results to make control measures more efficient. Methods: Data on diagnostic Q fever laboratory tests were obtained from two regional laboratories of medical microbiology in the high-incidence area in the south of the Netherlands. The proportion of patients testing positive was mapped per postal code area. Patients testing positive were compared to patients testing negative based on the distance between residential address and the nearest infected goat farm with adjustment for age and sex. Results and conclusion: Of 11,035 patients tested, 4,011 (36.4%) had a positive laboratory test result for Q fever. Maps showing the spatial pattern of tests performed and proportion of positive tests allowed for the identification of high- and low-risk Q fever areas. The proportion of patients testing positive was higher in areas close to infected goat farms compared to areas further away. Patients living 10 km away (OR 21.70, 95% CI 16.28–28.92). Laboratory test results have the potential to make control measures more efficient by identifying high-risk areas as well as low-risk areas.
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- 2013
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14. National surveillance pilot study unveils a multicenter, clonal outbreak of VIM-2-producing Pseudomonas aeruginosa ST111 in the Netherlands between 2015 and 2017
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I.T.M.A. Overdevest, A. Voss, Marga G van Santen-Verheuvel, M. den Reijer, J. H. Oudbier, M. van der Vusse, S. Dinant, A.G.M. Buiting, A. Stam, B.M.W. Diederen, T. Halaby, P. Schneeberger, B. Zwart, A.E. Muller, Sabine C. de Greeff, M.L. van Ogtrop, E.P.M. van Elzakker, R. Steingrover, A.L.M. Vlek, Heiman F. L. Wertheim, Sandra Witteveen, A. Troelstra, Daan W. Notermans, Jan Kluytmans, D. C. Melles, E. de Jong, E. Heikens, J.W. Dorigo-Zetsma, E.E. Mattsson, Jannette Pirzadian, S. Paltansing, W. Silvis, M. Damen, M. van der Linden, I. J. B. Spijkerman, J. C. Sinnige, T. Schulin, A. Maijer-Reuwer, M. van Rijn, Marjolein C. Persoon, S.P. van Mens, P. de Man, A.J. van Griethuysen, R.W. Bosboom, Erik Bathoorn, J.W. Cohen Stuart, Leo M. Schouls, H.M.E. Frénay, Cornelia C. H. Wielders, K.R.A. van Dijk, D.W. van Dam, Annelot F. Schoffelen, Juliëtte A. Severin, T. A. M. Trienekens, E. I. G. B. de Brauwer, K. Waar, Margreet C. Vos, M.A. Leversteijn-van Hall, A. van Dam, Corné H. W. Klaassen, M. van Trijp, M.J.H.M. Wolfhagen, Marcel G. Mennen, L. Bode, N. Roescher, A. Ott, F.S. Stals, Medical Microbiology and Infection Prevention, Nursing, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, AII - Infectious diseases, Experimental Immunology, Medical Microbiology & Infectious Diseases, Anatomy and neurosciences, AMS - Ageing & Vitality, AMS - Tissue Function & Regeneration, Amsterdam Neuroscience - Neurodegeneration, and Amsterdam Neuroscience - Neuroinfection & -inflammation
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Serotype ,medicine.medical_specialty ,Science ,Pilot Projects ,Microbial Sensitivity Tests ,Integron ,Disease cluster ,medicine.disease_cause ,Antimicrobial resistance ,History, 21st Century ,beta-Lactam Resistance ,beta-Lactamases ,Article ,Disease Outbreaks ,Medical microbiology ,medicine ,Humans ,Pseudomonas Infections ,Public Health Surveillance ,Geography, Medical ,Clinical microbiology ,Phylogeny ,Netherlands ,Multidisciplinary ,biology ,Molecular epidemiology ,Pseudomonas aeruginosa ,Transmission (medicine) ,Outbreak ,Virology ,Anti-Bacterial Agents ,biology.protein ,Next-generation sequencing ,Medicine ,Bacterial infection ,Multilocus Sequence Typing - Abstract
Verona Integron-encoded Metallo-beta-lactamase (VIM) is the most frequently-encountered carbapenemase in the healthcare-related pathogen Pseudomonas aeruginosa. In the Netherlands, a low-endemic country for antibiotic-resistant bacteria, no national surveillance data on the prevalence of carbapenemase-producing P. aeruginosa (CPPA) was available. Therefore, in 2016, a national surveillance pilot study was initiated to investigate the occurrence, molecular epidemiology, genetic characterization, and resistomes of CPPA among P. aeruginosa isolates submitted by medical microbiology laboratories (MMLs) throughout the country. From 1221 isolates included in the study, 124 (10%) produced carbapenemase (CIM-positive); of these, the majority (95, 77%) were positive for the blaVIM gene using PCR. Sequencing was performed on 112 CIM-positive and 56 CIM-negative isolates (n = 168), and genetic clustering revealed that 75/168 (45%) isolates were highly similar. This genetic cluster, designated Group 1, comprised isolates that belonged to high-risk sequence type ST111/serotype O12, had similar resistomes, and all but two carried the blaVIM-2 allele on an identical class 1 integron. Additionally, Group 1 isolates originated from around the country (i.e. seven provinces) and from multiple MMLs. In conclusion, the Netherlands had experienced a nationwide, inter-institutional, clonal outbreak of VIM-2-producing P. aeruginosa for at least three years, which this pilot study was crucial in identifying. A structured, national surveillance program is strongly advised to monitor the spread of Group 1 CPPA, to identify emerging clones/carbapenemase genes, and to detect transmission in and especially between hospitals in order to control current and future outbreaks.
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- 2021
15. A mandatory indication-registration tool in hospital electronic medical records enabling systematic evaluation and benchmarking of the quality of antimicrobial use: a feasibility study
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Michiel Duyvendak, Mieke van Triest, Berend H. H. Beishuizen, Eric A. F. Haak, Annemieke K. van den Broek, Cornelia C. H. Wielders, Jaap ten Oever, Jan M. Prins, Chris Sytsma, Graduate School, Infectious diseases, and AII - Infectious diseases
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Adult ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,media_common.quotation_subject ,030106 microbiology ,lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] ,Infectious and parasitic diseases ,RC109-216 ,Mandatory Programs ,Antimicrobial Stewardship ,03 medical and health sciences ,0302 clinical medicine ,Documentation ,Community-acquired pneumonia ,Electronic Health Records ,Humans ,Medicine ,Pharmacology (medical) ,Quality (business) ,030212 general & internal medicine ,Medical prescription ,Respiratory Tract Infections ,Netherlands ,media_common ,Antibiotic stewardship ,Respiratory tract infections ,business.industry ,Research ,Medical record ,Public Health, Environmental and Occupational Health ,Quality of care ,Antibiotic prescribing ,Benchmarking ,medicine.disease ,Hospitals ,Anti-Bacterial Agents ,Infectious Diseases ,Urinary Tract Infections ,Emergency medicine ,Antibiotic indication ,National surveillance ,Feasibility Studies ,Guideline Adherence ,business ,Empiric therapy - Abstract
ObjectivesEvaluation of the extent and appropriateness of antimicrobial use is a cornerstone of antibiotic stewardship programs, but it is time-consuming. Documentation of the indication at the moment of prescription might be more time-efficient. We investigated the real-life feasibility of mandatory documentation of the indication for all hospital antibiotic prescriptions for quality evaluation purposes.MethodsA mandatory prescription-indication format was implemented in the Electronic Medical Record (EMR) of three hospitals using EPIC or ChipSoft HIX software. We evaluated the retrieved data of all antibiotics (J01) prescribed as empiric therapy in adult patients with respiratory tract infections (RTI) or urinary tract infections (UTI), from January through December 2017 in Hospital A, June through October 2019 in Hospital B and May 2019 through June 2020 in Hospital C. Endpoints were the accuracy of the data, defined as agreement between selected indication for the prescription and the documented indication in the EMR, as assessed by manually screening a representative sample of eligible patient records in the EMR of the three hospitals, and appropriateness of the prescriptions, defined as the prescriptions being in accordance with the national guidelines.ResultsThe datasets of hospitals A, B and C contained 9588, 338 and 5816 empiric antibiotic prescriptions indicated for RTI or UTI, respectively. The selected indication was in accordance with the documented indication in 96.7% (error rate: 10/300), 78.2% (error rate: 53/243), and 86.9% (error rate: 39/298), respectively. A considerable variation in guideline adherence was seen between the hospitals for severe community acquired pneumonia (adherence rate ranged from 35.4 to 53.0%), complicated UTI (40.0–67.1%) and cystitis (5.6–45.3%).ConclusionsAfter local validation of the datasets to verify and optimize accuracy of the data, mandatory documentation of the indication for antibiotics enables a reliable and time-efficient method for systematic registration of the extent and appropriateness of empiric antimicrobial use, which might enable benchmarking both in-hospital and between hospitals.
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- 2021
16. Persistent high IgG phase I antibody levels against Coxiella burnetii among veterinarians compared to patients previously diagnosed with acute Q fever after three years of follow-up.
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Cornelia C H Wielders, Anneroos W Boerman, Barbara Schimmer, René van den Brom, Daan W Notermans, Wim van der Hoek, and Peter M Schneeberger
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Medicine ,Science - Abstract
BACKGROUND: Little is known about the development of chronic Q fever in occupational risk groups. The aim of this study was to perform long-term follow-up of Coxiella burnetii seropositive veterinarians and investigate the course of IgG phase I and phase II antibodies against C. burnetii antigens and to compare this course with that in patients previously diagnosed with acute Q fever. METHODS: Veterinarians with IgG phase I ≥ 1:256 (immunofluorescence assay) that participated in a previous seroprevalence study were asked to provide a second blood sample three years later. IgG antibody profiles were compared to a group of acute Q fever patients who had IgG phase I ≥ 1:256 twelve months after diagnosis. RESULTS: IgG phase I was detected in all veterinarians (n = 76) and in 85% of Q fever patients (n = 98) after three years (p
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- 2015
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17. Long-Term Serological Follow-Up of Acute Q-Fever Patients after a Large Epidemic.
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Cornelia C H Wielders, Joris A F van Loenhout, Gabriëlla Morroy, Ariene Rietveld, Daan W Notermans, Peter C Wever, Nicole H M Renders, Alexander C A P Leenders, Wim van der Hoek, and Peter M Schneeberger
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Medicine ,Science - Abstract
Serological follow-up of acute Q-fever patients is important for detection of chronic infection but there is no consensus on its frequency and duration. The 2007-2009 Q-fever epidemic in the Netherlands allowed for long-term follow-up of a large cohort of acute Q-fever patients. The aim of this study was to validate the current follow-up strategy targeted to identify patients with chronic Q-fever.A cohort of adult acute Q-fever patients, diagnosed between 2007 and 2009, for whom a twelve-month follow-up sample was available, was invited to complete a questionnaire and provide a blood sample, four years after the acute episode. Antibody profiles, determined by immunofluorescence assay in serum, were investigated with a special focus on high titres of IgG antibodies against phase I of Coxiella burnetii, as these are considered indicative for possible chronic Q-fever.Of the invited 1,907 patients fulfilling inclusion criteria, 1,289 (67.6%) were included in the analysis. At any time during the four-year follow-up period, 58 (4.5%) patients were classified as possible, probable, or proven chronic Q-fever according to the Dutch Q-fever Consensus Group criteria (which uses IgG phase I ≥1:1,024 to as serologic criterion for chronic Q-fever). Fifty-two (89.7%) of these were identified within the first year after the acute episode. Of the six patients that were detected for the first time at four-year follow-up, five had an IgG phase I titre of 1:512 at twelve months.A twelve-month follow-up check after acute Q-fever is recommended as it adequately detects chronic Q-fever in patients without known risk factors. Additional serological and clinical follow-up is recommended for patients with IgG phase I ≥1:512, as they showed the highest risk to progress to chronic Q-fever.
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- 2015
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18. Characteristics of hospitalized acute Q fever patients during a large epidemic, The Netherlands.
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Cornelia C H Wielders, Annemarie M H Wuister, Veerle L de Visser, Monique G de Jager-Leclercq, Cornelis A R Groot, Frederika Dijkstra, Arianne B van Gageldonk-Lafeber, Jeroen P G van Leuken, Peter C Wever, Wim van der Hoek, and Peter M Schneeberger
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Medicine ,Science - Abstract
From 2007 to 2009, The Netherlands experienced a major Q fever epidemic, with higher hospitalization rates than the 2-5% reported in the literature for acute Q fever pneumonia and hepatitis. We describe epidemiological and clinical features of hospitalized acute Q fever patients and compared patients presenting with Q fever pneumonia with patients admitted for other forms of community-acquired pneumonia (CAP). We also examined whether proximity to infected ruminant farms was a risk factor for hospitalization.A retrospective cohort study was conducted for all patients diagnosed and hospitalized with acute Q fever between 2007 and 2009 in one general hospital situated in the high incidence area in the south of The Netherlands. Pneumonia severity scores (PSI and CURB-65) of acute Q fever pneumonia patients (defined as infiltrate on a chest x-ray) were compared with data from CAP patients. Hepatitis was defined as a >twofold the reference value for alanine aminotransferase and for bilirubin.Among the 183 hospitalized acute Q fever patients, 86.0% had pneumonia. Elevated liver enzymes (alanine aminotransferase) were found in 32.3% of patients, although hepatitis was not observed in any of them. The most frequent clinical signs upon presentation were fever, cough and dyspnoea. The median duration of admission was five days. Acute Q fever pneumonia patients were younger, had less co-morbidity, and lower PSI and CURB-65 scores than other CAP patients. Anecdotal information from attending physicians suggests that some patients were admitted because of severe subjective dyspnoea, which was not included in the scoring systems. Proximity to an infected ruminant farm was not associated with hospitalization.Hospitalized Dutch acute Q fever patients mostly presented with fever and pneumonia. Patients with acute Q fever pneumonia were hospitalized despite low PSI and CURB-65 scores, presumably because subjective dyspnoea was not included in the scoring systems.
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- 2014
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19. Large regional differences in serological follow-up of Q fever patients in the Netherlands.
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Gabriëlla Morroy, Cornelia C H Wielders, Mandy J B Kruisbergen, Wim van der Hoek, Jan H Marcelis, Marjolijn C A Wegdam-Blans, Clementine J Wijkmans, and Peter M Schneeberger
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Medicine ,Science - Abstract
BACKGROUND: During the Dutch Q fever epidemic more than 4,000 Q fever cases were notified. This provided logistical challenges for the organisation of serological follow-up, which is considered mandatory for early detection of chronic infection. The aim of this study was to investigate the proportion of acute Q fever patients that received serological follow-up, and to identify regional differences in follow-up rates and contributing factors, such as knowledge of medical practitioners. METHODS: Serological datasets of Q fever patients diagnosed between 2007 and 2009 (N = 3,198) were obtained from three Laboratories of Medical Microbiology (LMM) in the province of Noord-Brabant. One LMM offered an active follow-up service by approaching patients; the other two only tested on physician's request. The medical microbiologist in charge of each LMM was interviewed. In December 2011, 240 general practices and 112 medical specialists received questionnaires on their knowledge and practices regarding the serological follow-up of Q fever patients. RESULTS: Ninety-five percent (2,226/2,346) of the Q fever patients diagnosed at the LMM with a follow-up service received at least one serological follow-up within 15 months of diagnosis. For those diagnosed at a LMM without this service, this was 25% (218/852) (OR 54, 95% CI 43-67). Although 80% (162/203) of all medical practitioners with Q fever patients reported informing patients of the importance of serological follow-up, 33% (67/203) never requested it. CONCLUSIONS: Regional differences in follow-up are substantial and range from 25% to 95%. In areas with a low follow-up rate the proportion of missed chronic Q fever is potentially higher than in areas with a high follow-up rate. Medical practitioners lack knowledge regarding the need, timing and implementation of serological follow-up, which contributes to patients receiving incorrect or no follow-up. Therefore, this information should be incorporated in national guidelines and patient information forms.
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- 2013
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20. Seasonality in carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in the general population: a pooled analysis of nationwide cross-sectional studies
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S.C. de Greeff, Eelco Franz, Cindy M Dierikx, Anouk P Meijs, Cornelia C. H. Wielders, G van den Bunt, W. van Pelt, Marc J. M. Bonten, and E. van Duijkeren
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Male ,0301 basic medicine ,Veterinary medicine ,Antibiotic resistance ,Epidemiology ,Cross-sectional study ,Klebsiella pneumoniae ,Logistic regression ,Feces ,0302 clinical medicine ,polycyclic compounds ,030212 general & internal medicine ,education.field_of_study ,biology ,seasonality ,Enterobacteriaceae Infections ,Middle Aged ,Infectious Diseases ,Carrier State ,Female ,Seasons ,medicine.symptom ,Adult ,Adolescent ,prevalence ,030106 microbiology ,Population ,Asymptomatic ,beta-Lactamases ,Young Adult ,03 medical and health sciences ,Enterobacteriaceae ,Bacterial Proteins ,Drug Resistance, Bacterial ,Escherichia coli ,medicine ,Short Paper ,Humans ,education ,Aged ,business.industry ,Odds ratio ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,Confidence interval ,Cross-Sectional Studies ,Carriage ,bacteria ,business - Abstract
Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are often preceded by asymptomatic carriage. Higher incidences in enteric infectious diseases during summer have been reported. Here, we assessed whether the presence of seasonality in intestinal ESBL-Escherichia coli/Klebsiella pneumoniae (ESBL-E/K) carriage in the general Dutch population exists. From 2014 to 2017, the faecal carriage of ESBL-E/K in healthy individuals was determined in three cross-sectional studies in the Netherlands, including 5985 subjects. Results were pooled to identify seasonal trends in prevalence (by month of sampling). Multivariate logistic regression analysis was used to calculate pooled odds ratios and 95% confidence intervals. Results were adjusted for age, sex, antibiotic use and travel. Overall prevalence of ESBL-E/K carriage was 4.3% (n = 260 ESBL-E/K-positive), with differences between months ranging from 2.6% to 7.4%. Compared to January, the monthly prevalence of ESBL-E carriage was highest in August (OR 1.88, 95% CI 1.02–3.49) and September (OR 2.25, 95% CI 1.30–3.89). The observed monthly differences in ESBL-E/K carriage rates suggest that there is seasonal variation in exposure to ESBL-E/K other than due to travelling and antibiotic use. This should be taken into account in designing future ESBL-E prevalence studies in temperate regions.
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- 2020
21. Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands
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Peter M. Schneeberger, Marit M A de Lange, Wim van der Hoek, Cornelia C. H. Wielders, Chantal P. Bleeker-Rovers, Jan Jelrik Oosterheert, Frederika Dijkstra, Pieter T de Boer, and Sonja E van Roeden
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Male ,economic evaluation ,Epidemiology ,Cost effectiveness ,Cost-Benefit Analysis ,lcsh:Medicine ,0302 clinical medicine ,Chronic Q fever ,Prevalence ,Mass Screening ,Targeted screening ,030212 general & internal medicine ,bacteria ,Netherlands ,Aged, 80 and over ,biology ,Incidence (epidemiology) ,Age Factors ,Middle Aged ,Infectious Diseases ,Coxiella burnetii ,Female ,Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands ,Adult ,Microbiology (medical) ,030231 tropical medicine ,Q fever ,Decision Support Techniques ,lcsh:Infectious and parasitic diseases ,Young Adult ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,Environmental health ,medicine ,Humans ,lcsh:RC109-216 ,cost-effectiveness ,Mass screening ,Aged ,business.industry ,Research ,screening ,the Netherlands ,lcsh:R ,medicine.disease ,biology.organism_classification ,zoonoses ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Economic evaluation ,business - Abstract
In the aftermath of a large Q fever (QF) epidemic in the Netherlands during 2007-2010, new chronic QF (CQF) patients continue to be detected. We developed a health-economic decision model to evaluate the cost-effectiveness of a 1-time screening program for CQF 7 years after the epidemic. The model was parameterized with spatial data on QF notifications for the Netherlands, prevalence data from targeted screening studies, and clinical data from the national QF database. The cost-effectiveness of screening varied substantially among subpopulations and geographic areas. Screening that focused on cardiovascular risk patients in areas with high QF incidence during the epidemic ranged from cost-saving to €31,373 per quality-adjusted life year gained, depending on the method to estimate the prevalence of CQF. The cost per quality-adjusted life year of mass screening of all older adults was €70,000 in the most optimistic scenario.
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- 2020
22. Comparing pandemic to seasonal influenza mortality: moderate impact overall but high mortality in young children.
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Cees C van den Wijngaard, Liselotte van Asten, Marion P G Koopmans, Wilfrid van Pelt, Nico J D Nagelkerke, Cornelia C H Wielders, Alies van Lier, Wim van der Hoek, Adam Meijer, Gé A Donker, Frederika Dijkstra, Carel Harmsen, Marianne A B van der Sande, and Mirjam Kretzschmar
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Medicine ,Science - Abstract
BackgroundWe assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed - and thus an underestimation - whereas seasonal influenza mortality is often more inclusively estimated. For a valid comparison, our study used the same statistical methodology and data types to estimate pandemic and seasonal influenza mortality.Methods and findingsWe used data on all-cause mortality (1999-2010, 100% coverage, 16.5 million Dutch population) and influenza-like-illness (ILI) incidence (0.8% coverage). Data was aggregated by week and age category. Using generalized estimating equation regression models, we attributed mortality to influenza by associating mortality with ILI-incidence, while adjusting for annual shifts in association. We also adjusted for respiratory syncytial virus, hot/cold weather, other seasonal factors and autocorrelation. For the 2009 pandemic season, we estimated 612 (range 266-958) influenza-attributed deaths; for seasonal influenza 1,956 (range 0-3,990). 15,845 years-of-life-lost were estimated for the pandemic; for an average seasonal epidemic 17,908. For 0-4 yrs of age the number of influenza-attributed deaths during the pandemic were higher than in any seasonal epidemic; 77 deaths (range 61-93) compared to 16 deaths (range 0-45). The ≥75 yrs of age showed a far below average number of deaths. Using pneumonia/influenza and respiratory/cardiovascular instead of all-cause deaths consistently resulted in relatively low total pandemic mortality, combined with high impact in the youngest age category.ConclusionThe pandemic had an overall moderate impact on mortality compared to 10 preceding seasonal epidemics, with higher mortality in young children and low mortality in the elderly. This resulted in a total number of pandemic deaths far below the average for seasonal influenza, and a total number of years-of-life-lost somewhat below average. Comparing pandemic and seasonal influenza mortality as in our study will help assessing the worldwide impact of the 2009 pandemic.
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- 2012
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23. Notification data and criteria during a large Q-fever epidemic reassessed
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Frederika Dijkstra, D. A. T. Hanssen, G. Morroy, Cornelia C. H. Wielders, W. van der Hoek, Peter M. Schneeberger, M.M.A. de Lange, MUMC+: DA MMI AIOS (9), and RS: FHML non-thematic output
- Subjects
medicine.medical_specialty ,COXIELLA-BURNETII ,ANTIBODY-RESPONSE ,Epidemiology ,Igm antibody ,OUTBREAK ,serology ,Enzyme-Linked Immunosorbent Assay ,Q fever ,DIAGNOSIS ,Polymerase Chain Reaction ,Serology ,Public health service ,Seroepidemiologic Studies ,INFECTION ,HISTORY ,Prevalence ,medicine ,Humans ,Mass Screening ,Seroprevalence ,ASSAYS ,Seroconversion ,Epidemics ,Disease Notification ,notification criteria ,Netherlands ,Original Paper ,Health professionals ,IGM PHASE-II ,business.industry ,Incidence ,Outbreak ,medicine.disease ,Infectious Diseases ,PCR ,Emergency medicine ,Acute Q-fever ,Laboratories ,Q Fever ,FOLLOW-UP ,business - Abstract
From 2007 to 2010, the largest reported Q-fever epidemic occurred in the Netherlands with 4026 notified laboratory-confirmed cases. During the course of the epidemic, health-seeking behaviour changed and awareness among health professionals increased. Changes in laboratory workflows were implemented. The aim of this study was to analyse how these changes instigated adjustments of notification criteria and how these adjustments affected the monitoring and interpretation of the epidemic. We used the articles on laboratory procedures related to the epidemic and a description of the changes that were made to the notification criteria. We compared the output of a regional laboratory with notifications to the regional Public Health Service and the national register of infectious diseases. We compared the international notification criteria for acute Q-fever. Screening with ELISA IgM phase II and PCR was added to the diagnostic workflow. In the course of the epidemic, serology often revealed a positive IgG/IgM result although cases were not infected recently. With increasing background seroprevalence, the presence of IgM antibodies can only be suggestive for acute Q-fever and has to be confirmed either by seroconversion of IgG or a positive PCR result. Differences in sero-epidemiology make it unlikely that full harmonisation of notification criteria between countries is feasible.
- Published
- 2019
24. Use of a Dose-Response Model to Study Temporal Trends in Spatial Exposure toCoxiella burnetii: Analysis of a Multiyear Outbreak of Q Fever
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Cornelia C. H. Wielders, Lance A. Waller, Peter M. Schneeberger, Russell John Brooke, Mirjam Kretzschmar, and Peter Teunis
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model-based geostatistics ,0301 basic medicine ,Time Factors ,Response model ,Epidemiology ,030106 microbiology ,Q fever ,Models, Biological ,Disease Outbreaks ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Journal Article ,Humans ,Medicine ,030212 general & internal medicine ,Netherlands ,outbreak ,General Veterinary ,General Immunology and Microbiology ,biology ,business.industry ,Intervention design ,Risk of infection ,Incidence (epidemiology) ,Public Health, Environmental and Occupational Health ,Outbreak ,Bayes Theorem ,Temporal correlation ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,Virology ,Infectious Diseases ,dose–response ,business - Abstract
The Netherlands underwent a large Q fever outbreak between 2007 and 2009. In this paper, we study spatial and temporal Coxiella burnetii exposure trends during this large outbreak as well as validate outcomes against other published studies and provide evidence to support hypotheses on the causes of the outbreak. To achieve this, we develop a framework using a dose-response model to translate acute Q fever case incidence into exposure estimates. More specifically, we incorporate a geostatistical model that accounts for spatial and temporal correlation of exposure estimates from a human Q fever dose-response model to quantify exposure trends during the outbreak. The 2051 cases, with the corresponding age, gender and residential addresses, reside in the region with the highest attack rates during the outbreak in the Netherlands between 2006 and 2009. We conclude that the multiyear outbreak in the Netherlands is caused by sustained release of infectious bacteria from the same sources, which suggests that earlier implementation of interventions may have prevented many of the cases. The model predicts the risk of infection and acute symptomatic Q fever from multiple exposure sources during a multiple-year outbreak providing a robust, evidence-based methodology to support decision-making and intervention design.
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- 2016
25. Reply to Million and Raoult
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Peter M. Schneeberger, Wim van der Hoek, Cornelia C. H. Wielders, Arko Scheepmaker, Laura E V Gijsen, and Marit M A de Lange
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0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Endocarditis ,business.industry ,030106 microbiology ,Heart Valve Diseases ,MEDLINE ,Raoult's law ,medicine.disease ,Dermatology ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Humans ,Medicine ,030212 general & internal medicine ,Q Fever ,business - Published
- 2018
26. Should acute Q-fever patients be screened for valvulopathy to prevent endocarditis?
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Wim van der Hoek, Cornelia C. H. Wielders, Laura E V Gijsen, Peter M. Schneeberger, Marit M A de Lange, and Arko Scheepmaker
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0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,heart valve disease ,030106 microbiology ,Antibiotics ,Q fever ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,echocardiography ,Endocarditis ,030212 general & internal medicine ,Antibiotic prophylaxis ,Stage (cooking) ,Q-fever ,business.industry ,Retrospective cohort study ,medicine.disease ,Articles and Commentary ,Infectious Diseases ,Coxiella burnetii ,Cohort ,endocarditis ,Population study ,business - Abstract
We found no difference in occurrence of chronic Q-fever between patients with or without a newly detected valvulopathy at time of acute Q-fever diagnosis. Thus, universal screening is not justified and would lead to unnecessary and undesirable long-term antibiotic use., Background Echocardiographic screening of acute Q-fever patients and antibiotic prophylaxis for patients with cardiac valvulopathy is considered an important approach to prevent chronic Q-fever-related endocarditis. During a large Q-fever epidemic in the Netherlands, routine screening echocardiography was discontinued, raising controversy in the international literature. We followed a cohort of acute Q-fever patients to estimate the risk for developing chronic Q-fever, and we evaluated the impact of screening in patients who were not yet known to have a valvulopathy. Methods The study population consisted of patients diagnosed with acute Q-fever in 2007 and 2008. We retrospectively reviewed all screening echocardiographs and checked for development of chronic Q-fever 8 years after the acute episode. Risks of developing chronic Q-fever in relation to the presence or absence of valvulopathy were analyzed with logistic regression. Results The cohort included 509 patients, of whom 306 received echocardiographic screening. There was no significant difference (P-value = .22) in occurrence of chronic Q-fever between patients with a newly detected valvulopathy (2/84, 2.4%) and those with no valvulopathy (12/202, 5.9%). Two patients with a newly detected valvulopathy, who did not receive antibiotic prophylaxis, developed chronic Q-fever at a later stage. Conclusions We found no difference in outcome between patients with and without a valvulopathy newly detected by echocardiographic screening. In retrospect, the 2 above-mentioned patients could have benefitted from antibiotic prophylaxis, but its omission must be weighed against the unnecessary large-scale and long-term use of antibiotics that would have resulted from universal echocardiographic screening.
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- 2018
27. Time to acquire and lose carriership of ESBL/pAmpC producing E. coli in humans in the Netherlands
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Eric G Evers, Cornelia C. H. Wielders, P Hengeveld, Peter Teunis, Cindy M Dierikx, and Engeline van Duijkeren
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0301 basic medicine ,Time Factors ,Molecular biology ,Gene Sequencing ,lcsh:Medicine ,Geographical locations ,Feces ,Sequencing techniques ,Longitudinal Studies ,DNA sequencing ,lcsh:Science ,Escherichia coli Infections ,Netherlands ,education.field_of_study ,Multidisciplinary ,Escherichia coli Proteins ,Enteric Bacteria ,Europe ,Research Design ,Carrier State ,Physical Sciences ,Population study ,Research Article ,medicine.medical_specialty ,030106 microbiology ,Population ,Bacterial host ,Biology ,Research and Analysis Methods ,Models, Biological ,beta-Lactamases ,03 medical and health sciences ,Bacterial Proteins ,Enterobacteriaceae ,Internal medicine ,medicine ,Escherichia coli ,Humans ,European Union ,education ,Short duration ,Survival analysis ,Behavior ,Bacteria ,lcsh:R ,Organisms ,Correction ,Biology and Life Sciences ,Probability Theory ,Probability Distribution ,Survival Analysis ,Probability Density ,Carriage ,Cross-Sectional Studies ,Molecular biology techniques ,Multilocus sequence typing ,lcsh:Q ,People and places ,Mathematics - Abstract
A subset of the study population from a cross-sectional study of carriership of ESBL/pAmpC-producing E. coli (ESBL-E) in the general population was followed up by five successive samples over an approximate half year period, leading to six samples in 333 persons. Fecal samples were cultured and analyzed for the presence of E. coli types as characterized by MLST, and ESBL/pAmpC genes were analysed by PCR and sequencing. The study included 255 persons who had a negative first sample, to allow observations of acquiring carriership of ESBL-E. Any individual record thus consisted of a series of snapshots of episodes of presence and absence of ESBL-E carriage. A survival model was built to estimate times to acquire or lose carriership, allowing for any combination of ESBL/pAmpC gene and E. coli MLST type. In carriers, the mean time to lose carriership was 1.1 (95% range 0.8-1.6) years. The estimated mean time to acquire carriership was 3.0 (95% range 1.6-6.3) years. Analysis of these times by ESBL/pAmpC gene found substantial variation among resistance genes both in persistence of carriership and in rates of acquiring carriership: blaCTX-M-1, blaCTX-M-14, blaCTX-M-15, blaCTX-M-27 and blaSHV-12 were easily acquired, but blaCTX-M-1 and blaSHV-12 were also easily lost, while blaCTX-M-15, blaCTX-M-27 and blaCMY-2 were more likely to persist. When in addition bacterial host types were included, some combinations appeared more persistent than others (blaCTX-M-1 in ST10 and ST58; blaCTX-M-14, blaCMY-2, and blaSHV-12 in ST69), or were acquired with higher frequency (blaCTX-M-14 in ST38, ST69, and ST131; blaCTX-M-15 and blaCTX-M-27 in ST131; blaSHV-12 in ST69). The relatively short duration of carriership means that when an intervention drastically reduces the exposure of humans to ESBL-E, the prevalence will be halved in 0.66 years. The observed differences between carriage rates of ESBL/pAmpC genes and E. coli strains need further investigation.
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- 2018
28. Correction: Time to acquire and lose carriership of ESBL/pAmpC producing E. coli in humans in the Netherlands
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Cornelia C. H. Wielders, Evers Eg, P Hengeveld, Cindy M Dierikx, Peter Teunis, and Engeline van Duijkeren
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Genetics ,Multidisciplinary ,lcsh:R ,lcsh:Medicine ,lcsh:Q ,Biology ,lcsh:Science - Abstract
[This corrects the article DOI: 10.1371/journal.pone.0193834.].
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- 2018
29. Single nucleotide polymorphisms in immune response genes in acute Q fever cases with differences in self-reported symptoms
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Peter M. Schneeberger, Y. T. H. P. Van Duynhoven, Christian J. P. A. Hoebe, Cornelia C. H. Wielders, A. de Klerk, B. Schimmer, Volker Hackert, Hennie M. Hodemaekers, Riny Janssen, Medische Microbiologie, Complexe Genetica, RS: CAPHRI School for Public Health and Primary Care, and RS: CAPHRI - R4 - Health Inequities and Societal Participation
- Subjects
Male ,COXIELLA-BURNETII ,NETHERLANDS ,RESPIRATORY SYNCYTIAL VIRUS ,Symptom Score ,SUSCEPTIBILITY ,Severe Acute Respiratory Syndrome ,Severity of Illness Index ,Disease Outbreaks ,Coxiella ,Medical microbiology ,INFECTIOUS-DISEASES ,D-RECEPTOR GENE ,education.field_of_study ,biology ,ASSOCIATION ,General Medicine ,Middle Aged ,STAT1 Transcription Factor ,Infectious Diseases ,Female ,Q Fever ,Adult ,Microbiology (medical) ,medicine.medical_specialty ,Tuberculosis ,Genes, MHC Class II ,Population ,Q fever ,Single-nucleotide polymorphism ,TUBERCULOSIS ,Polymorphism, Single Nucleotide ,Article ,Interferon-gamma ,Immune system ,medicine ,Animals ,Humans ,Genetic Predisposition to Disease ,education ,Respiratory Syncytial Virus Infection ,Outbreak ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,INTERFERON-GAMMA GENE ,Case-Control Studies ,Immunology ,Receptors, Calcitriol ,FATIGUE SYNDROME - Abstract
Genes involved in human immune response are well recognized to influence the clinical course of infection. The association of host genetics with susceptibility to and severity of clinical symptoms in acute Q fever was investigated. Single nucleotide polymorphisms (SNPs) in the IFNG (rs2430561/rs1861493), STAT1 (rs1914408), and VDR (rs2228570) genes were determined in 85 patients from the 2007 Dutch acute Q fever outbreak, and a symptom score was calculated. IFNG rs1861493 showed a significant association with the symptom score; IFNG rs2430561 showed a similar trend. These SNPs were then used to reproduce results in a 2009 outbreak population (n = 123). The median symptom score differed significantly in both populations: 2 versus 7. The significant association of IFNG rs1861493 with symptom score in the first population was not reproduced in the second population. We hypothesize that individuals in the second outbreak were exposed to a higher Coxiella burnetii dose compared to the first, which overruled the protection conferred by the A-allele of IFNG rs1861493 in the first population.
- Published
- 2015
30. Evaluation of Commonly Used Serological Tests for Detection of Coxiella burnetii Antibodies in Well-Defined Acute and Follow-Up Sera
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Cornelia C. H. Wielders, Marion Koopmans, M. C. A. Wegdam-Blans, H.A. Bijlmer, Tineke Herremans, J. M. Korbeeck, Peter M. Schneeberger, Jamie C. E. Meekelenkamp, and H. T. Tjhie
- Subjects
Male ,Microbiology (medical) ,Time Factors ,Clinical Biochemistry ,Immunology ,Enzyme-Linked Immunosorbent Assay ,Q fever ,Immunoglobulin G ,Serology ,Diagnostic Laboratory Immunology ,parasitic diseases ,medicine ,Humans ,Immunology and Allergy ,Fluorescent Antibody Technique, Indirect ,Direct fluorescent antibody ,Aged ,biology ,Middle Aged ,bacterial infections and mycoses ,medicine.disease ,Complement fixation test ,Coxiella burnetii ,biology.organism_classification ,Antibodies, Bacterial ,Virology ,Immunoglobulin M ,biology.protein ,Female ,Antibody ,Q Fever - Abstract
In this study, we comparedCoxiella burnetiiIgG phase I, IgG phase II, and IgM phase II detection among a commercially available enzyme-linked immunosorbent assay (ELISA) (Virion/Serion), an indirect fluorescent antibody test (IFAT) (Focus Diagnostics), and a complement fixation test (CFT) (Virion/Serion). For this, we used a unique collection of acute- and convalescent-phase sera from 126 patients with acute Q fever diagnosed by positiveCoxiella burnetiiPCR of blood. We were able to establish a reliable date of onset of disease, since DNA is detectable within 2 weeks after the start of symptoms. In acute samples, att= 0, IFAT demonstrated IgM phase II antibodies in significantly more sera than did ELISA (31.8% versus 19.7%), although the portion of solitary IgM phase II was equal for IFAT and for ELISA (18.2% and 16.7%, respectively). Twelve months after the diagnosis of acute Q fever, 83.5% and 62.2% of the sera were still positive for IgM phase II with IFAT and ELISA, respectively. At 12 months IFAT IgG phase II showed the slowest decline. Therefore, definitive serological evidence of acute Q fever cannot be based on a single serum sample in areas of epidemicity and should involve measurement of both IgM and IgG antibodies in paired serum. Based on IgG phase II antibody detection in paired samples (at 0 and 3 months) from 62 patients, IFAT confirmed more cases than ELISA and CFT, but the differences were not statically significant (100% for IFAT, 95.2% for ELISA, and 96.8% for CFT). This study demonstrated that the three serological tests are equally effective in diagnosing acute Q fever within 3 months of start of symptoms. In follow-up sera, more IgG antibodies were detected by IFAT than by ELISA or CFT, making IFAT more suitable for prevaccination screening programs.
- Published
- 2012
31. The burden of 2009 pandemic influenza A(H1N1) in the Netherlands
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Juanita A. Haagsma, Mirjam Kretzschmar, Cornelia C. H. Wielders, M A B van der Sande, Adam Meijer, W. van der Hoek, C.C. van den Wijngaard, E A van Lier, AB van Gageldonk-Lafeber, T M van 't Klooster, Anna K. Lugnér, Gé Donker, Medical Informatics, Public Health, and Child and Adolescent Psychiatry / Psychology
- Subjects
Adult ,Male ,Adolescent ,Population ,Disease ,Severity of Illness Index ,Young Adult ,Influenza A Virus, H1N1 Subtype ,Cost of Illness ,Environmental health ,Influenza, Human ,Pandemic ,Severity of illness ,medicine ,Humans ,Disability-adjusted life year ,Disabled Persons ,Registries ,Child ,education ,Pandemics ,Disease burden ,Netherlands ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Public Health, Environmental and Occupational Health ,Infant ,Middle Aged ,medicine.disease ,Child, Preschool ,Human mortality from H5N1 ,Female ,Medical emergency ,business - Abstract
Background: The disease burden of the 2009 influenza pandemic has been debated but reliable estimates are lacking. To guide future policy and control, these estimates are necessary. This study uses burden of disease measurements to assess the contribution of the pandemic influenza A(H1N1) virus to the overall burden of disease in the Netherlands. Methods: The burden of disease caused by 2009 pandemic influenza was estimated by calculating Disability Adjusted Life Years (DALY), a composite measure that combines incidence, sequelae and mortality associated with a disease, taking duration and severity into account. Available influenza surveillance data sources (primary care sentinel surveillance, notification data on hospitalizations and deaths and death registries) were used. Besides a baseline scenario, five alternative scenarios were used to assess effects of changing values of input parameters. Results: The baseline scenario showed a loss of 5800 DALY for the Netherlands (35 DALY per 100 000 population). This corresponds to 0.13% of the estimated annual disease burden in the Netherlands and is comparable to the estimated disease burden of seasonal influenza, despite a different age distribution in incidence and mortality of the pandemic compared to seasonal influenza. Conclusions: This disease burden estimate confirmed that, although there was a higher mortality observed among young people, the 2009 pandemic was overall a mild influenza epidemic. The disease burden of this pandemic was comparable to the burden of seasonal influenza in the Netherlands.
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- 2012
32. Persistent high IgG phase I antibody levels against Coxiella burnetii among veterinarians compared to patients previously diagnosed with acute Q fever after three years of follow-up
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Daan W. Notermans, Cornelia C. H. Wielders, Peter M. Schneeberger, Anneroos W. Boerman, B. Schimmer, Wim van der Hoek, and René van den Brom
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Male ,lcsh:Medicine ,Q fever ,Immunoglobulin G ,Veterinarians ,Serology ,Antigen ,medicine ,Humans ,lcsh:Science ,Autoantibodies ,Multidisciplinary ,biology ,business.industry ,lcsh:R ,Autoantibody ,bacterial infections and mycoses ,Coxiella burnetii ,biology.organism_classification ,medicine.disease ,Cross-Sectional Studies ,I antibody ,Immunology ,biology.protein ,bacteria ,Female ,lcsh:Q ,Antibody ,Q Fever ,business ,Research Article - Abstract
BACKGROUND: Little is known about the development of chronic Q fever in occupational risk groups. The aim of this study was to perform long-term follow-up of Coxiella burnetii seropositive veterinarians and investigate the course of IgG phase I and phase II antibodies against C. burnetii antigens and to compare this course with that in patients previously diagnosed with acute Q fever. METHODS: Veterinarians with IgG phase I ≥ 1:256 (immunofluorescence assay) that participated in a previous seroprevalence study were asked to provide a second blood sample three years later. IgG antibody profiles were compared to a group of acute Q fever patients who had IgG phase I ≥ 1:256 twelve months after diagnosis. RESULTS: IgG phase I was detected in all veterinarians (n = 76) and in 85% of Q fever patients (n = 98) after three years (p
- Published
- 2015
33. Severely impaired health status of non-notified Q fever patients leads to an underestimation of the true burden of disease
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Cornelia C. H. Wielders, W J Paget, J. van der Velden, W. van der Hoek, M. J. M. Cox, G. Morroy, Jeannine L A Hautvast, and J.A.F. van Loenhout
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Burden of disease ,Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Time Factors ,Epidemiology ,Health Status ,Q fever ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,Disease Outbreaks ,Quality of life ,Surveys and Questionnaires ,medicine ,media_common.cataloged_instance ,Humans ,European union ,Disease Notification ,Fatigue ,media_common ,Aged ,Netherlands ,Hepatitis ,biology ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Outbreak ,Middle Aged ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,Original Papers ,Surgery ,Pneumonia ,Infectious Diseases ,Cross-Sectional Studies ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Chronic Disease ,Quality of Life ,Female ,business ,Q Fever ,Follow-Up Studies - Abstract
SUMMARYQ fever patients are often reported to experience a long-term impaired health status, including fatigue, which can persist for many years. During the large Q fever epidemic in The Netherlands, many patients with a laboratory-confirmedCoxiella burnetiiinfection were not notified as acute Q fever because they did not fulfil the clinical criteria of the acute Q fever case definition (fever, pneumonia and/or hepatitis). Our study assessed and compared the long-term health status of notified and non-notified Q fever patients at 4 years after onset of illness, using the Nijmegen Clinical Screening Instrument (NCSI). The study included 448 notified and 193 non-notified Q fever patients. The most severely affected subdomain in both patient groups was ‘Fatigue’ (50·5% of the notified and 54·6% of the non-notified patients had severe fatigue). Long-term health status did not differ significantly between the notified and non-notified patient groups, and patients scored worse on all subdomains compared to a healthy reference group. Our findings suggest that the magnitude of the 2007–2009 Q fever outbreak in The Netherlands was underestimated when only notified patients according to the European Union case definition are considered.
- Published
- 2015
34. Persistent high antibody titres against Coxiella burnetiiafter acute Q fever not explained by continued exposure to the source of infection: a case-control study
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Cornelia C. H. Wielders, Monique Leclercq, Wim van der Hoek, Jeroen P. G. van Leuken, Shahan Shamelian, Rana Jajou, Peter M. Schneeberger, and Nicole H. M. Renders
- Subjects
Adult ,DNA, Bacterial ,Male ,medicine.medical_specialty ,Q fever ,Polymerase Chain Reaction ,Immunoglobulin G ,Serology ,Cohort Studies ,Medical microbiology ,medicine ,Humans ,Longitudinal Studies ,Chronic ,Epidemics ,Aged ,Netherlands ,Retrospective Studies ,biology ,Distance ,The Netherlands ,Environmental exposure ,Environmental Exposure ,Middle Aged ,Coxiella burnetii ,biology.organism_classification ,medicine.disease ,Antibodies, Bacterial ,Titer ,Infectious Diseases ,Logistic Models ,Case-Control Studies ,Immunology ,Chronic Disease ,biology.protein ,Female ,Antibody ,Research Article - Abstract
Background From 2007 to 2010, (the southern part of) the Netherlands experienced a large Q fever epidemic, with more than 4,000 reported symptomatic cases. Approximately 1 - 5% of the acute Q fever patients develop chronic Q fever. A high IgG antibody titre against phase I of Coxiella burnetii during follow-up is considered a marker of chronic Q fever. However, there is uncertainty about the significance and cause of persistence of high IgG phase I antibody titres in patients that do not have any additional manifestations of chronic Q fever. We studied whether continued or repeated exposure to the source of infection could explain elevated IgG phase I antibody levels. Methods A case-control study was performed to analyze predictors for possible chronic Q fever. Possible chronic Q fever cases (n = 53) are patients with phase I IgG antibody titre ≥1:1,024 at any point in the 9 - 18 months after acute Q fever diagnosis, with a negative PCR test result for C. burnetii DNA and without other disease manifestations. Controls (n = 110) are acute Q fever patients that did not develop chronic Q fever, and who consistently had phase I IgG antibody titre
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- 2014
35. Detection of phase I IgG antibodies to Coxiella burnetii with EIA as a screening test for blood donations
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Peter M. Schneeberger, H. L. Zaaijer, Cornelia C. H. Wielders, B. Schimmer, M. C. A. Wegdam-Blans, Jamie C. E. Meekelenkamp, W. van der Hoek, Amsterdam institute for Infection and Immunity, and Medical Microbiology and Infection Prevention
- Subjects
Adult ,Male ,Microbiology (medical) ,Blood transfusion ,Adolescent ,medicine.medical_treatment ,Blood Donors ,Q fever ,Immunofluorescence ,Sensitivity and Specificity ,Immunoenzyme Techniques ,Young Adult ,medicine ,Humans ,Mass Screening ,Child ,Aged ,Netherlands ,Aged, 80 and over ,biology ,medicine.diagnostic_test ,Outbreak ,General Medicine ,Middle Aged ,Coxiella burnetii ,biology.organism_classification ,medicine.disease ,bacterial infections and mycoses ,Antibodies, Bacterial ,Virology ,Titer ,Infectious Diseases ,Immunoglobulin G ,Immunoassay ,Immunology ,biology.protein ,Female ,Antibody ,Q Fever - Abstract
The presence of a high phase I IgG antibody titre may indicate chronic infection and a risk for the transmission of Coxiella burnetii through blood transfusion. The outbreak of Q fever in the Netherlands allowed for the comparison of an enzyme immunoassay (EIA) with the reference immunofluorescence assay (IFA) in a large group of individuals one year after acute Q fever. EIA is 100 % sensitive in detecting high (a parts per thousand yen1:1,024) phase I IgG antibody titres. The cost of screening with EIA and confirming all EIA-positive results with IFA is much lower than screening all donations with IFA. This should be taken into account in cost-effectiveness analyses of screening programmes
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- 2012
36. Correlations between Peripheral Blood Coxiella burnetii DNA Load, Interleukin-6 Levels, and C-Reactive Protein Levels in Patients with Acute Q Fever
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L. M. Kampschreur, Peter C. Wever, Daan W. Notermans, A. de Klerk, Cornelia C. H. Wielders, M. N. T. Kremers, Riny Janssen, Peter M. Schneeberger, P. M. Netten, Hennie M. Hodemaekers, and Mirjam H. A. Hermans
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Microbiology (medical) ,Adult ,DNA, Bacterial ,Male ,Adolescent ,Clinical Biochemistry ,Immunology ,Q fever ,Young Adult ,medicine ,Immunology and Allergy ,Humans ,Inducer ,Young adult ,Interleukin 6 ,Fatigue ,Aged ,Netherlands ,Aged, 80 and over ,Coxiella burnetii DNA ,biology ,Interleukin-6 ,C-reactive protein ,Outbreak ,Middle Aged ,Coxiella burnetii ,biology.organism_classification ,medicine.disease ,Bacterial Load ,Hospitalization ,Blood ,C-Reactive Protein ,biology.protein ,Clinical Immunology ,Female ,Q Fever - Abstract
From 2007 to 2010, the Netherlands experienced the largest reported Q fever outbreak, with >4,000 notified cases. We showed previously that C-reactive protein is the only traditional infection marker reflecting disease activity in acute Q fever. Interleukin-6 is the principal inducer of C-reactive protein. We questioned whether increased C-reactive protein levels in acute Q fever patients coincide with increased interleukin-6 levels and if these levels correlate with the Coxiella burnetii DNA load in serum. In addition, we studied their correlation with disease severity, expressed by hospital admission and the development of fatigue. Interleukin-6 and C-reactive protein levels were analyzed in sera from 102 patients diagnosed with seronegative PCR-positive acute Q fever. Significant but weak negative correlations were observed between bacterial DNA loads expressed as cycle threshold values and interleukin-6 and C-reactive protein levels, while a significant moderate-strong positive correlation was present between interleukin-6 and C-reactive protein levels. Furthermore, significantly higher interleukin-6 and C-reactive protein levels were observed in hospitalized acute Q fever patients in comparison to those in nonhospitalized patients, while bacterial DNA loads were the same in the two groups. No marker was prognostic for the development of fatigue. In conclusion, the correlation between interleukin-6 and C-reactive protein levels in acute Q fever patients points to an immune activation pathway in which interleukin-6 induces the production of C-reactive protein. Significant differences in interleukin-6 and C-reactive protein levels between hospitalized and nonhospitalized patients despite identical bacterial DNA loads suggest an important role for host factors in disease presentation. Higher interleukin-6 and C-reactive protein levels seem predictive of more severe disease.
- Published
- 2014
37. Spatial analysis of positive and negative Q fever laboratory results for identifying high- and low-risk areas of infection in the Netherlands
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Peter M. Schneeberger, Marjolijn C.A. Wegdam-Blans, Elsa J. van den Berg, Cornelia C. H. Wielders, and Wim van der Hoek
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medicine.medical_specialty ,Veterinary medicine ,goats ,Q fever ,Environmental Science (miscellaneous) ,lcsh:Infectious and parasitic diseases ,Medical microbiology ,Epidemiology ,medicine ,case–control ,risk factors ,lcsh:RC109-216 ,Original Research Article ,biology ,business.industry ,Zoonosis ,the Netherlands ,zoonosis ,Coxiella burnetii ,biology.organism_classification ,medicine.disease ,Laboratory results ,Positive Laboratory Test Result ,Patient diagnosis ,epidemiology ,business ,Goats ,The Netherlands ,Case-control ,Risk factors ,Demography - Abstract
Background: The Netherlands faced a large Q fever epidemic from 2007 to 2010, in which thousands of people were tested for the presence of antibodies against Coxiella burnetii as part of individual patient diagnosis. So far, only data of notified cases were used for the identification of high-risk areas, which can lead to misclassification of risk. Therefore, we identified high- and low-risk areas based on laboratory test results to make control measures more efficient. Methods: Data on diagnostic Q fever laboratory tests were obtained from two regional laboratories of medical microbiology in the high-incidence area in the south of the Netherlands. The proportion of patients testing positive was mapped per postal code area. Patients testing positive were compared to patients testing negative based on the distance between residential address and the nearest infected goat farm with adjustment for age and sex.Results and conclusion: Of 11,035 patients tested, 4,011 (36.4%) had a positive laboratory test result for Q fever. Maps showing the spatial pattern of tests performed and proportion of positive tests allowed for the identification of high- and low-risk Q fever areas. The proportion of patients testing positive was higher in areas close to infected goat farms compared to areas further away. Patients living 10 km away (OR 21.70, 95% CI 16.28-28.92). Laboratory test results have the potential to make control measures more efficient by identifying high-risk areas as well as low-risk areas. Keywords: zoonosis; Coxiella burnetii; goats; the Netherlands; casecontrol; risk factors; epidemiology(Published: 28 November 2013)Citation: Infection Ecology and Epidemiology 2013, 3: 20432 - http://dx.doi.org/10.3402/iee.v3i0.20432
- Published
- 2013
38. High Coxiella burnetii DNA load in serum during acute Q fever is associated with progression to a serologic profile indicative of chronic Q fever
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Mirjam H. A. Hermans, Cornelia C. H. Wielders, Peter C. Wever, Nicole H. M. Renders, Jeroen J. A. Schellekens, Peter M. Schneeberger, and P. C. A. Wijnbergen
- Subjects
Microbiology (medical) ,Adult ,DNA, Bacterial ,Male ,Serum ,Fluorescent Antibody Technique ,Q fever ,Immunofluorescence ,Real-Time Polymerase Chain Reaction ,Sensitivity and Specificity ,Serology ,Predictive Value of Tests ,medicine ,Humans ,medicine.diagnostic_test ,biology ,Outbreak ,Bacteriology ,Middle Aged ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,Bacterial Load ,Chronic infection ,Real-time polymerase chain reaction ,Predictive value of tests ,Immunology ,Chronic Disease ,Female ,Q Fever - Abstract
PCR is very effective in diagnosing acute Q fever in the early stages of infection, when bacterial DNA is present in the bloodstream but antibodies have not yet developed. The objective of this study was to further analyze the diagnostic value of semiquantitative real-time PCR (qPCR) in diagnosing acute Q fever in an outbreak situation. At the Jeroen Bosch Hospital, in 2009, qPCR testing for Coxiella burnetii DNA was performed for 2,715 patients suspected of having acute Q fever (positive, n = 385; negative, n = 2,330). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the qPCR assay were calculated for patients with negative qPCR results with a follow-up sample obtained within 14 days ( n = 305) and qPCR-positive patients with at least one follow-up sample ( n = 369). The correctness of the qPCR result was based on immunofluorescence assay results for samples submitted for qPCR and follow-up testing. The sensitivity of the Q fever qPCR assay was 92.2%, specificity 98.9%, PPV 99.2%, and NPV 89.8%. Patients who later developed serologic profiles indicative of chronic Q fever infection had significantly higher C. burnetii DNA loads during the acute phase than did patients who did not ( P < 0.001). qPCR testing is a valuable tool for the diagnosis of acute Q fever and should be used in outbreak situations when the onset of symptoms is C. burnetii DNA loads during the acute phase, as this might be an indicator for the development of a serologic profile indicative of chronic infection.
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- 2013
39. Large regional differences in serological follow-up of Q fever patients in the Netherlands
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M. C. A. Wegdam-Blans, G. Morroy, C.J. Wijkmans, Cornelia C. H. Wielders, Peter M. Schneeberger, Wim van der Hoek, Jan H. Marcelis, and Mandy J. B. Kruisbergen
- Subjects
Bacterial Diseases ,Q-Fever ,Pediatrics ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Infectious Disease Control ,Non-Clinical Medicine ,Epidemiology ,Health Care Providers ,Early detection ,lcsh:Medicine ,Q fever ,Microbiology ,Serology ,Medical microbiology ,Diagnostic Medicine ,Internal medicine ,Zoonoses ,Physicians ,Surveys and Questionnaires ,Chronic Q fever ,medicine ,Humans ,Serologic Tests ,Geographic and National Differences ,lcsh:Science ,Netherlands ,Multidisciplinary ,Health Care Policy ,biology ,business.industry ,lcsh:R ,Effective primary care and public health [NCEBP 7] ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,Pulmonology ,Infectious Diseases ,Immunology ,Medicine ,lcsh:Q ,business ,Q Fever ,Regional differences ,Screening Guidelines ,Research Article ,Follow-Up Studies - Abstract
Contains fulltext : 118717.pdf (Publisher’s version ) (Open Access) BACKGROUND: During the Dutch Q fever epidemic more than 4,000 Q fever cases were notified. This provided logistical challenges for the organisation of serological follow-up, which is considered mandatory for early detection of chronic infection. The aim of this study was to investigate the proportion of acute Q fever patients that received serological follow-up, and to identify regional differences in follow-up rates and contributing factors, such as knowledge of medical practitioners. METHODS: Serological datasets of Q fever patients diagnosed between 2007 and 2009 (N = 3,198) were obtained from three Laboratories of Medical Microbiology (LMM) in the province of Noord-Brabant. One LMM offered an active follow-up service by approaching patients; the other two only tested on physician's request. The medical microbiologist in charge of each LMM was interviewed. In December 2011, 240 general practices and 112 medical specialists received questionnaires on their knowledge and practices regarding the serological follow-up of Q fever patients. RESULTS: Ninety-five percent (2,226/2,346) of the Q fever patients diagnosed at the LMM with a follow-up service received at least one serological follow-up within 15 months of diagnosis. For those diagnosed at a LMM without this service, this was 25% (218/852) (OR 54, 95% CI 43-67). Although 80% (162/203) of all medical practitioners with Q fever patients reported informing patients of the importance of serological follow-up, 33% (67/203) never requested it. CONCLUSIONS: Regional differences in follow-up are substantial and range from 25% to 95%. In areas with a low follow-up rate the proportion of missed chronic Q fever is potentially higher than in areas with a high follow-up rate. Medical practitioners lack knowledge regarding the need, timing and implementation of serological follow-up, which contributes to patients receiving incorrect or no follow-up. Therefore, this information should be incorporated in national guidelines and patient information forms.
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- 2013
40. Strategies for early detection of chronic Q-fever: a systematic review
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Cornelia C. H. Wielders, Wim van der Hoek, Peter C. Wever, Peter M. Schneeberger, Roel A. Coutinho, and G. Morroy
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Pediatrics ,medicine.medical_specialty ,Endemic Diseases ,Clinical Biochemistry ,MEDLINE ,Early detection ,Q fever ,Biochemistry ,Asymptomatic ,Disease Outbreaks ,Serology ,Risk Factors ,Chronic Q fever ,medicine ,Humans ,Serologic Tests ,biology ,business.industry ,Outbreak ,General Medicine ,Effective primary care and public health [NCEBP 7] ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,Surgery ,Early Diagnosis ,Echocardiography ,medicine.symptom ,Q Fever ,business ,Follow-Up Studies - Abstract
Item does not contain fulltext BACKGROUND: Chronic Q-fever, a condition with high morbidity and mortality, may develop after an acute infection with Coxiella burnetii (acute Q-fever). Several strategies have been suggested for early detection of chronic Q-fever, focusing on follow-up of known acute Q-fever patients and detection of asymptomatic or unknown chronic infections. As there is no international standard or consensus, the aims of this study were to summarise the available literature and assess the evidence for different follow-up and screening strategies. DESIGN: We conducted a systematic review by searching PubMed and Embase. Twenty articles were included, of which fourteen only provided information on follow-up of known acute Q-fever cases, four presented data on identification of previously unknown C. burnetii infections, and two had information on both topics. RESULTS: The conversion rate of acute to chronic Q-fever ranged from 0 to 5.0%. Most studies advised serological follow-up of acute Q-fever patients, but without consistent advice on optimum timing and duration. The recommendation to use echocardiography for all acute Q-fever patients to detect valvular damage remains controversial. Screening of high-risk patients in an outbreak setting is advised by studies investigating such strategy. CONCLUSIONS: There is sufficient evidence to support serological follow-up of all known acute Q-fever patients at least once during the first year following the acute infection, and more frequently in patients with known risk factors for chronic disease, such as heart valve- or vascular prosthesis. Screening of risk groups should be considered in outbreaks of Q-fever.
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- 2013
41. Early diagnosis and treatment of patients with symptomatic acute Q fever do not prohibit IgG antibody responses to Coxiella burnetii
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Mirjam H. A. Hermans, Andy I. M. Hoepelman, M. M. Jager, Peter M. Schneeberger, Peter C. Wever, L. M. Kampschreur, Cornelia C. H. Wielders, Alexander C. A. P. Leenders, Medical Microbiology and Infection Prevention, and CCA - Innovative therapy
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Microbiology (medical) ,Male ,Clinical Biochemistry ,Immunology ,Q fever ,Immunoglobulin G ,Serology ,medicine ,Immunology and Allergy ,Humans ,Retrospective Studies ,biology ,business.industry ,Antibody titer ,Middle Aged ,Coxiella burnetii ,biology.organism_classification ,medicine.disease ,Antibodies, Bacterial ,Anti-Bacterial Agents ,Titer ,Early Diagnosis ,Immunoglobulin M ,biology.protein ,Female ,Clinical Immunology ,Antibody ,business ,Q Fever - Abstract
Little is known about the effect of timing of antibiotic treatment on development of IgG antibodies following acute Q fever. We studied IgG antibody responses in symptomatic patients diagnosed either before or during development of the serologic response toCoxiella burnetii. Between 15 and 31 May 2009, 186 patients presented with acute Q fever, of which 181 were included in this retrospective study: 91 early-diagnosed (ED) acute Q fever patients, defined as negative IgM phase II enzyme-linked immunosorbent assay (ELISA) and positive PCR, and 90 late-diagnosed (LD) acute Q fever patients, defined as positive/dubious IgM phase II ELISA and positive immunofluorescence assay (IFA). Follow-up serology at 3, 6, and 12 months was performed using IFA (IgG phase I and II). High IgG antibody titers were defined as IgG phase II titers of ≥1:1,024 together with IgG phase I titers of ≥1:256. At 12 months, 28.6% of ED patients and 19.5% of LD patients had high IgG antibody titers (P= 0.17). No statistically significant differences were found in frequencies of IgG phase I and IgG phase II antibody titers at all follow-up appointments for adequately and inadequately treated patients overall, as well as for ED and LD patients analyzed separately. Additionally, no significant difference was found in frequencies of high antibody titers and between early (treatment started within 7 days after seeking medical attention) and late timing of treatment. This study indicates that early diagnosis and antibiotic treatment of acute Q fever do not prohibit development of the IgG antibody response.
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- 2012
42. Screening for Coxiella burnetii seroprevalence in chronic Q fever high-risk groups reveals the magnitude of the Dutch Q fever outbreak
- Author
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Peter C. Wever, Olivier H.J. Koning, Nicole H. M. Renders, Peter J. Lestrade, Cornelia C. H. Wielders, Peter Elsman, Julia C.J.P. Hagenaars, L. M. Kampschreur, and Jan Jelrik Oosterheert
- Subjects
Adult ,Male ,Risk ,medicine.medical_specialty ,Epidemiology ,Short Report ,Q fever ,Disease Outbreaks ,Catchment Area, Health ,Seroepidemiologic Studies ,Internal medicine ,Chronic Q fever ,medicine ,Seroprevalence ,Humans ,Mass Screening ,Mass screening ,Aged ,Netherlands ,Aged, 80 and over ,biology ,business.industry ,Outbreak ,Middle Aged ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,Virology ,Confidence interval ,Infectious Diseases ,Female ,business ,Q Fever - Abstract
SUMMARYThe Netherlands experienced an unprecedented outbreak of Q fever between 2007 and 2010. The Jeroen Bosch Hospital (JBH) in 's-Hertogenbosch is located in the centre of the epidemic area. Based on Q fever screening programmes, seroprevalence of IgG phase II antibodies toCoxiella burnetiiin the JBH catchment area was 10·7% [785 tested, 84 seropositive, 95% confidence interval (CI) 8·5–12·9]. Seroprevalence appeared not to be influenced by age, gender or area of residence. Extrapolating these data, an estimated 40 600 persons (95% CI 32 200–48 900) in the JBH catchment area have been infected byC. burnetiiand are, therefore, potentially at risk for chronic Q fever. This figure by far exceeds the nationwide number of notified symptomatic acute Q fever patients and illustrates the magnitude of the Dutch Q fever outbreak. Clinicians in epidemic Q fever areas should be alert for chronic Q fever, even if no acute Q fever is reported.
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- 2012
43. Comparing pandemic to seasonal influenza mortality: moderate impact overall but high mortality in young children
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Carel Harmsen, Frederika Dijkstra, Alies van Lier, Liselotte van Asten, Adam Meijer, Cees C. van den Wijngaard, Marion Koopmans, Cornelia C. H. Wielders, Wim van der Hoek, Marianne A B van der Sande, Gé A. Donker, Mirjam Kretzschmar, Wilfrid van Pelt, Nico Nagelkerke, Virology, Erasmus MC other, Public Health, and Child and Adolescent Psychiatry / Psychology
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Viral Diseases ,Pediatrics ,medicine.medical_specialty ,Pulmonology ,Epidemiology ,Clinical Research Design ,Science ,Population ,medicine.disease_cause ,Age Distribution ,Influenza, Human ,Pandemic ,Influenza A virus ,medicine ,Humans ,education ,Biology ,Pandemics ,Generalized estimating equation ,education.field_of_study ,Multidisciplinary ,Population Biology ,business.industry ,Incidence ,Incidence (epidemiology) ,Mortality rate ,Infant, Newborn ,virus diseases ,Infant ,medicine.disease ,Pneumonia ,Infectious Diseases ,Child, Preschool ,Life expectancy ,Medicine ,Seasons ,business ,Research Article ,Demography - Abstract
BackgroundWe assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed - and thus an underestimation - whereas seasonal influenza mortality is often more inclusively estimated. For a valid comparison, our study used the same statistical methodology and data types to estimate pandemic and seasonal influenza mortality.Methods and findingsWe used data on all-cause mortality (1999-2010, 100% coverage, 16.5 million Dutch population) and influenza-like-illness (ILI) incidence (0.8% coverage). Data was aggregated by week and age category. Using generalized estimating equation regression models, we attributed mortality to influenza by associating mortality with ILI-incidence, while adjusting for annual shifts in association. We also adjusted for respiratory syncytial virus, hot/cold weather, other seasonal factors and autocorrelation. For the 2009 pandemic season, we estimated 612 (range 266-958) influenza-attributed deaths; for seasonal influenza 1,956 (range 0-3,990). 15,845 years-of-life-lost were estimated for the pandemic; for an average seasonal epidemic 17,908. For 0-4 yrs of age the number of influenza-attributed deaths during the pandemic were higher than in any seasonal epidemic; 77 deaths (range 61-93) compared to 16 deaths (range 0-45). The ≥75 yrs of age showed a far below average number of deaths. Using pneumonia/influenza and respiratory/cardiovascular instead of all-cause deaths consistently resulted in relatively low total pandemic mortality, combined with high impact in the youngest age category.ConclusionThe pandemic had an overall moderate impact on mortality compared to 10 preceding seasonal epidemics, with higher mortality in young children and low mortality in the elderly. This resulted in a total number of pandemic deaths far below the average for seasonal influenza, and a total number of years-of-life-lost somewhat below average. Comparing pandemic and seasonal influenza mortality as in our study will help assessing the worldwide impact of the 2009 pandemic.
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- 2012
44. Characteristics of Hospitalized Acute Q Fever Patients during a Large Epidemic, The Netherlands
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Arianne B van Gageldonk-Lafeber, Annemarie M. H. Wuister, Monique G.L. de Jager-Leclercq, Frederika Dijkstra, Wim van der Hoek, Peter C. Wever, Veerle L. de Visser, Jeroen P. G. van Leuken, Cornelia C. H. Wielders, Cornelis A. R. Groot, and Peter M. Schneeberger
- Subjects
Male ,Bacterial Diseases ,Pediatrics ,Time Factors ,Epidemiology ,lcsh:Medicine ,Zoonoses ,Young adult ,lcsh:Science ,Child ,Netherlands ,Aged, 80 and over ,Multidisciplinary ,Environmental exposure ,Middle Aged ,Hospitalization ,Infectious Diseases ,Child, Preschool ,Acute Disease ,Medicine ,Female ,Q Fever ,Research Article ,Adult ,Q-Fever ,medicine.medical_specialty ,Adolescent ,Clinical Research Design ,Q fever pneumonia ,Q fever ,Infectious Disease Epidemiology ,Young Adult ,medicine ,Humans ,Risk factor ,Epidemics ,Biology ,Aged ,Retrospective Studies ,Hepatitis ,Population Biology ,business.industry ,lcsh:R ,Environmental Exposure ,Pneumonia ,medicine.disease ,respiratory tract diseases ,Radiography ,lcsh:Q ,Bacterial Pneumonia ,business ,Follow-Up Studies - Abstract
Background From 2007 to 2009, the Netherlands experienced a major Q fever epidemic, with higher hospitalization rates than the 2–5% reported in the literature for acute Q fever pneumonia and hepatitis. We describe epidemiological and clinical features of hospitalized acute Q fever patients and compared patients presenting with Q fever pneumonia with patients admitted for other forms of community-acquired pneumonia (CAP). We also examined whether proximity to infected ruminant farms was a risk factor for hospitalization. Methods A retrospective cohort study was conducted for all patients diagnosed and hospitalized with acute Q fever between 2007 and 2009 in one general hospital situated in the high incidence area in the south of the Netherlands. Pneumonia severity scores (PSI and CURB-65) of acute Q fever pneumonia patients (defined as infiltrate on a chest x-ray) were compared with data from CAP patients. Hepatitis was defined as a >twofold the reference value for alanine aminotransferase and for bilirubin. Results Among the 183 hospitalized acute Q fever patients, 86.0% had pneumonia. Elevated liver enzymes (alanine aminotransferase) were found in 32.3% of patients, although hepatitis was not observed in any of them. The most frequent clinical signs upon presentation were fever, cough and dyspnoea. The median duration of admission was five days. Acute Q fever pneumonia patients were younger, had less co-morbidity, and lower PSI and CURB-65 scores than other CAP patients. Anecdotal information from attending physicians suggests that some patients were admitted because of severe subjective dyspnoea, which was not included in the scoring systems. Proximity to an infected ruminant farm was not associated with hospitalization. Conclusion Hospitalized Dutch acute Q fever patients mostly presented with fever and pneumonia. Patients with acute Q fever pneumonia were hospitalized despite low PSI and CURB-65 scores, presumably because subjective dyspnoea was not included in the scoring systems.
- Published
- 2014
45. Kinetics of antibody response to Coxiella burnetii infection (Q fever): Estimation of the seroresponse onset from antibody levels
- Author
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Cornelia C. H. Wielders, Mirjam H. A. Hermans, W. van der Hoek, Peter M. Schneeberger, and Peter Teunis
- Subjects
Adult ,Male ,Adolescent ,Epidemiology ,Q fever ,Immunofluorescence ,Microbiology ,lcsh:Infectious and parasitic diseases ,Serology ,Young Adult ,Mathematical model ,Antigen ,Seroepidemiologic Studies ,Virology ,medicine ,Humans ,Seroprevalence ,lcsh:RC109-216 ,Child ,Aged ,Netherlands ,Aged, 80 and over ,medicine.diagnostic_test ,biology ,Public Health, Environmental and Occupational Health ,Middle Aged ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,Kinetics ,Infectious Diseases ,Child, Preschool ,Antibody Formation ,Immunology ,biology.protein ,Female ,Parasitology ,Antibody - Abstract
Background From 2007 to 2009, the Netherlands experienced a major Q fever epidemic. Long-term serological follow-up of acute Q fever patients enabled the investigation of longitudinal antibody responses and estimating the onset of the seroresponse in individual patients. Methods All available IgG and IgM phase I and II antibody measurements determined by immunofluorescence assay at month 3, 6, 12, and 48 from 2321 acute Q fever patients were retrospectively analyzed. Characteristic features of the antibody response were calculated. To model the seroresponse onset, serological data from patients diagnosed with a positive C. burnetii PCR test ( n = 364), and therefore with a known time of infection, were used as reference. Results In 9083 IgG samples and 3260 IgM samples large heterogeneity in shape and magnitude of antibody responses was observed. Phase II reached higher levels than phase I, and IgG antibodies were more persistent than IgM. The estimated seroresponse latency allowed for determining the time since start of the seroresponse from the concentrations of the different antibodies against C. burnetii . Conclusions The extraordinary large serological dataset provides new insight into the kinetics of the immunoglobulins against C. burnetii antigens. This knowledge is useful for seroprevalence studies and helps to better understand infection dynamics.
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