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RIVM rapport:Infecties aan maag en darmen, zogeheten enterale infecties, worden veroorzaakt door verschillende bacteriën, parasieten of virussen. Meestal krijgen mensen daarvan maag-darmklachten, zoals overgeven, buikpijn en/of (bloederige) diarree. In sommige gevallen kunnen de klachten ernstig zijn, zoals hepatitis, bloedvergiftiging of hersenvliesontsteking. Mensen raken meestal besmet via voedsel of water dat in contact is gekomen met ontlasting van mensen of dieren. Als de ziekteverwekker via dieren wordt overgedragen, spreken we van zoönosen. Goede hygiëne in toiletten en keukens en bij de bereiding van vlees is heel belangrijk om een besmetting te voorkomen. In 2022 was het aantal mensen met maag-darminfecties veel lager door de coronapandemie, in 2023 was dat effect bijna niet meer te zien. Het aantal infecties was vergelijkbaar met de jaren voor de pandemie. Wel viel in 2023 het hoge aantal infecties op met Shigella, Shiga toxine-producerende E. coli (STEC), norovirus en Cryptosporidium. De stijging van shigellose is vooral te zien onder mannen die seks hebben met mannen (MSM). Voor de andere ziekteverwekkers is geen duidelijke oorzaak bekend. In 2023 is bij verschillende uitbraken onderzocht welke bron de oorzaak was: een uitbraak door de Campylobacter-bacterie, vier uitbraken door de Salmonella-bacterie en één door de STEC-bacterie. Alleen van twee salmonellose-uitbraken is de bron gevonden. Dat waren eieren van leghenbedrijven die besmet waren via besmet voer; en droge worst die niet genoeg was gerijpt. Ook geleedpotigen, zoals muggen en teken, kunnen bacteriën, parasieten en virussen bij zich dragen waar mensen ziek van worden. Hersen(vlies)infecties door het tekenencefalitisvirus zijn in 2023 in drie nieuwe gebieden in Nederland vastgesteld. Tot slot liepen dat jaar een recordaantal reizigers een dengue (knokkelkoorts) infectie op. Deze toename is in de hele wereld te zien. Het RIVM houdt bij hoe vaak dit soort infecties in Nederland voorkomen en brengt uitbraken i, Gastrointestinal, or enteric, infections are caused by various bacterial, parasitic and viral pathogens. Infected people usually experience gastrointestinal complaints, such as vomiting, abdominal pain and/or diarrhoea (which may be bloody). In some cases, serious complaints may develop, such as hepatitis, blood poisoning or meningitis. People usually become infected through food or water that has come into contact with human or animal faeces. When transmitted via animals, we speak of zoonoses. Good hygiene in toilets and kitchens and when preparing meat is very important to prevent infection. In 2022, the number of people with gastrointestinal infections was much lower due to the coronavirus pandemic, in 2023, this effect was almost no longer visible. The number of infections was comparable to the years before the pandemic. However, a notable factor in 2023 was the high number of infections with Shigella, Shiga toxin-producing E. coli (STEC), the norovirus, Cryptosporidium and leptospirosis. The increase in shigellosis was mainly seen among men who have sex with men (MSM). No clear cause is known for the other pathogens. In 2023, an active outbreak investigation was conducted into an outbreak of campylobacteriosis, four salmonellosis outbreaks and a STEC outbreak. The source of only two salmonellosis outbreaks was found. These were eggs from laying hen farms that had been contaminated via contaminated feed; and dry sausage that had insufficiently matured. Arthropods, such as mosquitoes and ticks, can also carry bacteria, parasites and viruses that make people ill. Tickborne encephalitis infections were diagnosed in three new areas in the Netherlands in 2023. Finally, there were a record number of travellers with a dengue infection in 2023. This increase was seen all over the world. RIVM keeps track of how often these types of infections occur in the Netherlands and maps outbreaks. An outbreak is when two or more people are infected by the same source. RIVM then tri

Infecties aan maag en darmen, zogeheten enterale infecties, worden veroorzaakt door verschillende bacteriën, parasieten of virussen. Meestal krijgen mensen daarvan maag-darmklachten, zoals overgeven, buikpijn en/of (bloederige) diarree. In sommige gevallen kunnen de klachten ernstig zijn, zoals hepatitis, bloedvergiftiging of hersenvliesontsteking. In 2023 is bij verschillende uitbraken onderzocht welke bron de oorzaak was: een uitbraak door de Campylobacter-bacterie, vier uitbraken door de Salmonella-bacterie en één door de STEC-bacterie. Alleen van twee salmonellose-uitbraken is de bron gevonden. Dat waren eieren van leghenbedrijven die besmet waren via besmet voer; en droge worst die niet genoeg was gerijpt.

Although CMML since long has been separated from MDS, many studies continue to evaluate the outcomes of both diseases after hematopoietic cell transplantation (allo-HCT) together. Data evaluating outcomes of a large CMML cohort after allo-HCT compared to MDS are limited. We aim to compare outcomes of CMML to MDS patients who underwent allo-HCT between 2010 and 2018. Patients ≥18 years with CMML and MDS undergoing allo-HCT reported to the EBMT registry were analyzed. Progression to AML before allo-HCT was an exclusion criterion. Overall survival (OS), progression/relapse-free survival (PFS), relapse incidence (including progression) (REL), and non-relapse mortality (NRM) were evaluated in univariable and multivariable (MVA) Cox proportional hazard models including interaction terms between disease and confounders. In total, 10832 patients who underwent allo-HCT were included in the study, there were a total of 1466 CMML, and 9366 MDS. The median age at time of allo-HCT in CMML (median 60.5, IQR 54.3–65.2 years) was significantly higher than in the MDS cohort (median 58.8, IQR 50.2–64.5 years; p < .001). A significantly higher percentage of CMML patients were male (69.4%) compared to MDS (61.2%; p < .001). There were no clinically meaningful differences in the distribution of Karnofsky score, Sorror HCT-CI score at allo-HCT, and donor type, between the CMML and MDS patients. RIC platforms were utilized in 63.9% of CMML allo-HCT, and in 61.4% of MDS patients (p = .08). In univariable analyses, we found that OS, PFS, and REL were significantly worse in CMML when compared with MDS (all p < .0001), whereas no significant difference was observed in NRM (p = .77). In multivariable analyses, the HR comparing MDS versus CMML for OS was 0.81 (95% CI, 0.74–0.88, p < .001), PFS 0.76 (95% CI 0.70–0.82, p < .001), relapse 0.66 (95% CI 0.59–0.74, p < .001), and NRM 0.87 (95% CI 0.78–0.98, p = .02), respectively. The association between baseline variables and outco

Each year, RIVM investigates how many people become sick or die from gastrointestinal infections. To this end, we look at 14 pathogens that can cause such infections. They are mainly transmitted through food (around 41 per cent). People can also come into contact with these pathogens in the environment (through surface water, for example) or through animals or other people. The burden of disease of these 14 pathogens was higher than in 2021 and 2020, but still a bit lower than in 2019, the year in which the COVID-19 pandemic began. This increase means that the burden of disease is almost back to pre-COVID-19 levels. The total cost associated with the burden of disease in 2022 was estimated at 478 million euros. This was much higher than in 2021 (397 million euros) and 2020 (317 million euros), but slightly lower than in 2019 (480 million euros). The Ministry of Health, Welfare and Sport commissioned this research. The results provide policymakers with insight into the burden of disease and the various ways in which people can acquire an infection with foodrelated pathogens. This research also allows to monitor possible trends in time of the burden of disease caused by foodborne infections, as well as of the associated costs.

RIVM rapport:Luchtverontreiniging is schadelijk voor de gezondheid. Het RIVM heeft onderzocht of blootstelling aan luchtvervuiling door fijnstof en stikstofdioxide invloed heeft op de kans om besmet te raken met het coronavirus en op de kans om daar ernstig ziek van te worden. Onder ernstig ziek verstaan we dat iemand in het ziekenhuis moet worden opgenomen of aan de ziekte overlijdt. Mensen die aan hoge concentraties luchtverontreiniging blootstonden, blijken een grotere kans te hebben om besmet te raken. Ook was hierdoor de kans groter dat mensen door corona in het ziekenhuis moesten worden opgenomen omdat ze erg ziek werden. Ten slotte was de kans dat ze aan corona stierven groter. Deze effecten zijn te zien kort (een tot twee weken) na een periode van meer luchtverontreiniging. Dat is ook zo wanneer mensen jaren wonen op een plek met meer luchtverontreiniging. Deze resultaten bevestigen eerdere conclusies uit internationaal onderzoek. Ook blijkt dat bij een langdurige blootstelling aan luchtverontreiniging de kans op een corona-infectie hetzelfde is als die op andere luchtwegaandoeningen. Denk aan andere luchtweginfecties met klachten die lijken op corona. Dat luchtverontreiniging in het algemeen een grotere kans geeft op luchtwegaandoeningen was al bekend. In het onderzoek is gekeken naar drie belangrijke bronnen van fijnstof in Nederland: landbouw, wegverkeer en industrie. Deze bronnen hebben invloed op de luchtkwaliteit. Ook verschilt per bron de samenstelling van fijnstof, en daarmee de schadelijkheid. Fijnstof van de veehouderij draagt bij aan zowel de kans op besmetting als de ernst van de ziekte. Fijnstof van wegverkeer lijkt meer invloed te hebben op de ernst van de ziekte en minder op de kans om met het virus besmet te raken. Fijnstof van industrie lijkt niet bij te dragen. De resultaten van het onderzoek ondersteunen het beleid van de Nederlandse overheid om de luchtkwaliteit te verbeteren. Het RIVM heeft dit onderzoek gedaan met de Universiteit Utrecht, Wageningen, Air pollution is harmful to health. RIVM has examined whether exposure to air pollution from particulate matter and nitrogen dioxide increases the risks of getting infected with SARS-CoV-2 and falling severely ill. Severe illness was defined as a person requiring hospitalisation or dying as a result of COVID-19. This study found that people who were exposed to high concentrations of air pollution had an increased risk of getting infected with SARS-CoV-2. This exposure also increased the risk of hospital admission or death due to COVID-19. These effects were observed shortly (within one to two weeks) after exposure to elevated concentrations of air pollution. This was also the case for people who had been living for years in locations with elevated concentrations of air pollution. These results confirm the findings of previous international studies. It was also found that, among people under long-term exposure to air pollution, the risk of getting infected with SARS-CoV-2 was not different from that of developing other respiratory diseases, such as those causing symptoms similar to those of SARS-CoV-2 infection. It was already known that exposure to air pollution increases the risk of developing respiratory diseases in general. This study also looked at three major sources of particulate matter emissions in the Netherlands: agriculture, road traffic and industry. These sources have an impact on air quality. In addition, the composition of particle matter emissions and therefore their harmfulness differ per source. Exposure to particular matter emissions from agriculture increases both the risk of getting infected and the severity of the illness. It was found that particular matter emissions from road traffic have a larger effect on the severity of COVID-19 but less of an effect on the risk of getting infected with SARS-CoV-2. Particular matter emissions from industry did not appear to contribute significantly to either. The results of this study support the policy of

There is an urgent need for biosurveillance of unregulated African meat imports at border points of entry in destination markets. This is underscored by recent pandemics linked to exotic wildlife products. Our objective was to catalog the quantity of meat that is informally transported from Africa into and through Europe often without any veterinary or sanitary checks. We searched and included peer-reviewed studies that contained data on the intercontinental movement of unregulated meat from the African continent. This was followed by an investigation of the reported contamination of such meat. We included fifteen airport studies with limited data on this topic. The references included in this review describe the quantity of meat found at border inspection posts and the presence of pathogens. Disease-causing pathogens were found to be present, and the results are organized into bacteria, virus, and parasite categories. The species of animal meat found in this review were linked to CITES-protected species some of which are known reservoir hosts for infectious diseases. This represents a potential and unquantified human health risk to populations along the supply chain, and a loss to biodiversity in supply countries. Meat samples described in this review were primarily found opportunistically by Customs officials, indicating that any estimate of the total quantities passing undetected through border checkpoints must remain tentative, and cannot rule out the possibility that it is indeed considerably higher. We propose a template for future studies regarding African meat imports at border points of entry. The result of this review illustrates a gap in knowledge and lacunae regarding the amount of unregulated African meat imports worldwide, the pathogens it may contain, and the resulting biodiversity loss that occurs from the intercontinental movement of this meat.

RIVM rapport:Enterale infecties worden veroorzaakt door verschillende bacteriële, parasitaire en virale ziekteverwekkers. Meestal krijgen mensen daarvan maag-darmklachten, zoals overgeven, buikpijn en/of (bloederige) diarree. In sommige gevallen kunnen ernstige klachten ontstaan, zoals hepatitis, bloedvergiftiging of hersenvliesontsteking. Mensen raken meestal besmet via voedsel of water dat in contact is gekomen met ontlasting van mensen of dieren. Bij een overdacht via dieren spreken we van zoönosen. Goede hygiëne in toiletten en keukens en bij de bereiding van vlees is heel belangrijk om een besmetting te voorkomen. Het RIVM monitort hoe vaak dit soort infecties in Nederland voorkomen. Ook brengt het RIVM uitbraken in kaart, waarna het de bronnen opspoort. Het doet dat samen met partners als de Nederlandse Voedsel- en Warenautoriteit (NVWA(Nederlandse Voedsel- en Warenautoriteit)) en Wageningen Food Safety Research (WFSR(Wageningen Food Safety Research )). In het algemeen was het aantal enterale infecties in 2022 hoger dan tijdens de COVID19 jaren 2020 en 2021. Het aantal mensen dat ziek werd van Campylobacter en Salmonella was nog wel lager dan vóór de pandemie. Het aantal infecties met Shiga toxine-producerende E. coli(Escherichia coli) (STEC(Shigatoxineproducerende E. coli-stammen)) was in 2022 het hoogst sinds 2016. De oorzaak is niet duidelijk. Het aantal mensen dat ziek werd door de Listeria-bacterie was net iets hoger dan in de jaren voor de COVID19 pandemie. Dit was een van de weinige ziekteverwekkers die tijdens de pandemie niet minder vaak voorkwam dan daarvoor. Dit komt waarschijnlijk doordat besmettingen bijna altijd via (rauw) voedsel verlopen. Het rotavirus- en norovirusseizoen 2021/2022 begon, net als in 2020/2021, eerder in het jaar (oktober) dan in de gebruikelijke wintermaanden. Dit komt waarschijnlijk doordat meer mensen vatbaarder zijn geworden voor deze virussen. In de COVID19 jaren kwamen deze virussen namelijk bijna niet voor en bouwden mensen er geen a, Enteric infections’ is an umbrella term for a diverse group of pathogens that infect humans primarily through the faecal-oral route. These infections can be caused by a diverse range of bacterial, parasitic and viral pathogens. They usually lead to gastrointestinal complaints such as vomiting, abdominal pain, diarrhoea and/or bloody diarrhoea. In some cases, these infections can lead to serious symptoms such as hepatitis, blood poisoning or meningitis. Some enteric infections, known as zoonoses, spread from agricultural and other pets to humans. For other infections, humans are the only host and the infection spreads from person to person. In both cases, transmission often occurs via contaminated food, or via the environment (soil/air/surface water) or direct contact with animals or faeces. In order to monitor the spread of enteric infections, RIVM charts for every year how often such infections and the pathogens occur in the Netherlands. Overall, the incidence of enteric infections mainly transmitted through food was higher in 2022 than during the COVID-19 pandemic years of 2020 and 2021, although the incidence of campylobacteriosis and salmonellosis was not yet at pre-pandemic levels. In contrast, the number of infections with Shiga toxin-producing E. coli (STEC) in 2022 reached the highest level since 2016. The reason behind the increase in domestically acquired cases is unclear. The incidence of listeriosis, which remarkably did not decrease during the pandemic, was also higher in 2022 compared to 2016–2019. The 2021/2022 rotavirus and norovirus season started earlier than usual, just like in 2020/2021. This was likely due to an increase in the number of susceptible individuals following the lifting of COVID19 restrictions. The total number of rotavirus cases was significantly higher in 2022 than in 2016-2019, while the total number of norovirus cases in 2022 was at the same level as before the pandemic. The most notable outbreak in 2022 was an outbreak with 72

Background: After years of significant decline, the incidence of Salmonella enterica serotype Enteritidis (SE) human infections in Europe has started stagnating in recent years. The reasons for this stagnation remain largely unclear and are possibly multifactorial and interconnected in nature. We assessed and ranked several potential determinants of the stagnating SE trend in Europe, as well as different options for intervention at the level of poultry health and production, public health (infra)structure, and pathogen biology.Methods: A Multi-Criteria Decision-Analysis (MCDA) approach based on the Analytical Hierarchy Process was used. Through two separate surveys, a European panel of Salmonella experts first provided weights for several pre-defined criteria and subsequently scored different potential determinants and options for intervention (i.e. alternatives) against the criteria, during 2020–21. The weighting and scoring were based on Saaty's pairwise comparisons. The final ranking of the alternatives was derived from the summation of the products of each criterion weight with the score of the corresponding alternative. Sensitivity analyses were performed to assess the impact of different methodological choices, including European regions, and domains of expertise on the ranking of the determinants and options for intervention.Results: The first and second-ranked determinants of the stagnated trend in human SE infections were related to poultry health and production, namely “inadequacies of sampling programmes” and “premature relaxation of control measures”. This ranking agreed with the ranking of the options for intervention, which were also those at the poultry health and production level, specifically “stricter biosecurity”, “improving sampling”, and “better/increased vaccination”. Differences in rankings were observed among European regions and domains of expertise.Conclusions: The rankings of potential determinants and options for intervention for the stag