Search

Measles is a notifiable disease, but not everyone infected seeks care, nor is every consultation reported. We estimated the completeness of reporting during a measles outbreak in The Netherlands in 2013-2014. Children below 15 years of age in a low vaccination coverage community (n = 3422) received a questionnaire to identify measles cases. Cases found in the survey were matched with the register of notifiable diseases to estimate the completeness of reporting. Second, completeness of reporting was assessed by comparing the number of susceptible individuals prior to the outbreak with the number of reported cases in the surveyed community and on a national level.We found 307 (15%) self-identified measles cases among 2077 returned questionnaires (61%), of which 27 could be matched to a case reported to the national register; completeness of reporting was 8.8%. Based on the number of susceptible individuals and number of reported cases in the surveyed community and on national level, the completeness of reporting was estimated to be 9.1% and 8.6%, respectively. Estimating the completeness of reporting gave almost identical estimates, which lends support to the credibility and validity of both approaches. The size of the 2013-2014 outbreak approximated 31 400 measles infections. [ABSTRACT FROM AUTHOR]

To assess correlates of protection against measles and against subclinical measles virus (MV) infection, we recruited once-vaccinated children from geographic regions associated with increased MV circulation and/or at schools with low vaccination coverage in the Netherlands. Paired blood samples were collected shortly after onset of the measles outbreak and after the outbreak. A questionnaire was used to document the likelihood of exposure to MV and occurrence of measles-like symptoms. All blood samples were tested for MV-specific antibodies with five different assays. Correlates of protection were assessed by considering the lowest neutralizing antibody levels in children without MV infection, and by ROC analyses. Among 91 participants, two seronegative children (2%) developed measles, and an additional 19 (23%) experienced subclinical MV infection. The correlate of protection against measles was lower than 0.345 IU/mL. We observed a decreasing attack rate of subclinical MV infection with increasing levels of specific antibodies until 2.1 IU/mL, above which no subclinical MV infections were detected. The ROC analyses found a correlate of protection of 1.71 IU/mL (95% CI 1.01-2.11) for subclinical MV infection. Our correlates of protection were consistent with previous estimates. This information supports the analyses of serosurveys to detect immunity gaps that require targeted intervention strategies.

Background: In the Netherlands, approximately 200 patients die annually from a chronic hepatitis B (CHB) infection, even though effective antiviral treatment is available. There are an estimated 49,000 Dutch CHB patients. Many of these patients have been lost to follow-up (LFU) over time. The study aimed to trace LFU CHB patients in the province of Utrecht and bring them back into care., Methods: Positive hepatitis B surface antigen (HBsAg) tests from 2001-2015 were collected from the four hospitals in the Utrecht province and linked to medical records. The general practitioners (GPs) were requested in writing to evaluate LFU CHB patients and to refer patients when needed. In addition, GPs were asked to fill out a questionnaire on the patients' characteristics and to indicate reasons for not being able to perform an evaluation., Results: A total of 2,242 chronic CHB patients were identified based on HBsAg-positive serology. After review of their medical records, 599 (27%) patients were eligible for retrieval. Of those, the GP response rate was 49% (n = 292) and 62 patients (10%) of the eligible CHB patients could be evaluated. Of these, 20 patients (3%) were referred to a hospital and 42 patients (7%) did not have an indication for referral., Conclusion: Lost to follow-up CHB patients can be traced through screening of past positive HBsAg tests. There was willingness among GPs to participate in the retrieval of CHB patients. This may contribute to the reduction of the CHB-related burden of disease.

Aims: Inherited cardiac diseases play an important role in sudden death (SD) in the young. Autopsy and cardiogenetic evaluation of relatives of young SD victims identifies relatives at risk. We studied the usual care after SD in the young aimed at identifying inherited cardiac disease, and assessed the efficacy of two interventions to improve this usual care., Methods and Results: We conducted a community-based intervention study to increase autopsy rates of young SD victims aged 1-44 years and referral of their relatives to cardiogenetic clinics. In the Amsterdam study region, a 24/7 central telephone number and a website were available to inform general practitioners and coroners. In the Utrecht study region, they were informed by a letter and educational meetings. In two control regions usual care was monitored. Autopsy was performed in 169 of 390 registered SD cases (43.3%). Cardiogenetic evaluation of relatives was indicated in 296 of 390 cases (75.9%), but only 25 of 296 families (8.4%) attended a cardiogenetics clinic. Autopsy rates were 38.7% in the Amsterdam study region, 45.5% in the Utrecht study region, and 49.0% in the control regions. The proportion of families evaluated at cardiogenetics clinics in the Amsterdam study region, the Utrecht study region, and the control regions was 7.3, 9.9, and 8.8%, respectively., Conclusions: The autopsy rate in young SD cases in the Netherlands is low and few families undergo cardiogenetic evaluation to detect inherited cardiac diseases. Two different interventions did not improve this suboptimal situation substantially., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Purpose: The goal of this study was to ascertain accordance between cause of death established by the forensic physician and autopsy results in young sudden death victims in the Netherlands., Methods: Sudden death victims aged 1-45 years examined by forensic physicians operating in the participating regions which also underwent an autopsy between January 2006 and December 2011 were included (n = 70). Cause of death established by the forensic physician based on the external medicolegal examination was compared with autopsy findings using the ICD10-classification., Results: Autopsy findings revealed that the majority of sudden death victims have died from a cardiac disease (n = 51, 73%). Most of the presumed heart disease related cases were confirmed by autopsy (n = 13, 87%). On the contrary, a large number of deaths caused by circulatory diseases were not recognised by the forensic physician (n = 38, 75%). In most of these cases, the forensic physician was forced to report an undetermined cause due to the lack of a solid explanation for death. Cause of death reported by the forensic physician appeared to be in agreement with the autopsy results in 12 cases (17%)., Conclusions: Cause of death determination in young sudden death victims is a difficult task for forensic physicians due to the limited tools available during the medicolegal examination. An effort should be made to standardize extensive post-mortem investigation after sudden death in the young. Autopsy can provide valuable information regarding the cause of death, which is of great importance in view of the identification of inheritable diseases among decedents and their families., (Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

We evaluated different approaches for diagnosing measles virus (MV) infection in unvaccinated children and in healthy contact persons (n=194) during a measles epidemic in The Netherlands. MV RNA was detected by reverse-transcriptase polymerase chain reaction in throat-swab specimens from 93% of the patients with clinical symptoms. MV RNA was detected from 5 days before until 12 days after the onset of symptoms. Most patients (88%) also secreted MV RNA in their urine until 5 weeks after the onset of symptoms. Oral fluid proved to be the most practical specimen for the simultaneous detection of MV-specific IgM antibody and viral RNA, which, together, confirmed 93% of measles cases. Viral RNA was also detected in oropharyngeal specimens from 3 healthy contact persons with serological proof of MV infection. The results of this study emphasize the feasibility of combined detection of viral RNA and MV-specific IgM antibodies in oropharyngeal specimens for the diagnosis of clinical and subclinical MV infection.

In two field trials in Nigeria, 74 male and female leprosy outpatients received intra-adipose depot injections of either dapsone (DDS) or monoacetyldapsone (MADDS) at 4-week intervals. Blood samples were taken regularly and sent to Amsterdam to determine the DDS and MADDS concentrations in serum using high-pressure liquid chromatography (HPLC). The DDS injection yielded a good sustained drug release. After repeated administration accumulation occurred, demonstrated by a statistically significant increase in the area under the curve (AUC) in time: until 28 days after the first injection, the mean AUC (+/- S.D.) amounted to 19.3 +/- 5.6 mg d/l in males and 15.1 +/- 5.2 in females; after the fourth injection, 26.4 +/- 7.5 and 24.6 +/- 9.0 mg d/l, respectively (p less than 0.001). One male patient developed an abscess at the injection site; otherwise no side effects were observed. Even better sustained-release results were observed with the MADDS injection. Unfortunately, the injection caused a number of abscesses. Consequently, the DDS injection was very well received by the patients of the DDS study, while half of the patients in the MADDS study would prefer tablets to the MADDS injection. Further investigations are required to find the cause of the abscesses before one of the injections, or possibly a combination of both, could be implemented in the multi-drug treatment regimen proposed by WHO to provide a valuable tool to combat noncompliance among leprosy patients.