85 research outputs found
Cascade of care among hepatitis B patients in Maastricht, the Netherlands, 1996 to 2018
No full textBackground & aims: There are approximately 49,000 people (0.34%) in the Netherlands with a chronic hepatitis B virus (HBV) infection. It is unclear how many are linked to care and under follow-up in hepatitis outpatient clinics. This study determined the cascade of care and identified predictors for not being linked to care and loss to follow-up in Maastricht, the Netherlands.Methods: All hepatitis B surface antigen (HBsAg)-positive patients between December 1, 1996 and September 30, 2018 were retrospectively identified.Results: In total, 644 HBsAg-positive patients were identified; of whom 75 had acute HBV infection, 471 chronic HBV infection and 98 unknown. Out of 569 individuals with a chronic/unknown HBV status, 134/569 (23.6%) were not linked to care and 58.7% (195/332 after excluding those who died or achieved HBsAg-seroclearance) were loss to follow-up (LTFU). A predictor for not being linked to care was Caucasian ethnicity (odds ratio (OR) = 2.76 (95% Confidence Interval (CI) = 1.21-6.29); p = .015). Predictors for LTFU were older age (OR = 0.97 (CI = 0.94-0.99); p = .008), HBV DNA >20,000 IU/mL (OR = 0.44 (CI = 0.21 - 0.93); p = .033) and Asian ethnicity (OR = 0.46, (CI = 0.21-1.00); p = .050). Rates of not being linked to care and LTFU decreased over time from 12.7% in 1996 to 4.4% in 2018 and from 79.2% in 1996 to 37.2% in 2018, respectively.Conclusions: A considerable amount of HBsAg-positive individuals were not linked to care or LTFU. This study indicates that ethnicity plays a role in linkage to care and follow-up. Further research is needed to elaborate on those results.</p
Case report of delayed seroprotection rather than non-response after primary three-dose hepatitis B vaccination
No full textWe describe a delayed hepatitis B seroprotection 12 weeks after the primary vaccination schedule in a 57-year-old male with smoldering multiple myeloma. Based on undetectable anti-HBs antibodies 6 weeks after the third vaccination, the index person was previously considered to be a hepatitis B vaccine non-responder. Because hepatitis B vaccination started in the 1980s, many hepatitis B vaccine non-responders have received a revaccination regimen. If more cases of genuine delayed hepatitis B seroprotection surface in patients with hematologic malignancies, delayed seroprotection should be considered before the commencement of hepatitis B revaccination. (C) 2019 Elsevier Ltd. All rights reserved.</p
Changes in the Dutch Bordetella pertussis population in the first 20 years after the introduction of whole-cell vaccines
No full textAdaptation of Bordetella pertussis to Vaccination: A Cause for Its Reemergence?
No full textIn The Netherlands, as in many other western countries, pertussis vaccines have been used extensively for more than 40 years. Therefore, it is conceivable that vaccine-induced immunity has affected the evolution of B. pertussis. Consistent with this notion, pertussis has reemerged in The Netherlands, despite high vaccination coverage. Further, a notable change in the population structure of B. pertussis was observed in The Netherlands subsequent to the introduction of vaccination in the 1950s. Finally, we observed antigenic divergence between clinical isolates and vaccine strains, in particular with respect to the surface-associated proteins pertactin and pertussis toxin. Adaptation may have allowed B. pertussis to remain endemic despite widespread vaccination and may have contributed to the reemergence of pertussis in The Netherlands
Replacing Traditional Diagnostics of Fecal Viral Pathogens by a Comprehensive Panel of Real-Time PCRs
No full textMolecular DNA-based diagnostics are increasingly being used for diagnosis of viral infections. For enteric viruses, PCR assays have also been developed. The aims of this study were to compile and evaluate a comprehensive panel of PCR assays for diagnosis of viruses causing diarrheal disease and to evaluate its use in a largely pediatric population in a 750-bed university medical center. The PCR panel was designed to include assays for detection of adenovirus, astrovirus, enterovirus, norovirus, parechovirus, rotavirus, and sapovirus. The results of the PCR panel were evaluated in relation to conventional viral diagnostics consisting of viral culture and/or rotavirus and adenovirus rapid antigen tests on samples that were taken for routine diagnostics. Comparing conventional with PCR-based testing, the number of viruses detected increased dramatically from 25 to 106 when PCR assays were used. This increase was due mainly to detection of previously undetected viruses, i.e., astrovirus, norovirus, and sapovirus. In 24% of the samples, norovirus was detected. Also, the lower detection limit of PCR-based adenovirus, enterovirus, parechovirus, and rotavirus diagnostics further increased the detection rate. By focusing on samples from patients with complaints of gastroenteritis, detection of a causative agent was increased from 49% by conventional tests to 97% by molecular diagnostics. However, many samples containing low viral loads were found in patients with complaints other than intestinal complaints. In conclusion, the proposed comprehensive PCR panel with appropriate cutoff values can be used for sensitive, rapid, and clinically relevant diagnosis of gastrointestinal viruses
Assessment of Growth Reduction of Five Clinical Pathogens by Injectable S53P4 Bioactive Glass Material Formulations
No full textThe one-stage treatment of chronic osteomyelitis with S53P4 bioactive glass (BAG) granules has shown excellent results. However, these granules possess suboptimal handling properties. Therefore, new injectable S53P4 putty materials have been developed by the incorporation of a synthetic binder to contain glass granules. The goal of the current study was to assess their potential to eradicate five clinically relevant pathogens:methicillin sensitive Staphylococcus aureus(MSSA),methicillin resistant Staphylococcus aureus(MRSA),Enterococcus coli(E. coli),Enterococcus faecalis(E. faecalis), and Pseudomonas aeruginosa(P. aeruginosa). As a control, S53P4 granules (500-800 mu m) and S66 glass (<45 mu m) were used. To evaluate the antimicrobial properties, the materials were cultured with the pathogens in a Muller-Hinton II broth for a week with daily colony forming unit (CFU) counting. One of the tested putty formulations was observed to reduce the number of CFU/mL compared to a negative control (no material, only pathogen in broth) for E. coli, E. faecalis and P. aeruginosa. However, none of the tested putty formulations was able to completely eradicate the pathogens in the broths, which would be needed for safe infection treatment. The results obtained for the control materials were unexpected. S66 glass showed full eradication of P. aeruginosa and reduced the number of CFUs of other pathogens, while the S53P4 granules did not show eradication. The observations on the loose S53P4 granules in this study contradict available literature, which needs further investigation. The results obtained in this study also stretch the importance for a better understanding of the underlying antimicrobial mechanism of S53P4 BAG and how this is related to the dosage. In addition, it should be elucidated how these antimicrobial properties are affected by changes in the material formulation, for example by addition of binders to improve the handling properties or by changing the surface area.</p
Studies on Prn variation in the mouse model and comparison with epidemiological data.
No full textThe virulence factor pertactin (Prn) is a component of pertussis vaccines and one of the most polymorphic Bordetella pertussis antigens. After the introduction of vaccination shifts in predominant Prn types were observed and strains with the Prn vaccine type (Prn1) were replaced by strains carrying non-vaccine types (Prn2 and Prn3), suggesting vaccine-driven selection. The aim of this study was to elucidate the shifts observed in Prn variants. We show that, although Prn2 and Prn3 circulated in similar frequencies in the 1970s and 1980s, in the 1990s Prn2 strains expanded and Prn3 strains disappeared, suggesting that in vaccinated populations Prn2 strains are fitter than Prn3 strains. We established a role for Prn in the mouse model by showing that a Prn knock-out (Prn-ko) mutation reduced colonization in trachea and lungs. Restoration of the mutation resulted in a significant increase in colonization compared to the knock-out mutant. The ability of clinical isolates with different Prn variants to colonize the mouse lung was compared. Although these isolates were also polymorphic at other loci, only variation in the promoter for pertussis toxin (ptxP) and Prn were found to contribute significantly to differences in colonization. Analysis of a subset of strains with the same ptxP allele revealed that the ability to colonize mice decreased in the order Prn1>Prn2 and Prn3. Our results are consistent with the predominance of Prn1 strains in unvaccinated populations. Our results show that ability to colonize mice is practically the same for Prn2 and Prn3. Therefore other factors may have contributed to the predominance of Prn2 in vaccinated populations. The mouse model may be useful to assess and predict changes in the B. pertussis population due to vaccination
Giving and Volunteering in the Netherlands : Sociological and Psychological Perspectives
Get PDFDissertation of the University of Utrecht
Volunteer work, membership of voluntary associations, philanthropy and
donation of blood and organs are studied by scholars from a wide range of disciplines.
Sociologists and economists assume that good intentions are universal, but that some
people have a stock of human and social capital that allows them to fulfill these
intentions while others lack the resources to do so. Thus, they have studied the effects
of financial capital (income and wealth), human capital (level of education and health),
and social capital (community and religious involvement) on giving and volunteering.
Personality and social psychologists, on the other hand, argue that across a variety of
social conditions, some people are more likely to contribute because they have an
‘altruistic personality’: they are more helpful, empathic, or more able to take the
perspective of people in need, while others are more likely to refuse, evade, or forget
their duties. However, we know very little about the relative effects of personality
characteristics and social conditions on prosocial behavior. Therefore, the first research
question of this dissertation is: To what extent can giving and volunteering behavior be
explained by prosocial motives and other psychological characteristics of people and
the social conditions in which they live?
But we know even less about the interactive effects of personality characteristics
and social conditions. This is the second research question: In which conditions are
prosocial motives and other psychological characteristics more strongly related to
giving and volunteering? An economist would say: especially if it does not cost them
too much. This idea is called the ‘low cost hypothesis’. Another idea in this regard
originated in personality psychology, and predicts that people act upon their individual
preferences when the expectations of others about their behavior are rather unclear.
This idea is called the ‘weak situation hypothesis’.
Using data of the Family Survey of the Dutch Population 2000 (n=1,587), I find
that on average, about 30% of all the variance in the examples of prosocial behavior
that was explained by the most extensive regression models was due to personality
characteristics and social value orientations. The most distinctive characteristic of
people who give time, money, blood and organs is their higher than average level of
education. In addition, people who are more religious, live in smaller communities,
work more hours for pay and earn higher incomes also tend to contribute more.
In contrast to the low cost-hypothesis and the weak situation-hypothesis,
personality is not more important for giving and volunteering when the price of giving
is low or social pressure is weak. However, I found evidence that the relations of giving
and volunteering with social conditions such as education or church attendance are
partly due to personality characteristics; and that purely sociological studies of
participation can lead to biased estimates of the effects of social conditions such as age
and education. The major implication for scholars is that studies from either sociology
or psychology are incomplete because they disregard the role of the determinants that
are part of the other discipline.
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Meer dan tachtig procent van de Nederlandse huishoudens geeft geld aan ‘goede
doelen’. Ongeveer één derde van de Nederlanders is regelmatig actief als onbetaald vrijwilliger voor een vereniging. Eén op de zes Nederlanders heeft besloten zijn of haar organen voor transplantatie of de wetenschap ter beschikking te stellen na de dood. En ongeveer één op de twintig Nederlanders geeft minstens één keer per jaar bloed bij de bloedbank. Geefgedrag – het geven van geld aan goede doelen, het geven van bloed, van organen, en het geven van tijd door vrijwilligerswerk – heet ook wel prosociaal gedrag. Het gaat om bijdragen aan collectieve goederen: zij vragen een persoonlijk offer van de gever, waarvan de baten ten goede komen aan groepen burgers of de samenleving als geheel.
Wie geeft er eigenlijk tijd, geld, bloed en organen? En waarom geven deze mensen
überhaupt tijd, geld, bloed en organen ten bate van anderen, als dat ten koste van henzelf gaat?
Dit proefschrift bestudeert deze vragen vanuit twee verschillende disciplines in de
sociale wetenschappen: vanuit de sociologie, en vanuit de sociale en persoonlijkheidspsychologie.
Screening for HIV, hepatitis B and syphilis on dried blood spots: A promising method to better reach hidden high-risk populations with self-collected sampling.
Get PDFMany people at high risk for sexually transmitted infections (STIs), e.g., men who have sex with men (MSM), are not optimally reached by current sexual health care systems with testing. To facilitate testing by home-based sampling or sampling in outreach setting we evaluated dried blood spots (DBS), a method for self-collected blood sampling for serological screening of HIV, hepatitis B (HBV) and syphilis. The aims of this study were to assess the acceptability and feasibility of self-collected DBS and to compare the test results for screening of HIV, HBV and syphilis from DBS with blood drawn by venous puncture.DBS were collected from men who have sex with men (MSM), visiting the STI clinic of the public health service South Limburg (n = 183) and HIV positive and HBV positive patients (n = 34), visiting the outpatient clinics of the Maastricht University Medical Centre in the period January 2012-April 2015. The 93 first participating MSM visiting the STI clinic were asked to fill in a questionnaire about the feasibility and acceptability about self-collection of DBS in a setting without going to a health care facility and were asked to collect the DBS themselves. Serological screening tests for HIV (HIV combi PT, Roche), HBV (HBsAg, Roche) and syphilis (Treponema pallidum Ig, Biokit 3.0) were performed on DBS and on blood drawn by venous puncture, which was routinely taken for screening.In total 217 participants were included in the study with a median age of 40 years (range between 17-80). Of MSM 84% agreed that it was clear and easy to do the finger-prick, while 53% agreed that it was clear and easy to apply the blood onto the DBS card. Also, 80% of MSM would use the bloodspot test again. In 91% (198) of DBS, sufficient material was collected to perform the three tests. No difference was observed in DBS quality between self-collected DBS and health care worker collected DBS. For HIV (n = 195 DBS-serum pairs) sensitivity and specificity were 100%. For HBV the sensitivity for HBsAg (n = 202) was 90% and specificity was 99%. For syphilis (n = 191) the sensitivity of the DBS was 93% with a specificity of 99%. Analysis of the DBS of HIV positive participants (n = 38) did show similar test performance for HBV and syphilis as in HIV negatives.DBS is an acceptable self-sampling method for MSM, as there was no difference in DBS quality in self-collected and health care worker collected DBS. Test performance, i.e., its high sensitivity (>90%) and specificity (>99%) measures show that DBS is a valid alternative for venous blood puncture. Especially when DBS is combined with home-collected sampling for Chlamydia trachomatis and Neisseria gonorrhoeae, complete STI screening can be done in outreach setting and/or home-collected sampling in MSM
Controlling a human parainfluenza virus-3 outbreak in a haematology ward in a tertiary hospital:the importance of screening strategy and molecular diagnostics in relation to clinical symptoms
No full textBACKGROUND: Human parainfluenza 3 (HPIV-3) outbreak at the haemato-oncology ward of the Maastricht University Medical Center in the summer of 2016.AIM: To describe an effective strategy to control the largest reported HPIV-3 outbreak at an adult haematology-oncology ward in the Netherlands by implementing infection control measures and molecular epidemiology investigation.METHODS: Clinical, patient and diagnostic data were both pro- and retrospectively collected. HPIV-3 real-time-PCR (HPIV-3 RT-PCR) was validated using oropharyngeal rinse samples. Screening of all new and admitted patients was implemented to identify asymptomatic infection or prolonged shedding of HPIV-3 allowing cohort isolation.FINDINGS: The HPIV-3 outbreak occurred between 9 July and 28 September 2016 and affected 53 patients. HPIV-3 RT-PCR on oropharyngeal rinse samples demonstrated an up to tenfold higher sensitivity compared to pharyngeal swabs. Monitoring showed that at first positive PCR, 20 patients (38%) were asymptomatic (of which 11 remained asymptomatic) and the average duration of shedding was 14 days (range 1-58). Asymptomatic patients had lower viral load, shorter period of viral shedding (≤14 days) and were mostly immune competent oncology patients. The outbreak was under control 5 weeks after implementation of screening of asymptomatic patients.CONCLUSION: Implementation of a sensitive screening method identified both symptomatic and asymptomatic patients which had lower viral load and allowed early cohort isolation. This is especially important in a ward that combines patients with varying immune status, since both immunocompromised and immune competent patients are likely to spread the HPIV-3 virus, either through prolonged shedding or through asymptomatic course of disease.</p
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