Publications by authors named "Barbara Schimmer"

24 Publications

  • Page 1 of 1

High Coxiella burnetii Seroconversion Rate in Veterinary Students, the Netherlands, 2006-2010.

Emerg Infect Dis 2020 12;26(12):3086-3088

We examined Coxiella burnetii seroconversion rates by measuring C. burnetii IgG among 2 cohorts of veterinary students. During follow-up of 118 seronegative veterinary students, 23 students seroconverted. Although the clinical importance of the presence of antibodies is unknown, veterinary students should be informed about the potential risks for Q fever.
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http://dx.doi.org/10.3201/eid2612.200063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706948PMC
December 2020

Risk Factors for Sporadic Cryptosporidiosis in the Netherlands: Analysis of a 3-Year Population Based Case-Control Study Coupled With Genotyping, 2013-2016.

J Infect Dis 2019 03;219(7):1121-1129

Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.

Background: In 2012, cryptosporidiosis cases increased in the Netherlands, but no single source was identified. In April 2013, we began a 3-year population-based case-control study coupled with genotyping to identify risk factors for sporadic cryptosporidiosis.

Methods: Cryptosporidium cases were laboratory confirmed (by microscopy or polymerase chain reaction), and the species (ie, C. hominis or C. parvum) was determined. We analyzed data by study year, combined and by species. We performed single-variable analysis, and variables with a P value of ≤ .10 were included in a multivariable logistic regression model adjusting for age, sex, and season.

Results: The study included 609 cases and 1548 frequency-matched controls. C. parvum was the predominant species in the first 2 study years, shifting to C. hominis in the third year. Household person-to-person transmission and eating barbequed food were strongly associated with being a case. Eating tomatoes was negatively associated. When the analysis was stratified by study year, person-to-person transmission was an independent risk factor. Analysis by species identified different risk factors for cases infected with C. parvum and C. hominis.

Conclusion: This was the first case-control study examining risk factors for sporadic cryptosporidiosis in the Netherlands. Providing information about Cryptosporidium exposure during outdoor activities and improvements in hygiene within households could prevent future sporadic infections.
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http://dx.doi.org/10.1093/infdis/jiy634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420163PMC
March 2019

Marked increase in leptospirosis infections in humans and dogs in the Netherlands, 2014.

Euro Surveill 2016 Apr;21(17)

Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.

In the Netherlands, 97 human leptospirosis cases were notified in 2014. This represents a 4.6-fold increase in autochthonous cases (n = 60) compared with the annual average between 2010 and 2013. Most cases had symptom onset between June and November. This marked increase in humans coincided with an increase of leptospirosis in dogs. In 2014, 13 dogs with leptospirosis were reported, compared with two to six dogs annually from 2010 to 2013. The majority of the autochthonous cases (n = 20) were linked to recreational exposure, e.g. swimming or fishing, followed by occupational exposure (n = 15). About sixty per cent (n = 37) of the autochthonous cases were most likely attributable to surface water contact, and 13 cases to direct contact with animals, mainly rats. A possible explanation for this increase is the preceding mild winter of 2013-2014 followed by the warmest year in three centuries, possibly enabling rodents and Leptospira spp. to survive better. A slight increase in imported leptospirosis was also observed in Dutch tourists (n = 33) most of whom acquired their infection in Thailand (n = 18). More awareness and early recognition of this mainly rodent-borne zoonosis by medical and veterinary specialists is warranted.
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http://dx.doi.org/10.2807/1560-7917.ES.2016.21.17.30211DOI Listing
April 2016

Integrating interdisciplinary methodologies for One Health: goat farm re-implicated as the probable source of an urban Q fever outbreak, the Netherlands, 2009.

BMC Infect Dis 2015 Sep 3;15:372. Epub 2015 Sep 3.

Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, , 3720 BA, Bilthoven, The Netherlands.

Background: In spring 2008, a goat farm experiencing Q fever abortions ("Farm A") was identified as the probable source of a human Q fever outbreak in a Dutch town. In 2009, a larger outbreak with 347 cases occurred in the town, despite no clinical Q fever being reported from any local farm.

Methods: Our study aimed to identify the source of the 2009 outbreak by applying a combination of interdisciplinary methods, using data from several sources and sectors, to investigate seventeen farms in the area: namely, descriptive epidemiology of notified cases; collation of veterinary data regarding the seventeen farms; spatial attack rate and relative risk analyses; and GIS mapping of farms and smooth incidence of cases. We conducted further spatio-temporal analyses that integrated temporal data regarding date of onset with spatial data from an atmospheric dispersion model with the most highly suspected source at the centre.

Results: Our analyses indicated that Farm A was again the most likely source of infection, with persons living within 1 km of the farm at a 46 times larger risk of being a case compared to those living within 5-10 km. The spatio-temporal analyses demonstrated that about 60 - 65 % of the cases could be explained by aerosol transmission from Farm A assuming emission from week 9; these explained cases lived significantly closer to the farm than the unexplained cases (p = 0.004). A visit to Farm A revealed that there had been no particular changes in management during the spring/summer of 2009, nor any animal health problems around the time of parturition or at any other time during the year.

Conclusions: We conclude that the probable source of the 2009 outbreak was the same farm implicated in 2008, despite animal health indicators being absent. Veterinary and public health professionals should consider farms with past as well as current history of Q fever as potential sources of human outbreaks.
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http://dx.doi.org/10.1186/s12879-015-1083-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558730PMC
September 2015

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.

PLoS One 2015 20;10(1):e0116937. Epub 2015 Jan 20.

Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.

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<0.001). IgG phase I ≥ 1:1,024, indicating possible chronic Q fever, was found in 36% of veterinarians and 12% of patients (OR 3.95, 95% CI: 1.84-8.49).

Conclusions: IgG phase I persists among veterinarians presumably because of continuous exposure to C. burnetii during their work. Serological and clinical follow-up of occupationally exposed risk groups should be considered.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116937PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300228PMC
October 2015

Human hantavirus infections in the Netherlands.

Emerg Infect Dis 2014 Dec;20(12):2107-10

We report the recent epidemiology and estimated seroprevalence of human hantavirus infections in the Netherlands. Sixty-two cases were reported during December 2008-December 2013. The estimated seroprevalence in the screened municipalities in 2006-2007 was 1.7% (95% CI 1.3%-2.3%). Findings suggest that hantavirus infections are underdiagnosed in the Netherlands.
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http://dx.doi.org/10.3201/eid2012.131886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257821PMC
December 2014

[Surveillance].

Authors:
Barbara Schimmer

Tijdschr Diergeneeskd 2014 Jan;139(1):18-9

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January 2014

Seroepidemiological survey for Coxiella burnetii antibodies and associated risk factors in Dutch livestock veterinarians.

PLoS One 2013 16;8(1):e54021. Epub 2013 Jan 16.

Department of Small Ruminant Health, Animal Health Service, Deventer, The Netherlands.

Since 2007, Q fever has become a major public health problem in the Netherlands and goats were the most likely source of the human outbreaks in 2007, 2008 and 2009. Little was known about the consequences of these outbreaks for those professional care providers directly involved. The aim of this survey was to estimate the seroprevalence of antibodies against C. burnetii among Dutch livestock veterinarians and to determine possible risk factors. Single blood samples from 189 veterinarians, including veterinary students in their final year, were collected at a veterinary conference and a questionnaire was filled in by each participant. The blood samples were screened for IgG antibodies against phase I and phase II antigen of C. burnetii using an indirect immunofluorescent assay, and for IgM antibodies using an ELISA. Antibodies against C. burnetii were detected in 123 (65.1%) out of 189 veterinarians. Independent risk factors associated with seropositivity were number of hours with animal contact per week, number of years graduated as veterinarian, rural or sub urban living area, being a practicing veterinarian, and occupational contact with swine. Livestock veterinarians should be aware of this risk to acquire an infection with C. burnetii. Physicians should consider potential infection with C. burnetii when treating occupational risk groups, bearing in mind that the burden of disease among veterinarians remains uncertain. Vaccination of occupational risk groups should be debated.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054021PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546960PMC
July 2013

Smooth incidence maps give valuable insight into Q fever outbreaks in The Netherlands.

Geospat Health 2012 Nov;7(1):127-34

Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands.

From 2007 through 2009, The Netherlands faced large outbreaks of human Q fever. Control measures focused primarily on dairy goat farms because these were implicated as the main source of infection for the surrounding population. However, in other countries, outbreaks have mainly been associated with non-dairy sheep and The Netherlands has many more sheep than goats. Therefore, a public discussion arose about the possible role of non-dairy (meat) sheep in the outbreaks. To inform decision makers about the relative importance of different infection sources, we developed accurate and high-resolution incidence maps for detection of Q fever hot spots. In the high incidence area in the south of the country, full postal codes of notified Q fever patients with onset of illness in 2009, were georeferenced. Q fever cases (n = 1,740) were treated as a spatial point process. A 500 x 500 m grid was imposed over the area of interest. The number of cases and the population number were counted in each cell. The number of cases was modelled as an inhomogeneous Poisson process where the underlying incidence was estimated by 2-dimensional P-spline smoothing. Modelling of numbers of Q fever cases based on residential addresses and population size produced smooth incidence maps that clearly showed Q fever hotspots around infected dairy goat farms. No such increased incidence was noted around infected meat sheep farms. We conclude that smooth incidence maps of human notifications give valuable information about the Q fever epidemic and are a promising method to provide decision support for the control of other infectious diseases with an environmental source.
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http://dx.doi.org/10.4081/gh.2012.111DOI Listing
November 2012

Seroprevalence and risk factors for Coxiella burnetii (Q fever) seropositivity in dairy goat farmers' households in The Netherlands, 2009-2010.

PLoS One 2012 27;7(7):e42364. Epub 2012 Jul 27.

Centre for Infectious Disease Control, National Institute for Public Health and The Environment, Bilthoven, The Netherlands.

Community Q fever epidemics occurred in The Netherlands in 2007-2009, with dairy goat and dairy sheep farms as the implicated source. The aim of the study was to determine the seroprevalence and risk factors for seropositivity in dairy goat farmers and their household members living or working on these farms. Sera of 268 people living or working on 111 dairy goat farms were tested for Coxiella burnetii IgG and IgM antibodies using immunofluorescence assay. Seroprevalences in farmers, spouses and children (12-17 years) were 73.5%, 66.7%, and 57.1%, respectively. Risk factors for seropositivity were: performing three or more daily goat-related tasks, farm location in the two southern provinces of the country, proximity to bulk milk-positive farms, distance from the nearest stable to residence of 10 meters or less, presence of cats and multiple goat breeds in the stable, covering stable air spaces and staff not wearing farm boots. Goat farmers have a high risk to acquire this occupational infection. Clinicians should consider Q fever in this population presenting with compatible symptoms to allow timely diagnosis and treatment to prevent severe sequelae. Based on the risk factors identified, strengthening general biosecurity measures is recommended such as consistently wearing boots and protective clothing by farm staff to avoid indirect transmission and avoiding access of companion animals in the goat stable. Furthermore, it provides an evidence base for continuation of the current vaccination policy for small ruminants, preventing spread from contaminated farms to other farms in the vicinity. Finally, vaccination of seronegative farmers and household members could be considered.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0042364PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407076PMC
January 2013

Risk factors of Coxiella burnetii (Q fever) seropositivity in veterinary medicine students.

PLoS One 2012 21;7(2):e32108. Epub 2012 Feb 21.

Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.

Background: Q fever is an occupational risk for veterinarians, however little is known about the risk for veterinary medicine students. This study aimed to assess the seroprevalence of Coxiella burnetii among veterinary medicine students and to identify associated risk factors.

Methods: A cross-sectional study with questionnaire and blood sample collection was performed among all veterinary medicine students studying in The Netherlands in 2006. Serum samples (n = 674), representative of all study years and study directions, were analyzed for C. burnetii IgG and IgM phase I and II antibodies with an immunofluorescence assay (IFA). Seropositivity was defined as IgG phase I and/or II titer of 1:32 and above.

Results: Of the veterinary medicine students 126 (18.7%) had IgG antibodies against C. burnetii. Seropositivity associated risk factors identified were the study direction 'farm animals' (Odds Ratio (OR) 3.27 [95% CI 2.14-5.02]), advanced year of study (OR year 6: 2.31 [1.22-4.39] OR year 3-5 1.83 [1.07-3.10]) having had a zoonosis during the study (OR 1.74 [1.07-2.82]) and ever lived on a ruminant farm (OR 2.73 [1.59-4.67]). Stratified analysis revealed study direction 'farm animals' to be a study-related risk factor apart from ever living on a farm. In addition we identified a clear dose-response relation for the number of years lived on a farm with C. burnetii seropositivity.

Conclusions: C. burnetii seroprevalence is considerable among veterinary medicine students and study related risk factors were identified. This indicates Q fever as an occupational risk for veterinary medicine students.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0032108PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283734PMC
June 2012

Seroprevalence and risk factors of Q fever in goats on commercial dairy goat farms in the Netherlands, 2009-2010.

BMC Vet Res 2011 Dec 30;7:81. Epub 2011 Dec 30.

Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.

Background: The aim of this study was to estimate the seroprevalence of Coxiella burnetii in dairy goat farms in the Netherlands and to identify risk factors for farm and goat seropositivity before mandatory vaccination started. We approached 334 eligible farms with more than 100 goats for serum sampling and a farm questionnaire. Per farm, median 21 goats were sampled. A farm was considered positive when at least one goat tested ELISA positive.

Results: In total, 2,828 goat serum samples from 123 farms were available. Farm prevalence was 43.1% (95%CI: 34.3%-51.8%). Overall goat seroprevalence was 21.4% (95%CI: 19.9%-22.9%) and among the 53 positive farms 46.6% (95%CI: 43.8%-49.3%). Multivariable logistic regression analysis included 96 farms and showed that farm location within 8 kilometres proximity from a bulk milk PCR positive farm, location in a municipality with high cattle density (≥ 100 cattle per square kilometre), controlling nuisance animals through covering airspaces, presence of cats or dogs in the goat stable, straw imported from abroad or unknown origin and a herd size above 800 goats were independent risk factors associated with Q fever on farm level. At animal level almost identical risk factors were found, with use of windbreak curtain and artificial insemination as additional risk factors.

Conclusion: In 2009-2010, the seroprevalence in dairy goats in the Netherlands increased on animal and farm level compared to a previous study in 2008. Risk factors suggest spread from relatively closely located bulk milk-infected small ruminant farms, next to introduction and spread from companion animals, imported straw and use of artificial insemination. In-depth studies investigating the role of artificial insemination and bedding material are needed, while simultaneously general biosecurity measures should be updated, such as avoiding companion animals and vermin entering the stables, next to advice on farm stable constructions on how to prevent introduction and minimize airborne transmission from affected dairy goat farms to prevent further spread to the near environment.
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http://dx.doi.org/10.1186/1746-6148-7-81DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292966PMC
December 2011

The 2007–2010 Q fever epidemic in The Netherlands: characteristics of notified acute Q fever patients and the association with dairy goat farming.

FEMS Immunol Med Microbiol 2012 Feb;64(1):3-12

National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.

We describe the Q fever epidemic in the Netherlands with emphasis on the epidemiological characteristics of acute Q fever patients and the association with veterinary factors. Data from 3264 notifications for acute Q fever in the period from 2007 through 2009 were analysed. The patients most affected were men, smokers and persons aged 40–60 years. Pneumonia was the most common clinical presentation (62% in 2007 and 2008). Only 3.2% of the patients were working in the agriculture sector and 0.5% in the meat-processing industry including abattoirs. Dairy goat farms with Coxiella burnetii-induced abortion waves were mainly located in the same area where human cases occurred. Airborne transmission of contaminated dust particles from commercial dairy goat farms in densely populated areas has probably caused this epidemic. In 2010, there was a sharp decline in the number of notified cases following the implementation of control measures on dairy goat and sheep farms such as vaccination, hygiene measures and culling of pregnant animals on infected farms. In combination with a rise in the human population with antibodies against C. burnetii, these have most likely ended the outbreak. Development of chronic Q fever in infected patients remains an important problem for years to come.
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http://dx.doi.org/10.1111/j.1574-695X.2011.00876.xDOI Listing
February 2012

A regional Salmonella enterica serovar Typhimurium outbreak associated with raw beef products, The Netherlands, 2010.

Foodborne Pathog Dis 2012 Feb 2;9(2):102-7. Epub 2011 Nov 2.

Centre for Infectious Disease Control, National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, The Netherlands.

Between April and May 2010, several medical microbiological laboratories in the Netherlands notified a total of 90 cases of Salmonella enterica serovar Typhimurium with the same antibiogram type (resistant for ampicillin, tetracycline, and co-trimoxazol) and the same multiple locus variable number tandem repeats analysis pattern (03-16-09-NA-311) or single locus variants. Date of illness onset ranged from end of March to mid-May with a peak in the second week of April. Almost half of the cases were hospitalized. Cases completed a questionnaire about food items and other risk factors in the 7 days before illness onset. A matched case-control study was performed. Consumption of "ossenworst" (matched odds ratio 48.2 [95% confidence interval (CI): 3.9-595.9]) and filet américain (8.5 [95% CI: 1.0-73.6]) were found to be significant risk factors for illness. Eighty percent of the cases had eaten at least one or both raw meat products. The producer of the ground beef that was used to produce the "ossenworst" was identified, but no microbiological evidence was found. Consumers should be made more aware of the presence of raw meat in ready-to-eat products and of the potential risk in eating these products. Vulnerable persons such as young children, elderly, and persons with poor health should be discouraged from eating these products. Detection of this outbreak was mainly based on the antibiogram pattern that had identified possible cases 10 days before detailed typing results from the reference laboratory became available, thus facilitating early case findings.
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http://dx.doi.org/10.1089/fpd.2011.0978DOI Listing
February 2012

Q fever among culling workers, the Netherlands, 2009-2010.

Emerg Infect Dis 2011 Sep;17(9):1719-23

National Institute for Public Health and the Environment, Bilthoven, the Netherlands.

In 2009, dairy goat farms in the Netherlands were implicated in >2,300 cases of Q fever; in response, 51,820 small ruminants were culled. Among 517 culling workers, despite use of personal protective equipment, 17.5% seroconverted for antibodies to Coxiella burnetii. Vaccination of culling workers could be considered.
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http://dx.doi.org/10.3201/eid1709.110051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322078PMC
September 2011

Self-reported sexually transmitted infections and their correlates among men who have sex with men in Norway: an Internet-based cross-sectional survey.

BMC Infect Dis 2010 Sep 6;10:261. Epub 2010 Sep 6.

Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway.

Background: The incidences of reportable sexually transmitted infections (STI) among men who have sex with men (MSM) have increased since the late 1990 s in Norway. The objectives of our study were to assess factors, associated with recent selected STI among MSM, living in Norway in order to guide prevention measures.

Methods: We conducted a cross-sectional Internet-based survey during 1-19 October 2007 among members of a MSM-oriented Norwegian website using an anonymous questionnaire on demographics, sexual behaviour, drug and alcohol use, and STI. The studied outcomes were gonorrhoea, syphilis, HIV or Chlamydia infection in the previous 12 months. Associations between self-reported selected STI and their correlates were analysed by multivariable Poisson regression. P value for trend (p-trend), adjusted prevalence ratios (PR) with 95% confidence intervals [] were calculated.

Results: Among 2430 eligible 16-74 years old respondents, 184 (8%) reported having had one of the following: syphilis (n = 17), gonorrhoea (n = 35), HIV (n = 42) or Chlamydia (n = 126) diagnosed in the past 12 months. Reporting Chlamydia was associated with non-western background (PR 2.8 [1.4-5.7]), number of lifetime male partners (p-trend < 0.001), unsafe sex under the influence of alcohol (PR 1.8 [1.1-2.9]) and with younger age (p-trend = 0.002). Reporting gonorrhoea was associated with unrevealed background (PR 5.9 [1.3-26.3]), having more than 50 lifetime male partners (PR 4.5 [1.3-15.6]) and more than 5 partners in the past 6 months (PR 3.1 [1.1-8.8]), while mid-range income was protective (PR 0.1 [0.0-0.6]). Reporting HIV was associated with residing in Oslo or Akershus county (PR 2.3 [1.2-4.6]), non-western background (PR 5.4 [1.9-15.3]), unrevealed income (PR 10.4 [1.5-71.4]), number of lifetime male partners (p-trend < 0.001) and being under the influence of selected drugs during sex in the past 12 months (PR 5.2 [2.7-11.4]). In addition, the frequency of feeling drunk was reversibly associated with HIV.

Conclusions: Our study demonstrates different associations of demographic and behavioural factors with different STI outcomes in the study population. Number of lifetime male partners was the most important potential predictor for Chlamydia and HIV. The STI prevention efforts among MSM should focus on Oslo and Akershus, promote safe sex practices and tackle sex-related drug and alcohol use.
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http://dx.doi.org/10.1186/1471-2334-10-261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2944348PMC
September 2010

The use of a geographic information system to identify a dairy goat farm as the most likely source of an urban Q-fever outbreak.

BMC Infect Dis 2010 Mar 16;10:69. Epub 2010 Mar 16.

Centre for Infectious Disease Control, National Institute for Public Health and the Environment, A van Leeuwenhoeklaan 9, PO Box 1, 3720 BA Bilthoven, the Netherlands.

Background: A Q-fever outbreak occurred in an urban area in the south of the Netherlands in May 2008. The distribution and timing of cases suggested a common source. We studied the spatial relationship between the residence locations of human cases and nearby small ruminant farms, of which one dairy goat farm had experienced abortions due to Q-fever since mid April 2008. A generic geographic information system (GIS) was used to develop a method for source detection in the still evolving major epidemic of Q-fever in the Netherlands.

Methods: All notified Q-fever cases in the area were interviewed. Postal codes of cases and of small ruminant farms (size >40 animals) located within 5 kilometres of the cluster area were geo-referenced as point locations in a GIS-model. For each farm, attack rates and relative risks were calculated for 5 concentric zones adding 1 kilometre at a time, using the 5-10 kilometres zone as reference. These data were linked to the results of veterinary investigations.

Results: Persons living within 2 kilometres of an affected dairy goat farm (>400 animals) had a much higher risk for Q-fever than those living more than 5 kilometres away (Relative risk 31.1 [95% CI 16.4-59.1]).

Conclusions: The study supported the hypothesis that a single dairy goat farm was the source of the human outbreak. GIS-based attack rate analysis is a promising tool for source detection in outbreaks of human Q-fever.
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http://dx.doi.org/10.1186/1471-2334-10-69DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848044PMC
March 2010

Outbreak of haemolytic uraemic syndrome in Norway caused by stx2-positive Escherichia coli O103:H25 traced to cured mutton sausages.

BMC Infect Dis 2008 Apr 3;8:41. Epub 2008 Apr 3.

Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.

Background: On 20-21 February 2006, six cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) were reported by paediatricians to the Norwegian Institute of Public Health. We initiated an investigation to identify the etiologic agent and determine the source of the outbreak in order to implement control measures.

Methods: A case was defined as a child with diarrhoea-associated HUS or any person with an infection with the outbreak strain of E. coli O103 (defined by the multi-locus variable number tandem repeats analysis (MLVA) profile) both with illness onset after January 1st 2006 in Norway. After initial hypotheses-generating interviews, we performed a case-control study with the first fifteen cases and three controls for each case matched by age, sex and municipality. Suspected food items were sampled, and any E. coli O103 strains were typed by MLVA.

Results: Between 20 February and 6 April 2006, 17 cases were identified, of which 10 children developed HUS, including one fatal case. After pilot interviews, a matched case-control study was performed indicating an association between a traditional cured sausage (odds ratio 19.4 (95% CI: 2.4-156)) and STEC infection. E. coli O103:H25 identical to the outbreak strain defined by MLVA profile was found in the product and traced back to contaminated mutton.

Conclusion: We report an outbreak caused by a rare STEC variant (O103:H25, stx2-positive). More than half of the diagnosed patients developed HUS, indicating that the causative organism is particularly virulent. Small ruminants continue to be important reservoirs for human-pathogen STEC. Improved slaughtering hygiene and good manufacturing practices for cured sausage products are needed to minimise the possibility of STEC surviving through the entire sausage production process.
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http://dx.doi.org/10.1186/1471-2334-8-41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2335110PMC
April 2008

Outbreak of Yersinia enterocolitica serogroup O:9 infection and processed pork, Norway.

Emerg Infect Dis 2007 May;13(5):754-6

Norwegian Institute of Public Health, Oslo, Norway.

An outbreak involving 11 persons infected with Yersinia enterocolitica O:9 was investigated in Norway in February 2006. A case-control study and microbiologic investigation indicated a ready-to-eat pork product as the probable source. Appropriate control measures are needed to address consumer risk associated with this product.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738467PMC
http://dx.doi.org/10.3201/eid1305.061062DOI Listing
May 2007

A large community outbreak of waterborne giardiasis-delayed detection in a non-endemic urban area.

BMC Public Health 2006 May 25;6:141. Epub 2006 May 25.

Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.

Background: Giardia is not endemic in Norway, and more than 90% of reported cases acquire the infection abroad. In late October 2004, an increase in laboratory confirmed cases of giardiasis was reported in the city of Bergen. An investigation was started to determine the source and extent of the outbreak in order to implement control measures.

Methods: Cases were identified through the laboratory conducting giardia diagnostics in the area. All laboratory-confirmed cases were mapped based on address of residence, and attack rates and relative risks were calculated for each water supply zone. A case control study was conducted among people living in the central area of Bergen using age- and sex matched controls randomly selected from the population register.

Results: The outbreak investigation showed that the outbreak started in late August and peaked in early October. A total of 1300 laboratory-confirmed cases were reported. Data from the Norwegian Prescription Database gave an estimate of 2500 cases treated for giardiasis probably linked to the outbreak. There was a predominance of women aged 20-29 years, with few children or elderly. The risk of infection for persons receiving water from the water supply serving Bergen city centre was significantly higher than for those receiving water from other supplies. Leaking sewage pipes combined with insufficient water treatment was the likely cause of the outbreak.

Conclusion: Late detection contributed to the large public health impact of this outbreak. Passive surveillance of laboratory-confirmed cases is not sufficient for timely detection of outbreaks with non-endemic infections.
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http://dx.doi.org/10.1186/1471-2458-6-141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1524744PMC
May 2006

Dengue fever: new paradigms for a changing epidemiology.

Emerg Themes Epidemiol 2005 Mar 2;2(1). Epub 2005 Mar 2.

Department of Public Health and Epidemiology Université catholique de Louvain 3094 Clos chapelle aux champs 1200 Brussels Belgium.

Dengue is the most important arthropod-borne viral disease of public health significance. Compared with nine reporting countries in the 1950s, today the geographic distribution includes more than 100 countries worldwide. Many of these had not reported dengue for 20 or more years and several have no known history of the disease. The World Health Organization estimates that more than 2.5 billion people are at risk of dengue infection. First recognised in the 1950s, it has become a leading cause of child mortality in several Asian and South American countries.This paper reviews the changing epidemiology of the disease, focusing on host and societal factors and drawing on national and regional journals as well as international publications. It does not include vaccine and vector issues. We have selected areas where the literature raises challenges to prevailing views and those that are key for improved service delivery in poor countries.Shifts in modal age, rural spread, and social and biological determinants of race- and sex-related susceptibility have major implications for health services. Behavioural risk factors, individual determinants of outcome and leading indicators of severe illness are poorly understood, compromising effectiveness of control programmes. Early detection and case management practices were noted as a critical factor for survival. Inadequacy of sound statistical methods compromised conclusions on case fatality or disease-specific mortality rates, especially since the data were often based on hospitalised patients who actively sought care in tertiary centres.Well-targeted operational research, such as population-based epidemiological studies with clear operational objectives, is urgently needed to make progress in control and prevention.
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http://dx.doi.org/10.1186/1742-7622-2-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC555563PMC
March 2005

Serious psychiatric symptoms after chloroquine treatment following experimental malaria infection.

Ann Pharmacother 2005 Mar;39(3):551-4

Department of General Internal Medicine and Center for Clinical Malaria Studies, Nijmegen University Medical Centre, 6500 HB Nijmegen, Netherlands.

Objective: To report serious psychiatric symptoms after standard chloroquine treatment following human malaria infection induced for research.

Case Summary: A 34-year-old healthy woman volunteered to participate in a study of malaria treatment. She was infected on day 0 with a chloroquine-susceptible strain of Plasmodium falciparum and was treated with a standard 3-day course of chloroquine from day 9 onward, following a positive blood smear (parasitemia 0.001%). On day 10, the blood smear became negative. On day 11, she developed a psychotic disorder not otherwise specified, most probably caused by chloroquine use, with symptoms of depersonalization and anxiety. The diagnosis of delirium was considered but ruled out because of clear consciousness with lack of diurnal fluctuations. She refused to take antipsychotic medication. Three weeks later, the woman still encountered serious concentration problems. All complaints gradually subsided over the next 4 months, after which she felt completely recovered. Plasma chloroquine concentrations were within the therapeutic range.

Discussion: Chloroquine may achieve high concentrations in the brain and has a long half-life. As quinolines, the antimalarials may have the same pathologic activity as the fluoroquinolone antibiotics in acting as N-methyl-d-aspartate agonists and gamma-aminobutyric acid antagonists. Application of the Naranjo probability scale indicated that, in this patient, chloroquine was the probable cause of the serious psychiatric symptoms.

Conclusions: Our unique observation demonstrates that serious psychiatric symptoms can emerge as a rare occurrence during standard chloroquine therapy. This adverse effect may persist for several months.
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http://dx.doi.org/10.1345/aph.1E409DOI Listing
March 2005
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