Publications by authors named "Marlies Weltevrede"

2 Publications

  • Page 1 of 1

Healthcare costs attributable to congenital cytomegalovirus infection.

Arch Dis Child 2018 05 23;103(5):452-457. Epub 2018 Jan 23.

Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.

Objective: Congenital cytomegalovirus infection (cCMV) can cause symptoms at birth as well as long-term impairment. This study estimates cCMV-related healthcare costs in the Netherlands in early childhood.

Design, Setting And Patients: In a nationwide retrospective cohort study, 156 children with cCMV were identified by testing 31 484 neonatal dried blood spots for cCMV. Use of healthcare resources in the first 6 years of life by children with cCMV and a matched cCMV-negative control group were analysed. Mean costs per child were calculated by multiplying healthcare resource use by its reference prices.

Exposure: Children with cCMV were compared with cCMV-negative children.

Main Outcome Measures: The average total healthcare costs per child were based on the average costs for hospital admissions and consultations by healthcare providers.

Results: Mean healthcare costs of children with cCMV (€6113, n=133) were higher than children without cCMV (€3570, n=274), although statistically not significant, with a mean difference of €2544 (95% CI €-451 to €5538). The costs of children with long-term impairment were two times higher in children with cCMV (€17 205) compared with children without cCMV (€8332).

Conclusions: Children with cCMV, especially those with long-term impairment and those symptomatic at birth, accrue higher healthcare costs than cCMV-negative children in the first 6 years of life, although this is not statistically significant. This economic impact is of importance in the evaluation of preventive measures against cCMV.

Trial Registration Number: NTR3582.
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May 2018

Cytomegalovirus persistence and T-cell immunosenescence in people aged fifty and older: A systematic review.

Exp Gerontol 2016 May 13;77:87-95. Epub 2016 Feb 13.

National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Centre for Immunology of Infectious Diseases and Vaccines, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands. Electronic address:

Introduction: Immunosenescence is the age-related deterioration of immunocompetence which is reflected in a poorer response to new antigens. This process is characterized by decreases in naïve T cells and increases in memory T cells. The highly prevalent β-herpesvirus cytomegalovirus (CMV) is thought to enhance T-cell immunosenescence. The aim of this study was to perform a systematic review on the current evidence regarding the relation between CMV-infection and immunosenescence in Western people aged fifty years and older.

Methods: Studies that investigated the relation between CMV infection and immune parameters in Western people aged 50 years and older were eligible for inclusion. No restrictions were placed on study type. This article focuses on the relation between CMV infections as measured by serology and T cell subsets. A narrative approach to data synthesis was applied.

Results: In the majority of included studies higher levels of Effector Memory (EM) and TEMRA (Effector Memory T cells re-expressing CD45RA) cells were found in the CD4+ and the CD8+ T cell pools in CMV-seropositive elderly compared to CMV-seronegative elderly. No clear evidence was found for lower levels of naïve T cells in CMV-seropositive elderly compared to CMV-seronegative elderly. The total CD8+ T cell pool appeared to be larger in CMV-seropositive elderly in three out of four studies, while the total CD4+ T cell pool appeared to be smaller in CMV-seropositive elderly in two out of four studies.

Discussion: CMV seems to enhance immunosenescence based on the high levels of the highly differentiated EM and TEMRA cells in the CD8+ and CD4+ T cell pools. The relation of the shifts within the T cell compartments in CMV-seropositive elderly in relation to susceptibility to infectious diseases remains to be investigated.
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May 2016