[Monkeypox, a new pandemic?] / Uitbraak van monkeypox: een nieuwe pandemie?

Monkeypox (MPX) is a disease caused by the monkeypox virus. It is a viral zoonotic disease, endemic in Central and West Africa. Human-to-human spread also occurs and is a feature of the current global outbreak. As far as we know, exponential transmission during this outbreak is not related to changed viral characteristics but due to multiple high-risk contacts in a subset of people that have contracted the virus, so far almost exclusively affecting men who have sex with men (MSM). Appropriate public health measures and increased alertness of all health care providers is needed to increase case-finding and decrease transmission. There is a real chance of MPX to become endemic in large parts of the world.

Incidence and mortality of necrotizing fasciitis in The Netherlands: the impact of group A Streptococcus.

BACKGROUND: Little is known about the exact incidence of necrotizing soft tissue infections. The few incidences reported in international literature are not directly relatable to the Netherlands, or other European countries, due to geographic heterogeneity in causative micro-organisms involved. This resulted in the aim of this study to map the incidence, mortality rate and hospital course of necrotizing fasciitis infections in the Netherlands to gain insight in the incidence of necrotizing fasciitis in the Netherlands and the associated mortality and health care burden. METHODS: This nationwide retrospective database study used three distinct data sources to map the incidence of necrotizing fasciitis in the Netherlands between 2014 and 2019, being data from the Dutch Hospital Data (DHD) foundation, data from Osiris-AIZ, which is a database of notifiable diseases managed by regional Public Health Services (GGD) and the National Institute for Public Health and the Environment (RIVM), and previously published studies on necrotizing fasciitis conducted in the Netherlands. RESULTS: The incidence of necrotizing fasciitis in the Netherlands is estimated to be approximately 1.1 to 1.4 cases per 100,000 person years, which corresponds to 193-238 patients per year. Of all necrotizing fasciitis infections, 34 to 42% are caused by the group A Streptococcus. Annually, 56 patients die as a result of a necrotizing fasciitis infection (mortality of 23-29%) and 26 patients undergo an amputation for source control (11-14%). Patients stay a mean of 6 to 7 days at the intensive care unit and have a mean hospital length of stay of 24 to 30 days. CONCLUSION: The combination of nationwide databases provides reliable insight in the epidemiology of low-incidence and heterogenic diseases. In the Netherlands, necrotizing fasciitis is a rare disease with group A Streptococcus being the most common causative micro-organism of necrotizing fasciitis. The prior Dutch cohort studies on necrotizing fasciitis report slightly higher sample mortality rates, compared to the population mortality. However, necrotizing fasciitis remain associated with substantial morbidity and mortality, risk at amputation and health care burden characterized by prolonged ICU and hospital stay.

[Tick-borne encephalitis in the Netherlands]. / Teken-encefalitis in Nederland.

Tick-borne encephalitis (TBE) is endemic in South-Scandinavia, Central Europe and Eastern Europe. In 2016 the first patient was reported with TBE virus infection contracted in the Netherlands, in a forested area between Driebergen and Maarn (near Utrecht). At the time, field research did not identify any TBE-positive ticks at the supposed infection site. In the last two years, two patients have been diagnosed with TBE in the Diakonessenhuis Hospital in Utrecht; one patient was bitten by a tick in the Netherlands. This time round, tests on ticks from a different area near Utrecht (the forests around Zeist) did identify TBE-positive ticks. TBE infection is often asymptomatic. However, in a small proportion of patients, disease can develop and there is currently no curative therapy available. An effective vaccine is available. At the moment no vaccination recommendation is issued in the Netherlands. TBE should be considered in patients presenting with fever after a recent tick bite. When neurological symptoms appear, referral to a neurologist is necessary.

Evaluation of the surveillance system for invasive meningococcal disease (IMD) in the Netherlands, 2004-2016.

BACKGROUND: Enhanced surveillance for confirmed cases of invasive meningococcal disease (IMD) was introduced in the Netherlands in 2003, in which reference laboratory data (NRLBM) are linked with notification data (OSIRIS). The quality of surveillance information is important for public health decision making. Our objective was to describe the system and evaluate it for data completeness and timeliness. METHODS: Cases reported in the surveillance system from 2004 to 2016 were included. For the notification data, we used information on serogroup, vaccination status, mortality, and country of infection as indicators for record completeness. Notification times to regional and national level were calculated using the reported dates available in the notification database. RESULTS: A total of 2123 cases were reported in the years 2004-2016, of which 1.968 (93%) were reported by the reference laboratory and 1.995 (94%) in the notification system. Of all cases, 1.840 cases (87%) were reported in both systems and could be linked. The serogroup was known in 86% of the notified cases, and was significantly higher (94%) in the years 2013-2016. Information on vaccination status, mortality and country of infection was available in 88, 99 and 97% of notified cases, respectively. Regional notification of cases occurred within one working day for 86% of cases and 98% were notified nationally within three days. CONCLUSIONS: A well performing IMD surveillance system was demonstrated and serogroup completeness has improved over the years. Underlining the need for reporting to both the clinical and laboratory surveillance system remains important to further improve the overall performance in supporting public health response and vaccination policy.

[Fighting mosquitoes in the Netherlands: risks and control of exotic mosquitoes]. / Muggenbestrijding in Nederland: risico's en bestrijding van exotische muggen.

Mosquitoes play a significant role globally in the transmission of so-called vector-borne diseases. In the Netherlands, native mosquitoes are capable of transmitting infectious disease. This has not resulted in outbreaks of disease over the last 50 years. The establishment of exotic mosquito species could pose risks to public health, especially in the case of the Asian tiger mosquito (Aedes albopictus). Several organisations are working together to prevent the establishment of exotic mosquitoes in the Netherlands. A plan for controlling native mosquito species is also currently being developed.