Hepatitis B vaccination targeted at behavioural risk groups in the Netherlands: does it work?

In November 2002, the Netherlands adopted a vaccination program targeted at behavioural risk groups. Between January 2003 and December 2007, 1386 patients acutely infected with HBV were reported. Reported cases declined from 326 in 2003 to 220 in 2007. Sexual intercourse was the most frequently reported mode of transmission (65%), especially among men having sex with men. Genotypes A and D remained predominant. In total, 40,600 participants were fully vaccinated, the overall compliance was 62%, and the estimated overall program coverage was 12% of the at-risk population. With more effort, more susceptibles may be reached, but the program will not be sufficient to substantially reduce HBV in the Netherlands. Therefore, universal vaccination should be considered.

Significance of isolated antibody to hepatitis B core antigen in Dutch national vaccination campaign of behavioural high-risk groups.

In the Dutch national vaccination campaign for behavioural risk groups, anti-HBcore is used as the primary HBV screening test. Samples with positive results undergo testing for active infection (HBsAg) but are otherwise accepted as indicating past infection, thereby assuming immunity. This study evaluated evidence for immunity in the target population screened on the basis of this algorithm, by re-analysing 1000 anti-HBcore-positive blood samples equally divided among risk groups: 14.7% of confirmed anti-HBcore lacked anti-HBs ('isolated' anti-HBcore). Independent risk factors for isolated anti-HBcore were risk group, HCV infection in hard-drug users (DU) and origin from Sub-Saharan Africa. After extrapolation, the proportion of participants who were said to be immune but lacked any additional evidence of immunity amounted to 9.6% (ranging from 12.5% in DU to 6.5% in men who have sex with men). It is recommended that as a minimum anti-HBs screening is included in testing algorithms used to determine vaccination programmes for risk groups, in particular in DU.

Erythromycin resistance in the commensal throat flora of patients visiting the general practitioner: a reservoir for resistance genes for potential pathogenic bacteria.

The prevalence and mechanism of erythromycin resistance in commensal throat streptococci was determined from October 2000 until December 2002 as part of an ongoing study of the NIVEL in general practice patients (N=678). Resistance prevalence for 1mg/L and 16 mg/L erythromycin was 57% and 20%, respectively. The percentage of total commensal flora resistant within each patient ranged from 1% to 100% (median, 1%). mefA was predominantly found among isolates on the 1mg/L plates, and ermB was found in 64% of the isolates on the 16 mg/L plates. Erythromycin resistance was transferred from a commensal isolate to Streptococcus pneumoniae with a frequency of 1 x 10(-9). Commensal streptococci of general practice patients in The Netherlands form a large reservoir of transferable erythromycin resistance (genes) for potential pathogenic microorganisms.

[Pharmaco-economic aspects of vaccination against invasive pneumococcal infections in persons over 65 years of age; review of the literature on cost effectiveness analysis]. / Farmaco-economische aspecten van vaccinatie tegen invasieve pneumokokkeninfecties bij 65-plussers; literatuuroverzicht van kosteneffectiviteitsanalysen.

OBJECTIVE: To assess the cost-effectiveness of vaccination to prevent invasive pneumococcal disease in the elderly. DESIGN: Review of the literature. METHODS: Articles in Dutch or English reporting studies into the cost-effectiveness of vaccination for the prevention of invasive pneumococcal infection in persons over 65 years of age were retrieved from Medline (1980-2000; search terms: 'pneumococcal' and 'vaccine' in combination with 'costs' or 'economics') and on the basis of the reference lists in the articles found. The following aspects of the selected studies were assessed: the net costs per year of life gained, the incidence of invasive pneumococcal disease in the elderly, the mortality due to invasive pneumococcal infections, the effectiveness of the vaccine in the prevention of invasive pneumococcal infections, and the costs of the vaccine and its administration. Attention was also given to specific age categories and to the effects of varying certain crucial assumptions. RESULTS: We retrieved a total of five studies: one each for the USA, Canada, the Netherlands and Spain and a multinational study for five European countries. The cost-effectiveness of vaccination of the elderly against invasive pneumococcal infections varied from cost savings to [symbol: see text] 33,000,-per life-year gained. The Dutch study estimated the cost-effectiveness at [symbol: see text] 10,100,-per life-year gained (price level 1995). Almost all the studies selected based their estimate of the effectiveness of vaccination on the same case-control study from the USA. The potential effects on cost-effectiveness of more extensive influenza vaccination and of the inclusion of re-vaccination against pneumococci were not included in the analyses. CONCLUSION: The cost-effectiveness of vaccination against invasive pneumococcal infections in persons over 65 years of age (in the Netherlands as well as in several other countries) was below the previously accepted threshold of [symbol: see text] 20,000,-.

Bronchiolitis hospitalisations in the Netherlands from 1991 to 1999.

In order to analyse trends in the bronchiolitis hospitalisations in the Netherlands from 1991 to 1999 for children aged 0-4 years, the national number of bronchiolitis hospitalisations were compared with those of asthma and pneumonia hospitalisations of the same age group. The number of bronchiolitis hospitalisations significantly increased, whereas the number of asthma and pneumonia hospitalisations remained unchanged.

Surveillance of respiratory pathogens and influenza-like illnesses in general practices - The Netherlands, winter 1997-98.

The Netherlands Institute of Primary Health Care (NIVEL) has coordinated the activities of a sentinel surveillance network of 43 general practices since 1970. These practices care for 1% of the Dutch population, a sample representative of the national pop