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The Netherlands UvA-DARE (Digital Academic Repository) Breaking the chain of transmission: Immunisation and outbreak investigation Whelan, E.J. Publication date 2013 Document Version Final published version Link to publication Citation for published version (APA): Whelan, E. J. (2013). Breaking the chain of transmission: Immunisation and outbreak investigation. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:11 Oct 2021 n n F o a i l t e O a h g i t W s N I e e N v n A n i a J H O k I a S C e r S I E b t u H M o T S d n N G a n A N I o i R t K T a s i A n E u R m m B i BREAKING THE CHAIN OF TRANSMISSION immunisation and outbreak investigation Jane Whelan Breaking the chain of transmission Immunisation and outbreak investigation 26660 Whelan kopie.indd 1 02-11-13 16:03 © 2013 Jane Whelan, Amsterdam ISBN 978-90-6464-732-1 Cover: Mona Hatoum. Undercurrent (red), 2012. Cloth covered electric cable, light bulbs, dimmer device, dimensions variable. Reproduced with permission. Photo: Nick Malyon at The Goetz Collection exhibition, Munich. Reproduced with permission. Cover layout: Ebo Peerboms (www.ebokai.com) Thesis layout-design: Ferdinand van Nispen, Citroenvlinder-DTP.nl, Bilthoven, the Netherlands. Thesis DTP: Ubel Smid Vormgeving, Roden, the Netherlands. Printing: GVO drukkers & vormgevers BV, Ponsen &Looijen, Amsterdam, the Netherlands. Publication of this thesis was financially supported by the Geneeskundige en Gezondheidsdienst (GGD) Amsterdam and the Academic Medical Centre (AMC), Amsterdam. 26660 Whelan kopie.indd 2 02-11-13 16:03 Breaking the Chain of Transmission Immunisation and Outbreak investigation ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam op gezag van de Rector Magnificus prof. dr. D.C. van den Boom ten overstaan van een door het college voor promoties ingestelde commissie, in het openbaar te verdedigen in de Agnietenkapel op dinsdag 17 december 2013, te 12.00 uur door Elizabeth Jane Whelan geboren te Carlow, Ierland. 26660 Whelan kopie.indd 3 02-11-13 16:03 Promotiecommissie Promotor Prof. dr. M.W. Borgdorff Co-promotores Dr. J.A.R. van den Hoek Dr. G.J.B. Sonder Overige leden Prof. dr. R.A. Coutinho Dr. S.E. Geerlings Prof. C. Kelleher Prof. dr. M. Prins Prof. dr. H.L Zaaijer Prof. dr. A.H. Zwinderman Faculteit der Geneeskunde 26660 Whelan kopie.indd 4 02-11-13 16:03 Table of Contents 010 Introduction 7 Part I Immunisation 020 Incidence of acute hepatitis B in different ethnic groups in a low- 21 endemic country, 1992−2009: Increased risk in second generation migrants Vaccine 2012;30:5651-55 030 Targeted vaccination programme successful in reducing acute 33 Hepatitis B in men having sex with men in Amsterdam, The Netherlands J Hepatol. 2013. In Press 040 Immunogenicity of a hexavalent vaccine co-administered with 55 7-valent pneumococcal conjugate vaccine. Findings from the National Immunisation Programme in The Netherlands Hum Vaccin Immunother 2012;8:743-8. 050 Declining incidence of hepatitis A in Amsterdam (The Netherlands), 67 1996-2011: Second generation migrants still an important risk group for virus importation Vaccine 2013;31:1806-11 060 Evaluation of hepatitis A vaccine in post-exposure prophylaxis, The 83 Netherlands, 2004−2012 PLoS ONE 2013; 8: e78914 26660 Whelan kopie.indd 5 02-11-13 16:03 Part II Outbreak Investigation 070 Mumps outbreak among vaccinated university students associated 97 with a large party, The Netherlands, 2010 Vaccine 2012;30:4676-80 080 Q fever among culling workers, The Netherlands, 2009–2010 109 Emerg Infect Dis 2011;17:1719-23 090 Visits on ‘lamb-viewing days’ at a sheep farm open to the public was a 119 risk factor for Q fever in 2009 Epidemiol Infect 2012;140:858-864 1101 National outbreak of Salmonella Typhimurium (Dutch) phage-type 131 132 in The Netherlands, October to December 2009 Euro Surveill 20 10;15:pii=19705. 1111 Risk factors for secondary transmission of Shigella infection within 141 households: implications for current prevention policy BMC Infect Dis 2012;12:347 1121 Discussion 155 Summary 171 Samenvatting 179 Acknowledgements 187 Biography 191 Portfolio & List of publications 193 26660 Whelan kopie.indd 6 02-11-13 16:03 Introduction 1 26660 Whelan kopie.indd 7 02-11-13 16:03 CHAPTER 1 INTRODUctiON Introduction ‘1.3 grams of mercurous chloride, followed by 3 grams of pulverized cornachin.... The same doses followed for four days and nights.’1 The dose of mercury was considered sufficient to cause drooling and diarrhoea, and perhaps even to make a patient’s teeth fall out. Combined with cornachin, ‘a retch-inducing mixture of antimony and cream of tartar’,2 and ‘where necessary, some blood [to] gently purge the humors’,3 the cocktail was lauded in the 1750s as part of an elaborate preparation to prevent smallpox. At first, in a process known as variolation, a small amount of live smallpox virus from the pustule of an infected patient was scratched into a person’s skin with a needle or knife. This was followed by three weeks of daily vomiting, bleeding, purging, and fevers. Finally, if well enough to go home, the patients and their clothes were hosed down with sulphur.2 By today’s standards, it’s difficult to conceive that healthy individuals would volunteer themselves and their children for such a punishing preventive routine, with limited guarantee of its safety or effect. By 1800, Edward Jenner (who himself had been subjected to this miserable experience as a boy), had developed a safer and more reliable cow-pox derived vaccine, credited by a contemporary as ‘one of the greatest improvements that has ever been made in medicine’.4 It would be another 100 years before the association between microbial agents, infection, disease, and immunity would be elucidated and allied control measures effectively evolved: sanitation, disinfection, antibiotics and vaccination. Despite extraordinary recent advances in cellular immunology, vaccinology, communications, epidemiology, mathematics and related fields, effective infectious disease control remains elusive. New threats are emerging or re-emerging as a combination of drivers result in dynamic changes in the distribution of disease over geographic areas and through populations.5-7 These include socio-demographic factors such as unprecedented population growth, changing human demography and behaviour; environmental and globalisation factors such as climate change, urbanisation, changes in food production, migration and international travel; and public health capacity factors including health care provision, animal health and food safety. Meanwhile microbes are constantly adapting beyond our technology.8,9 8 26660 Whelan kopie.indd 8 02-11-13 16:03 CHAPTER 1 INTRODUctiON 1. The transmission chain and principles of infectious disease control 1 A contemporary model of infection is the transmission chain (figure 1).10 The chain comprises essential elements or links which, occurring in a sequential process, lead to infection. These elements include: an etiologic or causative agent (virus, bacterium, protozoan, fungus or the like), a reservoir or habitat where the agent pools and propagates (this may be human, animal or environmental), a source (contaminated foodstuff in a supermarket, infectious patient), a mode of transmission (direct contact with contaminated material, or indirect contact via a vector such as a mosquito), an entry portal into the host (respiratory tract, alimentary canal for example), and a susceptible host who because of genetic, immune, or other factors may be predisposed to infection. The elements are diverse and once the susceptible host has been exposed, progression to disease, cure or death is non-linear. Not all susceptible hosts exposed to an infectious agent will become infected, and agent properties and host outcomes differ: Some hosts will be infected but never develop symptoms, some will become ill but will recover, and some may die; Some agents will be eliminated from the host, and some will leave a life-long legacy as the host develops temporary or lifelong immunity in the form of antibodies and other immune markers, or becomes a carrier of the agent and can go on to infect other susceptible hosts, thus perpetuating the cycle. As chains of transmission occur in a population over time, the risk factors for exposure and disease progression, and rates of transition between states in the infectious process, undergo dynamic change.11 Change may occur rapidly, as in sudden unexpected disease outbreaks, or evolve slowly over time. Underpinning effective action is good surveillance, and focused epidemiological studies which inform public health action as problems evolve. Breaking the chain of transmission is complex, requiring timely intervention at some or every step in the transmission chain. Management of the within-host infectious process and disease progression lies within the medical realm, while controlling disease transmission through prevention of exposure and infection is traditionally a public health function.
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